Chapter One – Evaluating health services: multidisciplinary
- Research is the systematic and rigorous process of enquiry which aims to describe phenomena and to
develop and test explanatory concepts and theories.
- Research methods should not be seen in isolation from one another; it is recommended to use a
triangulated or combined methodological approach to address different facets of a research issue.
- If research aims to find information on topic that little is known about, too complex, sensitive for the
development of standardized tools, then qualitative measurements should be used.
- For research that aims to find cause-and-effect issues, then the experimental design is required.
- Qualitative research findings can enhance quantitative data by placing it into real social contexts.
- The true experimental design: randomised controlled trial (RCT), but not always ideal.
- Health research: defined in relation to health generally; emphasis on health services and informing
the planning and operation of services aiming to achieve health. Ex: develop tools to prevent and cure
illness and mitigate its effects, and devise better approaches to health care.
- Health systems: the structures used to deliver health care, the geographical boundaries of the latter, or
the strategies used to attain population health.
- Health systems research: Improving the health of a community, by enhancing the efficiency and
effectiveness of the health system as an integrated part of the overall process of socio-economic
- In UK and US, the focus is more on health services research, rather than on health systems research.
- Health services research/health technology assessment: It is the evaluation of health services in
relation to their appropriateness, effectiveness and costs. This type of research is not insulated from the
society within which it is placed, it is often responsive to current policy and political issues, and is thus
dependent upon decisions taken by others in relation to research topics and research funding. Should
transcend (acquiring knowledge) and the D (translating that knowledge into action) divide. Ex: The
identification of the health care needs of communities and the study of the provision, effectiveness and
use of health services.
Health Services Research (6)
- Concerned with the relationship between the provision, effectiveness, and efficient use of health services
and the health needs of the population; it is narrower than heath research:
- The relationship between the populations’s need and demand for health services, and the supply,
use and acceptability of health services;
- The process and structures, including the quality and efficiency, of health services;
- The appropriateness and effectiveness of health service interventions wrt effectiveness and cost-
effectiveness, including patient perceptions of outcome in relation to the effects on their health,
health related quality of life and their satisfaction with the outcome.
- It is distinct from audit and quality assurance/assessment, which aim to monitor whether predefined
and agreed standards have been met.
- Health services research has evaluation rather than monitoring as its aim.
- Broader than clinical research because focuses on outcome of medical interventions from social,
psychological physical and economic perspectives.
The Assessment of Quality (7)
- Approaches include performance indicators and assessment, and patient surveys.
- Systematic evaluations of quality follow Donabedian or Maxwell’s broader approaches:
- Donabedian focused on the measurement of structure (inputs and resources, such as staffing,
buildings, fundings); process (service delivery, organisation and use, including resources – e.g.
rates of consultations and referrals, waiting times, admission and discharge procedures,
prescribing practices); output (productivity and throughput including discharge rates, access,
effectiveness, equity); and outcome (death, disease, disability, discomfort, dissatisfaction).
- Maxwell described six dimensions of quality: appropriateness; social acceptability (patient’s
views, met expectations); effectiveness (consistent with desired effect); relevance to need;
equity; and acceptability (sitting, language, disability friendly).
- Higginson stated that quality of care needs to include humanity, effectiveness, acceptability,
equity, accessibility and efficiency. Building on the work of Shaw and Black, she defined quality of
health care in broader terms:
- Effectiveness (achieving the intended benefits in the population, under usual conditions of
- Acceptability and humanity (to the consumer and provider);
- Equity and accessibility (the provision and availability of services to everyone likely to benefit
- Efficiency (greatest benefit for least cost).
- Also believed that patient empowerment is important to increase their control over the services
and so care is appropriate.
- Directed at the maintenance and achievement of quality in health care.
- Aims to improve patient outcome, to develop a more cost effective use of resources, and to have an
educational function for health professionals.
Chapter one evaluating health services: multidisciplina ry collaboration. Research is the systematic and rigorous process of enquiry which aims to describe phenomena and to develop and test explanatory concepts and theories. Research methods should not be seen in isolation from one another; it is recommended to use a t riangulated or combined methodological approach to address different facets of a research issue. If research aims to find information on topic that little is known about, too complex, sensitive for the development of standardized tools, then qualitative measurements should be used. For research that aims to find cause-and-effect issues, then the experimental design is required. Qualitative research findings can enhance quantitative data by placing it into real social contexts. The true experimental design: randomised controlled t rial (rct), but not always ideal. Health research: defined in relation to health generally; emphasis on health services and informing the planning and operation of services aiming to achieve health.