Intended for healthcare professionals


New approaches to evaluating complex health and care systems

BMJ 2016; 352 doi: (Published 01 February 2016) Cite this as: BMJ 2016;352:i154
  1. Tara Lamont, scientific adviser1,
  2. Nicholas Barber, director of research2,
  3. John de Pury, assistant director of policy3,
  4. Naomi Fulop, professor of healthcare organisation and management4,
  5. Stephanie Garfield-Birkbeck, assistant director5,
  6. Richard Lilford, chair in public health6,
  7. Liz Mear, chief executive7,
  8. Rosalind Raine, professor of healthcare evaluation4,
  9. Ray Fitzpatrick, professor of public health and primary care8
  1. 1National Institute for Health Research Health Services and Delivery Research Programme, University of Southampton, SO16 7NS, UK
  2. 2The Health Foundation, London, UK
  3. 3Universities UK, London, UK
  4. 4University College London, UK
  5. 5University of Southampton, UK
  6. 6University of Warwick, Coventry, UK
  7. 7North West Coast Academic Health Science Network, Warrington, UK
  8. 8University of Oxford, UK
  1. Correspondence to: T Lamont t.lamont{at}
  • Accepted 11 December 2015

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

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.

Time to evaluate

At a time of straitened resources we cannot afford to make poor choices. As Twain said, “Supposing is good, but finding out is better.” This is the right time for researchers to get more engaged in supporting service change. In 2014 the NHS Five Year Forward View set out clearly the case for major system innovations and new ways of working.5 It suggests that future gains will come as much from changes in process and service delivery …

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