Realism and rhetoric in the evaluation of a New Care Model

Grimwood, Tom (2019) Realism and rhetoric in the evaluation of a New Care Model. Journal of Integrated Care . Item availability may be restricted.

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Abstract

This paper discusses the methodological challenges to evaluating one of the 50 Vanguard sites of the New Care Model (NCM) programme for integrated care in England. The paper suggests that the ambition and complexity of the NCM required a more nuanced approach to cause and effect than traditional evaluation strategies. ‘Before and after’ comparisons are unlikely to capture the multiple dimensions of NCM delivery, and simple measures of frequency and correlation were unable to capture the specific kinds of change (which are as much embedded within cultural and communicative change than reorganised pathways and data sharing). Furthermore, the population-based foundation of the NCMs required a contextually-sensitive series of evaluation activities which can be linked together to provide micro, meso and macro analysis. As such, the evaluation of the Vanguard site drew on realist approaches to evaluation, in order to move away from high-level outcome foci, and towards contextualised accounts of who a programme works for, in what context, and why; as part of an ongoing cycle of evaluation. However, the evaluators found, from an early stage in the evaluation project, there were a number of challenges concerning how the delivery of the NCM related to the possibilities of utilising the realist method (challenges which have since been reflected in many sites across the Vanguard programme): the lack of clear and consistent criteria for ‘what success looks like’, the size and shape of particular interventions, where the NCM ‘begins’ and ‘ends’ in terms of inclusion of activities, and identifying the specific contribution of vanguard resources to existing interventions in relation to other funding sources, and so on. Given that these were often issues concerning the system design, rather than application, developing realist hypotheses for testing was challenging. The paper argues that, in the case of this particular Vanguard site, the tangible benefit of the realist approach was not in providing a firm epistemological basis for evaluation, but rather in drawing out and articulating the ontological rhetoric of such large-scale transformation programmes. By understanding the work of the NCM less as an objective ‘system’, and more as a dynamic form of persuasion, aimed at securing the ‘adherence of minds’ (Perelman and Olbrechts-Tyteca 2008, p. 8) in multiple audiences, the paper suggests that realist evaluation can be used to address both the systematic issues and localised successes the NCMs encountered.

Item Type: Article
Journal or Publication Title: Journal of Integrated Care
Publisher: Emerald
ISSN: 2042-8685
Departments: Health and Social Care Evaluations (HASCE)
Depositing User: Tom Grimwood
Date Deposited: 25 Jan 2019 17:27
Last Modified: 26 Jan 2019 06:09
URI: http://insight.cumbria.ac.uk/id/eprint/4429

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