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Abstract

The scale and complexity of major system change in health care (typically involving multiple change processes, organisations and stakeholders) presents particular conceptual and methodological challenges for evaluation by researchers. This essay summarises some current approaches to evaluating major system change from the field of management and organisational research, and discusses conceptual and methodological questions for further developing the field. It argues that multilevel conceptual frameworks and mixed-methods approaches are required to capture the complexity and the heterogeneity of the mechanisms, processes and outcomes of major system change. Future evaluation designs should aim to represent key components of major system change – the context, processes and practices, and outcomes – by looking for ways that quantitative and qualitative methods can enrich one another. Related challenges in ensuring that findings from evaluating major system change are used by decision-makers to inform policy and practice are also discussed