Evaluating systems for health using boundary critique
Abstract: Two professional domains – evaluation (with big ‘E’) practitioners, associated with the policy domain, and health systems practitioners, associated with research and implementation domain– might be regarded as experiencing transitional phases in the past 5-10 years, both relating to their use of systems thinking. In evaluation, the shift can be seen as one moving from what I have caricatured as an ‘evaluation-industrial complex’ towards a more benign ‘evaluation-adaptive complex’. One feature of this is an increasing concern for developmental evaluation (cf. Michael Patton) in place of a conventional divide between formative and summative evaluation, particularly manifest in arguments for and against evidence-based evaluation. In health care practice, the shift might be considered as moving from say, ‘health governance’ towards ‘governance for health’, or ‘health systems’ towards ‘systems for health’.
Both shifts in professional praxis draw variably on systems thinking ideas. Particularly prominent are ideas of system dynamics and complex adaptive systems. Less prominent but potentially more helpful as complementary aides to evaluators and health practitioners are tools and methods associated with soft/critical systems tradition. Drawing on this tradition, a model of systemic praxis (systems thinking in practice) based on boundary critique is presented as a framework to generate developmental evaluation of systems for health. Core features of the framework are discussed in relation to a case study in developing (and evaluating) systems for health partnerships.
Biographical notes: Dr Martin Reynolds is Senior Lecturer and Qualifications Director in Systems Thinking in Practice. He is lead academic liaison for the Applied Systems Thinking in Practice Group at The Open University, UK. His teaching and research focus on issues of critical systems thinking and evaluation of interventions in relation to international development, environmental management, health systems support and business administration. Martin has co-authored and been lead editor on 3 books including: Systems Approaches to Managing Change (Springer, 2010); The Environmental Responsibility Reader (Zed Books, 2009); and Operational Research and Environmental Management: A New Agenda (Operational Research Society, 2001). Many of his papers – including his own chapters from these publications - have been negotiated for open access. As part of his research and scholarship Martin has worked with the widely acclaimed systems philosopher, Professor Werner Ulrich from Switzerland, and in 2010 co-authored with him a significant revision of Ulrich’s celebrated systems approach Critical Systems Heuristics. Martin provides workshop support and facilitation for professional development in systems practice and for his specialist field of critical systems thinking.