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The role of evaluation in iterative learning and implementation of quality of care interventions
Background: The Lancet Global Health Commission (LGHC) has argued that quality of care (QoC) is an emergent property that requires an iterative process to learn and implement. Such iterations are required given that health systems are complex adaptive systems. Objective: This paper explores the mult...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Taylor & Francis
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216261/ https://www.ncbi.nlm.nih.gov/pubmed/34148508 http://dx.doi.org/10.1080/16549716.2021.1882182 |
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author | Shah, Nikhil Mathew, Sharon Pereira, Amanda Nakaima, April Sridharan, Sanjeev |
author_facet | Shah, Nikhil Mathew, Sharon Pereira, Amanda Nakaima, April Sridharan, Sanjeev |
author_sort | Shah, Nikhil |
collection | PubMed |
description | Background: The Lancet Global Health Commission (LGHC) has argued that quality of care (QoC) is an emergent property that requires an iterative process to learn and implement. Such iterations are required given that health systems are complex adaptive systems. Objective: This paper explores the multiple roles that evaluations need to play in order to help with iterative learning and implementation. We argue evaluation needs to shift from a summative focus toward an approach that promotes learning in complex systems. A framework is presented to help guide the iterative learning, and includes the dimensions of clinical care, person-centered care, continuum of care, and ‘more than medicine. Multiple roles of evaluation corresponding to each of the dimensions are discussed. Methods: This paper is informed by reviews of the literature on QoC and the roles of evaluation in complex systems. The proposed framework synthesizes the multiple views of QoC. The recommendations of the roles of evaluation are informed both by review and experience in evaluating multiple QoC initiatives. Results: The specific roles of different evaluation approaches, including summative, realist, developmental, and participatory, are identified in relationship to the dimensions in our proposed framework. In order to achieve the potential of LGHC, there is a need to discuss how different evaluation approaches can be combined in a coherent way to promote iterative learning and implementation of QoC initiatives. Conclusion: One of the implications of the QoC framework discussed in the paper is that time needs to be spent upfront in recognizing areas in which knowledge of a specific intervention is not complete at the outset. This, of course, implies taking stock of areas of incompleteness in knowledge of context, theory of change, support structures needed in order for the program to succeed in specific settings. The role of evaluation should not be limited to only providing an external assessment, but an important goal in building evaluation capacity should be to promote adaptive management among planners and practitioners. Such iterative learning and adaptive management are needed to achieve the goals of sustainable development goals. |
format | Online Article Text |
id | pubmed-8216261 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Taylor & Francis |
record_format | MEDLINE/PubMed |
spelling | pubmed-82162612021-07-06 The role of evaluation in iterative learning and implementation of quality of care interventions Shah, Nikhil Mathew, Sharon Pereira, Amanda Nakaima, April Sridharan, Sanjeev Glob Health Action Original Article Background: The Lancet Global Health Commission (LGHC) has argued that quality of care (QoC) is an emergent property that requires an iterative process to learn and implement. Such iterations are required given that health systems are complex adaptive systems. Objective: This paper explores the multiple roles that evaluations need to play in order to help with iterative learning and implementation. We argue evaluation needs to shift from a summative focus toward an approach that promotes learning in complex systems. A framework is presented to help guide the iterative learning, and includes the dimensions of clinical care, person-centered care, continuum of care, and ‘more than medicine. Multiple roles of evaluation corresponding to each of the dimensions are discussed. Methods: This paper is informed by reviews of the literature on QoC and the roles of evaluation in complex systems. The proposed framework synthesizes the multiple views of QoC. The recommendations of the roles of evaluation are informed both by review and experience in evaluating multiple QoC initiatives. Results: The specific roles of different evaluation approaches, including summative, realist, developmental, and participatory, are identified in relationship to the dimensions in our proposed framework. In order to achieve the potential of LGHC, there is a need to discuss how different evaluation approaches can be combined in a coherent way to promote iterative learning and implementation of QoC initiatives. Conclusion: One of the implications of the QoC framework discussed in the paper is that time needs to be spent upfront in recognizing areas in which knowledge of a specific intervention is not complete at the outset. This, of course, implies taking stock of areas of incompleteness in knowledge of context, theory of change, support structures needed in order for the program to succeed in specific settings. The role of evaluation should not be limited to only providing an external assessment, but an important goal in building evaluation capacity should be to promote adaptive management among planners and practitioners. Such iterative learning and adaptive management are needed to achieve the goals of sustainable development goals. Taylor & Francis 2021-06-20 /pmc/articles/PMC8216261/ /pubmed/34148508 http://dx.doi.org/10.1080/16549716.2021.1882182 Text en © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Shah, Nikhil Mathew, Sharon Pereira, Amanda Nakaima, April Sridharan, Sanjeev The role of evaluation in iterative learning and implementation of quality of care interventions |
title | The role of evaluation in iterative learning and implementation of quality of care interventions |
title_full | The role of evaluation in iterative learning and implementation of quality of care interventions |
title_fullStr | The role of evaluation in iterative learning and implementation of quality of care interventions |
title_full_unstemmed | The role of evaluation in iterative learning and implementation of quality of care interventions |
title_short | The role of evaluation in iterative learning and implementation of quality of care interventions |
title_sort | role of evaluation in iterative learning and implementation of quality of care interventions |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216261/ https://www.ncbi.nlm.nih.gov/pubmed/34148508 http://dx.doi.org/10.1080/16549716.2021.1882182 |
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