Realistic Evaluation Bloodlines

Pawson, Ray; Tilley, Nick

doi:10.1177/109821400102200305

Cited by 417 publications

(888 citation statements)

References 5 publications

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“…We developed the program theory in a step-wise fashion based on guidance in literature (16, 17, 26). We first summarized prior theory and research on the subject, then collected data on contextual factors that could affect the expected outcomes of the intervention, and finally formulated the implicit theory of the intervention.…”

Section: Methodsmentioning

confidence: 99%

“…In realist evaluation, the mechanisms could be understood as the agency through which the resources introduced into the system by the program produce the outcome. However, context, in the form of the appropriate external environment (or not), is critical for the manifestation of the outcome (17). A detailed description of the intervention is provided in File S1 in Supplementary Material.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Capacity-Building Program of District Health Managers in India: A Contextualized Theoretical Framework

Prashanth

Marchal

Kegels

et al. 2014

Front. Public Health

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Performance of local health services managers at district level is crucial to ensure that health services are of good quality and cater to the health needs of the population in the area. In many low- and middle-income countries, health services managers are poorly equipped with public health management capacities needed for planning and managing their local health system. In the south Indian Tumkur district, a consortium of five non-governmental organizations partnered with the state government to organize a capacity-building program for health managers. The program consisted of a mix of periodic contact classes, mentoring and assignments and was spread over 30 months. In this paper, we develop a theoretical framework in the form of a refined program theory to understand how such a capacity-building program could bring about organizational change. A well-formulated program theory enables an understanding of how interventions could bring about improvements and an evaluation of the intervention. In the refined program theory of the intervention, we identified various factors at individual, institutional, and environmental levels that could interact with the hypothesized mechanisms of organizational change, such as staff’s perceived self-efficacy and commitment to their organizations. Based on this program theory, we formulated context–mechanism–outcome configurations that can be used to evaluate the intervention and, more specifically, to understand what worked, for whom and under what conditions. We discuss the application of program theory development in conducting a realist evaluation. Realist evaluation embraces principles of systems thinking by providing a method for understanding how elements of the system interact with one another in producing a given outcome.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of Capacity-Building Program of District Health Managers in India: A Contextualized Theoretical Framework

Prashanth

Marchal

Kegels

et al. 2014

Front. Public Health

View full text Add to dashboard Cite

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“…Evaluators have now become more interested in a deeper process-oriented inquiry in order to understand how complex health programmes or treatments work in the way they do (McEvoy and Richards 2003;Clark, Lissel, and Davis 2008). Pawson and Tilley (2001) claimed that evaluation is cursed with 'short-termism'. They proposed that there is too much emphasis on programmes and methods that are aimed at meeting pragmatic ends with findings that lean towards parochial concerns.…”

Section: Introductionmentioning

confidence: 99%

Applying a realist(ic) framework to the evaluation of a new model of emergency department based mental health nursing practice

2010

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Evaluation has become progressively popular within public health and healthcare programme research, with an emphasis on outcomes and a desire to improve practice and service delivery. Mixed methods approaches are consequently being employed to capture the multidimensional characteristics of programmes that aim to address problematic situations affecting targeted populations. This paper provides an overview of critical realism, a modern philosophical perspective that seeks contextualised causal understandings of social phenomena. Realistic evaluation, a research methodology adapted from critical realism, is highlighted as a means of obtaining a deeper appreciation of how complex programmes work, for whom they work, and under what circumstances. The evaluation of a mental health nurse practitioner outpatient service based in the emergency department of a large teaching hospital in Sydney Australia is used to illustrate the application of a realist perspective to research in nursing practice.

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“…247,255,256 Crucially, the conclusions of realist studies are recognised to be both provisional and fallible. 257 …”

Section: Foundations Of Realist Inquirymentioning

confidence: 99%

“…236,244,257 Guided by the approach to realist inquiry adopted by Pawson,228 we address the need to develop a more subtle analysis of context by specifying four main levels of contextual hierarchy (infrastructural system, institutional setting, interpersonal relations and individual) with all but the individual level divided into substrata (see Figure 5). …”

Section: Intervention: a Distinct Analytical Categorymentioning

confidence: 99%

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Realistic Evaluation Bloodlines

Cited by 417 publications

References 5 publications

Evaluation of Capacity-Building Program of District Health Managers in India: A Contextualized Theoretical Framework

Evaluation of Capacity-Building Program of District Health Managers in India: A Contextualized Theoretical Framework

Applying a realist(ic) framework to the evaluation of a new model of emergency department based mental health nursing practice

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

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