Family Practice Vol. 19, No. 5, 569-570
© Oxford University Press 2002
Book review |
Action evaluation of health programmes and changes: a handbook for a user-focused approach.
John Øvretveit. (255 pages, £27.50.) Radcliffe Medical Press Ltd, 2002. ISBN 1-85775-925-7.
Independent health researcher, with training in medical sociology and extensive experience of health services development, who has carried out evaluations of a variety of initiatives in the UK, mainly in primary health care
The world of evaluation is complex and can be confusing. Understanding is often clouded by jargon and the tendency of authors to stake out territory, ‘brand’ their own approach and present it as distinctive or new. Øvretveit’s book is advertised as a guide for the uninitiated and it covers the paradigms, principles and practice of evaluation thoroughly and with admirable clarity. Within this overview, Øvretveit also promotes "action evaluation", an approach he has pioneered in the field of health care, which emphasizes gaining agreement on the purpose of an evaluation, selecting methods appropriate to the task and giving decision makers rapid feedback on changes in practice or policy.
Others, notably Patton,1 have advocated similar user-focused methods to increase the usefulness of evaluation, but Øvretveit makes the approach accessible and relevant to health professionals and managers by his clear exposition, amply illustrated with examples from evaluations of health services. He leavens the text throughout with amusing anecdotes and practical wisdom from a variety of evaluations. Evaluators and evaluated alike will find echoes of their own experience in the descriptions of the reality of working with "wobbly interventions", "fuzzy boundaries", "ghastly goals" and "Jar-Jar Binks team members". The best thing about this book is that it is down to earth and readable without sacrificing academic rigour.
Øvretveit makes a strong case for action evaluation as a practical and valuable alternative to randomized controlled trials and other standard research designs derived from the dominant clinical research paradigm, which are now acknowledged to have serious limitations when used to evaluate complex health care interventions. It draws on the tradition of action research and adopts the methods of social science in a framework that can be used even when objectives are fluid, change is endemic, there is uncertainty about impact and information is demanded quickly. The skills required are not just technical; Øvretveit makes it abundantly clear that evaluators need to be political animals, alive to conflicting interests and hidden agendas. It is refreshing to find a chapter on the ethics of evaluation that lays out the difficulties and avoids glib answers.
Handbooks on evaluation are, however, no substitute for hands-on experience. It is over-optimistic to expect that simply studying this book will enable health professionals and managers to plan evaluations and carry them through successfully without support from specialist evaluators. Its value lies in the contribution it could make to the ‘evaluation literacy’ of those working in health care. Evaluation is no longer an optional extra, but when badly designed and executed it is simply a waste of time and money. Helping those involved to understand, critically assess and feel confident about participating in evaluation is an essential step towards improving quality of care.
References
1 Patton MQ. Utilization-focused Evaluation. London: Sage, 1997
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||