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. 2019 Nov 6;34(3):313-324.
doi: 10.1108/JHOM-05-2019-0139.

Evaluating complex transformation

Allan Best  1   2 , Narelle Ong  3 , Penny Cooper  4 , Carolyn Davison  5 , Katherine Coatta  3 , Alex Berland  1 , Carol Herbert  1 , Craig Mitton  2 , John Millar  6 , Stephen Reichert  3 , Allison Cano  3
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Free article

Evaluating complex transformation

Allan Best et al. J Health Organ Manag. .
Free article

Abstract

Purpose: The purpose of this paper is to present a detailed case study of the evaluation strategies of a complex, multi-faceted response to a public health emergency: drug-related overdose deaths. It sets out the challenges of evaluating such a complex response and how they were overcome. It provides a pragmatic example of the rationale and issues faced to address the what, the why and particularly the how of the evaluation.

Design/methodology/approach: The case study overviews British Columbia's Provincial Response to the Overdose Public Health Emergency, and the aims and scope of its evaluation. It then outlines the conceptual approach taken to the evaluation, setting out key methodological challenges in evaluating large-scale, multi-level, multisectoral change.

Findings: The evaluation is developmental and summative, utilization focused and system informed. Defining the scope of the evaluation required a strong level of engagement with government leads, grantees and other evaluation stakeholders. Mixed method evaluation will be used to capture the complex pattern of relationships that have informed the overdose response. Working alongside people with drug use experience to both plan and inform the evaluation is critical to its success.

Originality/value: This case study builds on a growing literature on evaluating large-scale and complex service transformation, providing a practical example of this.

Keywords: Emergency response; Evaluation; Opioid crisis; System transformation.

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References

    1. BC Centre for Substance Use (2018), “A guidelines for the clinical management of opioid use disorder”, available at: www.bccsu.ca/wp-content/uploads/2017/06/BC-OUD-Guidelines_June2017.pdf (accessed October 25, 2019).
    1. Becu, A. and Allan, L. (2017), “Peer payment standards for short-term engagement”, BC Centre for Disease Control, Vancouver.
    1. Best, A., Greenhalgh, T., Saul, J., Lewis, S., Carroll, S. and Bitz, J. (2012), “Large system transformation in health care: a realist review and evaluation of its usefulness in a policy context”, Milbank Quarterly, Vol. 90 No. 3, pp. 421-456, available at: www.milbank.org/publications/the-milbank-quarterly/featured-articles/art... (accessed May 8, 2019).
    1. Checkland, P.B. and Poulter, J. (2016), Learning for Action: A Short Definitive Account of Soft Systems Methodology and Its Use for Practitioners, Teachers, and Students, John Wiley, Chichester.
    1. First Nations Health Authority (2010), Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans - Chapter 9: Research Involving the First Nations, Inuit and Métis Peoples of Canada, 2nd ed., Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and Social Sciences and Humanities Research Council of Canada, December.

Further reading

    1. Flicker, S., O’Campo, P., Monchalin, R., Thistle, J., Worthington, C., Masching, R. and Thomas, C. (2015), “Research done in ‘a good way’: the importance of indigenous elder involvement in HIV community-based research”, American Journal of Public Health, Vol. 105 No. 6, pp. 1149-1154.
    1. Meadows, D.H. (1999), “Leverage points: places to intervene in a system”, available at: www.sustainabilityinstitute.org/pubs/Leverage-Points.pdf (accessed June 15, 2010).

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