There is growing recognition of the limitations of realist evaluation, and other theory driven approaches to evaluation, in the context of healthcare policies. These approaches, which seek to surface ‘programme theories’ or construct ‘logic models’, are often unable to account for empirical observations of policy implementation in real-life situations. In this talk, Lorelei will discuss previous work with Justin Waring, to argue that this failure stems from insufficient theoretical elaboration of the social, cultural, and political dimensions of healthcare policies. Drawing from institutional theory, critical theory and discourse theory, and from organizational ethnography, they have set out an alternative approach to research on healthcare reform. Lorelei will illustrate this with examples from their experience of research on acute care ‘reconfiguration’, integrated health and social care and other forms of major system change in the NHS in England.
I am an anthropologist in the UCL Department of Applied Health Research. My research looks at the changing social organisation of health care services and professional work in the context of contemporary policy reforms. My doctoral research was an ethnographic study of the politically contested issue of hospital planning. I am currently interested in the role of expertise in governing, using policies for ‘major system change’ and the practices of policy evaluation as particular cases. I am a member of the editorial board for Sociology of Health and Illness, and co-convenor of the London Medical Sociology Group where we explore the links between social theory, philosophy and medical sociology.