Tara Lamont and colleagues discuss how researchers can help service leaders to evaluate rapidly changing models of care, with a range of approaches depending on needs and resources

BackgroundAcademic Health Science Networks (AHSNs) were recently created in the NHS to accelerate the spread of innovations that could promote population-level health gain and also pursue novel goals of wealth creation. They are 15 regionally based networks. They reflect a continuing stream of national health policy on stimulating NHS knowledge mobilisation, which has now created a novel institutional architecture.ObjectivesThe overall research aims were (1) to explore AHSNs’ strategies and practices of knowledge mobilisation in their formative phase, when they were building up health- and wealth-related networks; and (2) to investigate how knowledge leadership took place in these settings and the characteristics of people perceived as knowledge leaders (KLs). Specific research objectives operationalised these broad aims.DesignIt was a mixed-methods study with a large qualitative component but also social network analysis (SNA). It contained a sequence of work packages: (1) an initial literature review to inform interviews; (2) an analysis of the national policy stream in this field; (3) a SNA of the AHSNs’ health and wealth networks; (4) five case studies of different AHSNs with 10 innovation tracers; and (5) interviews with individuals nominated as KLs.SettingWe studied a sample of five of the 15 English AHSNs, along with the development of the national policy stream.ParticipantsWe interviewed and surveyed AHSNs and other relevant staff, including national policy-level respondents.Data sources(1) A review of national- and AHSN-level documents, grey literature and relevant academic material; (2) semi-structured interviews with AHSN very senior managers, along with other staff, policy respondents and nominated ‘KLs’; and (3) a SNA (with two time points) using snowball survey methods.Review methodsThe literature review took a structured and narrative-based approach in what was a diffuse and multidisciplinary academic field.Results(1) We found that different networks were emerging around AHSNs’ health and wealth goals and, perhaps not surprisingly, the wealth networks were at an exploratory stage; (2) we found that these networks took different forms in different AHSNs; (3) we developed a general typology of the approaches AHSNs took towards spreading new ideas and innovations; and (4) we uncovered some characteristics of ‘KLs’.LimitationsThe study proceeded with the AHSNs still in a formative phase (early 2014 to early 2016). The SNA had two data points that were close together. We could not undertake a longer-term impact assessment. Future work should take a more longitudinal approach.ConclusionsThe study’s results have implications for (1) AHSN knowledge mobilisation strategies and networks, (2) the shape of AHSN regional knowledge networks and (3) the construction of knowledge leadership in these settings.Future researchOur top priority recommendations were (1) a longer-term AHSN impact assessment and (2) greater exploration of the AHSNs’ novel wealth creating role.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

There is a need for 'step change in the historic performance of the health, health care and social care system' that will depend on 'skilful design and robust implementation of a range of initiatives, not just once but in a dynamic stream, rooted in and modified by information on impact: in short, rooted in intelligent evaluation that is sensitive to the complexity'. 1 This call to arms appears in the foreword to a new collection of papers by leading thinkers that sets out the current state of the science for the 'intelligent evaluation' of complex health and public health interventions. 2 It offers insights into methodological challenges and potential future directions across the broad disciplinary menu of evaluative research and proposes thoughtful approaches to the competing priorities of, on the one hand, rigour and generalizability, and on the other hand, appropriate scale, cost and the need for prompt results. A particular trigger for the production of this volume was the launch in England of the NHS Five Year Forward View 3 which articulates not just the urgency of change for health care systems given new patterns of ill health but also the aspiration that such changes should no longer be centrally driven. The NHS is being encouraged to pursue local and regional experiments to bring about a range of new models of care; innovation is henceforth to be achieved from the 'bottom up'. Writers involved in this volume felt that an authoritative 'forward view' of evaluative research methods was also required in response: bottom-up transformation has to be shown to work (using a range of appropriate research methods), underlying mechanisms and accommodating contexts need to be clarified and research evidence needs to be provided in a timely fashion to ensure effective dissemination and the adoption of optimal system and service change.