Categories of context in realist evaluation

Realist evaluation has become widespread partly because of its sensitivity to the influence of contexts on policy implementation. In many such evaluations, the range of contexts considered relevant nevertheless remains disparate and under-conceptualised. This article uses findings from a realist evaluation of English Patient Safety Collaboratives during 2015–2018 to develop a realist taxonomy of contexts, differentiating contexts according to how they affect the corresponding policy mechanism. By analysing the main context-mechanism-outcome configurations that made up the English Patient Safety Collaboratives, we derive a taxonomy of the contexts that affected implementation and outcomes. The categories of context were structural (network, hierarchy, market and organisational contexts); resource-based (actors, material, financial); motivational (receptivity, outcome headroom), and temporal (continuity, history and convergence). To the categories found in previous studies, this study adds the three temporal contexts.

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Analysis Implementation System Incident Report With Method Realist Evaluation at Siloam Hospitals Balikpapan 2018

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.5214 ◽

2020 ◽

Vol 8 (T2) ◽

pp. 152-156

Author(s):

Muhammad Fauzi Saputra ◽

Alimin Maidin ◽

Anwar Mallongi ◽

Syamsuddin Syamsuddin

Keyword(s):

Patient Safety ◽

Case Study Research ◽

Realist Evaluation ◽

Incident Reporting ◽

Incident Report ◽

Evaluation Approach ◽

Reporting Process ◽

Patient Safety Incidents ◽

Research Type

BACKGROUND: According to Permenkes No. 11 Tahun 2017, patient safety incidents are any unintended or unexpected incident which could have, or did, lead to harm that could be prevented to patient. Incident reporting system which designed to obtain information about patient safety is used for individual and organization learning. AIM: This study aimed to analyze the increased success of incident report at Siloam Hospitals Balikpapan. METHODS: Research design which used is qualitative research with the case study research type and the realist evaluation approach. RESULTS: The data collection is done through observation and profound interview to five officers who’s in charge of incident reporting process at Siloam Hospitals Balikpapan. The data processing uses content analysis. The result shows that incident reporting system’s implementation at Siloam Hospitals Balikpapan which seen from the side of context mechanism outcome has been working well. CONCLUSION: The conclusion of this research defines that the implementation’s success due to incident reporting program is accorded by reporting guide which has been legitimated by hospital’s directors, human resources who have been equipped with training about reporting program facilitate the reporting process and Head Quality Risk as responsible division to the incident reporting process has high responsibility to the program.

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Applying the Realist Evaluation Approach to the Complex Process of Policy Implementation—The Case of the User Fee Exemption Policy for Cesarean Section in Benin

Frontiers in Public Health ◽

10.3389/fpubh.2021.553980 ◽

2021 ◽

Vol 9 ◽

Author(s):

Jean-Paul Dossou ◽

Sara Van Belle ◽

Bruno Marchal

Keyword(s):

Health Policy ◽

Cesarean Section ◽

Policy Implementation ◽

National Health ◽

Realist Evaluation ◽

Systems Research ◽

Fee Exemption ◽

Exemption Policy ◽

User Fee ◽

Central Level

Realist evaluation is making inroads in the field of health policy and systems research to a large extent because of its good fit with complex issues. Until now, most realist studies focused on evaluating interventions or projects related to health care delivery, organization of health services, education, management, and leadership of health workers in high income countries. With this paper, we apply the realist approach to the study of national health policy implementation in a low resource country. We use the case of the user fee exemption policy for cesarean section in Benin, which we followed up from 2009 to 2018. We report on how realist evaluation can be applied for policy implementation research. We illustrate how we developed the initial programme theory—the starting point of any realist evaluation -, how we designed the study and data collection tools, and how we analyzed the data. For each step, we present current good practices, how we adapted them when needed, the challenges and the lessons learned. We report also on how the dynamic interactions between the central level (the national implementing agency) and the peripheral level (an implementing hospital) shaped the policy implementation. We found that at central level, availability of resources for a given policy is constantly challenged in the competitive national resource allocation arena. Key factors include the political power and the legitimacy of the group supporting the policy. These are influenced by the policy implementation structure, how the actual outputs of the implementation align with promises of the group supporting the policy and consequently how these outputs, the policy and its promoters are perceived by the community. We found that the service providers are key to the implementation, and that they are constrained or influenced by the dependability of the funding, their autonomy, their personal background, and the accountability arrangements. This study can inform the design and implementation of national health policies that involve interactions between central and operational level in other low-income countries.

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