Chasing Chameleons, Chimeras and Caterpillars: Evaluating an Organizational Innovation in the National Health Service

Although some might argue that too little attention is paid to the evaluation of health service innovations, evaluation research has burgeoned alongside the ubiquitous healthcare reform of the UK NHS which escalated under the Conservative government of the 1980s and has continued under the Labour government since the late 1990s. In terms of funding and activity health service evaluation is something of an industry: to give just one example the NHS Service Delivery and Organization (SDO) R&D Programme has spent some £6m since 2002 funding research to evaluate models of service delivery(http://sdo.lshtm.ac.ukhttp://sdo.lshtm.ac.uk).Evaluative research is a quest for evidence and an answer to ‘what works (or doesn’t) for whom in which context?’ often driven by a desire to inform the change process. This chapter is about one particular evaluative research project which examined an organizational innovation introduced as part of wider NHS reforms undertaken by the New Labour government. Our focus is not on answering the ‘what works’ question per se, but instead we critically examine what makes evaluation research difficult. We draw on our experience of researching one innovation, but the challenges arising from the specifics of this particular project are not unique; indeed we argue that the chameleons, chimeras and caterpillars we encountered may well be persistent features of evaluative research.