New approaches to evaluating complex health and care systems

The NHS has many examples of effective service changes that took too long to implement, from structured patient education in diabetes1 to enhanced recovery programmes in surgery.2 Other initiatives have seemed promising but didn’t deliver—or made things worse. For example, telephone triage and some types of case management increase demand for services rather than divert pressure from urgent care.3 Without the right evaluation, it is difficult to know which innovations are worth adopting. The scale of opportunity and real costs of implementing untested innovations and ignoring lessons learnt elsewhere are substantial.

In 2015 a large international summit was held in London, convened by the National Institute for Health Research, the Health Foundation, the Medical Research Council (MRC), Universities UK, and AcademyHealth, which led to an authoritative overview of the array of methods available to evaluate healthcare services.4 Here we summarise a parallel discussion that took place between research funders, practitioners, and leaders to identify the institutional barriers to healthcare evaluation and potential solutions. We argue for closer partnership between service leaders and researchers, based on a shared culture of basic principles and awareness of a range of options for evaluation.