School of Sociology and Social Policy, University of Leeds, Leeds, UK.
School of Sociology and Social Policy, University of Leeds, Leeds, UK.
Soc Sci Med. 2014 Aug;114:129-37. doi: 10.1016/j.socscimed.2014.05.032. Epub 2014 May 27.
Planners, managers and policy makers in modern health services are not without ingenuity - they will always try, try and try again. They face deep-seated or 'wicked' problems, which have complex roots in the labyrinthine structures though which healthcare is delivered. Accordingly, the interventions devised to deal with such stubborn problems usually come in the plural. Many different reforms are devised to deal with a particular stumbling block, which may be implemented sequentially, simultaneously or whenever policy fashion or funding dictates. This paper examines this predicament from the perspective of evidence based policy. How might researchers go about reviewing the evidence when they are faced with multiple or indeed competing interventions addressing the same problem? In the face of this plight a rather unheralded form of research synthesis has emerged, namely the 'typological review'. We critically review the fortunes of this strategy. Separating the putative reforms into series of subtypes and producing a scorecard of their outcomes has the unintended effect of divorcing them all from an understanding of how organisations change. A more fruitful approach may lie in a 'theory-driven review' underpinned by an understanding of dynamics of social change in complex organisations. We test this thesis by examining the primary and secondary research on the many interventions designed to tackle a particularly wicked problem, namely the inexorable rise in demand for healthcare.
规划者、管理者和政策制定者在现代医疗服务中并非没有创造力——他们总会不断尝试、尝试、再尝试。他们面临着深层次或“棘手”的问题，这些问题在医疗保健服务所涉及的错综复杂的结构中有着复杂的根源。因此，为解决这些顽固问题而设计的干预措施通常是多种多样的。许多不同的改革措施被设计用来解决一个特定的绊脚石，这些措施可能会按顺序、同时或根据政策潮流或资金情况来实施。本文从循证政策的角度探讨了这种困境。当研究人员面对多种甚至相互竞争的干预措施来解决同一个问题时，他们如何对证据进行审查？面对这种困境，一种相当不为人知的研究综合形式出现了，即“类型学综述”。我们批判性地回顾了这种策略的命运。将假设的改革措施分为一系列亚型，并对其结果进行评分卡，这无意中使它们都与组织变革的理解脱节。一种更有成效的方法可能在于一种“理论驱动的综述”，这种综述基于对复杂组织中社会变革动态的理解。我们通过检查旨在解决一个特别棘手问题（即医疗保健需求的不可阻挡的增长）的许多干预措施的主要和次要研究来检验这一论点。
