Health Care Analysis

, Volume 16, Issue 2, pp 127–144 | Cite as

Action Research—a Necessary Complement to Traditional Health Science?

  • Mike Walsh
  • Gordon Grant
  • Zoë Coleman
Original Paper


There is continuing interest in action research in health care. This is despite action researchers facing major problems getting support for their projects from mainstream sources of R&D funds partly because its validity is disputed and partly because it is difficult to predict or evaluate and is therefore seen as risky. In contrast traditional health science dominates and relies on compliance with strictly defined scientific method and rules of accountability. Critics of scientific health care have highlighted many problems including a perpetual quality gap between what is publicly expected and what is deliverable in the face of rising costs and the cultural variability of scientific medicine. Political demand to close the quality gap led to what can be seen as an elitist reform of policy on UK health research by concentrating more resources on better fewer centres and this may also have reduced support for action research. However, incompetent, unethical or criminal clinical practice in the UK has shifted policy towards greater patient and public involvement in health care and research. This highlights complementarity between health science and action research because action research can, as UK health policy requires, involve patients and public in priority setting, defining research outcomes, selecting research methodology, patient recruitment, and interpretation of findings and dissemination of results. However action research will remain marginalised unless either scientific research is transformed generally into a more reflective cycle or there is increased representation of action research enthusiasts within the establishment of health R&D or current peer review and public accountability arrangements are modified. None of these seem likely at this time. The case for complementarity is illustrated with two case studies.


Cooperative inquiry Action research Culture Patient and public involvement Research and development Science Soft systems Community operational research 


  1. 1.
    Aaron, H. J. (2002). The unsurprising surprise of renewed health care cost inflation, Health Affairs, web exclusive, accessed 16/11/06.
  2. 2.
    Ackoff, R. (1981). Creating the corporate future. New York, NY: Wiley.Google Scholar
  3. 3.
    Altrichter, H., Kemmis, S., McTaggert, R., & Zuber-Skerrit, O. (2002) The concept of action research. The learning organisation, 9(3), 125–131.CrossRefGoogle Scholar
  4. 4.
    Boddenheimer, T (2005). High and rising health care cost. Part 1: seeking an explanation. Annals of Internal Medicine, 142(10), 847–854.Google Scholar
  5. 5.
    Boyd A., Geerling T., Gregory W., Kagan C.M., Midgley G., Murray P., & Walsh M. (2006). Systemic evaluation: A participative, multi-method approach Journal of the Operational Research Society,  doi: 10.1057/palgrave.jors.2602281.
  6. 6.
    Burrell, G. (1996). Normal science, paradigms, metaphors, discourses and genealogies of analysis. In S. Clegg, C. Hardy, & W. Nord (Eds.), The handbook of organization studies. London: Sage.Google Scholar
  7. 7.
    Burrell, G., & Morgan, G. (1979). Sociological paradigms and organizational analysis. London: Heineman.Google Scholar
  8. 8.
    Chalmers, I. (1990). Underreporting research is scientific misconduct. Journal of the American Medical Association, 263, 1155–1156.Google Scholar
  9. 9.
    Checkland, P. B., & Scholes, J. (1990). Soft systems methodology in action. Chichester: Wiley.Google Scholar
  10. 10.
    Command. (2000). Westminster Hall debate on Down’s syndrome, Iddon (Bolton, South East), 10.00 am, column 3WH; Spelman (Meriden), 10.39 am, 4th July 2000, column 11WH,, accessed 16/11/06.
  11. 11.
    Commission for Health Improvement. (2000). Investigation into The North Lakeland NHS Trust, Report to The Secretary of State for Health, November, 2000, Commission for Health Improvement, (accessed 3/7/07).
  12. 12.
    Darwinian. (2002). Darwin Dons Hit Tabloids, The Darwinian (newsletter of Darwin College), Autumn.Google Scholar
  13. 13.
    Davis, S. (2006). Professor Sally highlights the importance of the new NHS R&D Strategy. UKCRN News. The Newsletter of the clinical Research Network. Issue 2. Spring/Summer 2006.Google Scholar
  14. 14.
    Denzin, N. K., & Lincoln, Y. S. (1994). Introduction: Entering the field of qualitative research. In N. K. Denzin, & Y. S. Lincoln (Eds.), Handbook of qualitative research (pp. 1–17). Thousand Oaks, CA: Sage.Google Scholar
  15. 15.
    Department of Health. (2005). Feedback on annual report for user centred NHS research programme RWA (RV9) 2004–2005.Google Scholar
  16. 16.
    Department of Health. (2006). Best research for best health. A new national health research strategy, Department of Health, London.Google Scholar
  17. 17.
    Dewey J. (1967). Psychology. In J. Boydston (Ed.), John Dewey: The early works, 1882–1898 (Vol. 2, pp. 7–27). Carbondale and Edwardsville, IL: Southern Illinois University Press. (Original work published in 1887).Google Scholar
  18. 18.
    Dick, B. (2000). Soft systems methodology. Session 13 of Areol—action research and evaluation on line., accessed 6th August 2006.
  19. 19.
    Friend, J, & Hickling, A. (1997). Planning under pressure—The strategic choice approach (2nd ed.). Oxford: Pergamon Press.Google Scholar
  20. 20.
    Grant, G, & Ramcharan, P. (2006). User involvement in research. In K. Gerrish, & A. E. Lacey (Eds.), The research process in nursing. Oxford: Blackwell.Google Scholar
  21. 21.
    Grant, G., Courtney, D., King, S., Minogue, V., & Walsh, M. (2006). Accounting for research: The difficulties posed for user-centred research. Mental Health and Learning Disabilities Research and Practice, 3(1), 5–19.Google Scholar
  22. 22.
    Gregory, W., Romm, R. A., & Walsh, M. (1994). The trent quality initiative: A multiagency evaluation of quality standards in the national health service: Research report. Hull, Centre for Systems Studies, University of Hull.Google Scholar
  23. 23.
    Hammersley, M. (2004). Action research: A contradiction in terms? Oxford Review of Education, 30(2), 165–181.CrossRefGoogle Scholar
  24. 24.
    Hart, E., & Bond, M. (1995). Action research for health and social care. Buckingham: Open University Press.Google Scholar
  25. 25.
    Helman, C. (1990). Culture, health and illness. London: Wright.Google Scholar
  26. 26.
    Holter, I. M., & Schwartz-Barcott, D. (1993). Action research: What is it? How has it been used and how can it be used in nursing? Journal of Advanced Nursing, 18, 298–304.PubMedCrossRefGoogle Scholar
  27. 27.
    Illich, I., Zola, I., McKnight, J., Caplan, J., & Shaiken, H. (1977). Disabling professions. London: Marion Boyers Publishers Ltd.Google Scholar
  28. 28.
    INVOLVE (1991) Accessed 31/05/06.
  29. 29.
    Jacobs, B. (2004). Using soft systems methodology for performance improvement and organisational change in the English national health service. Journal of Contingencies and Crisis Management, 12(4) 138–149.CrossRefGoogle Scholar
  30. 30.
    Kemmis, S. (1988). Action research in retrospect and prospect. In S. Kemmis, & R. McTaggart (Eds.) (pp. 27–39). The action research reader (3rd ed.). Geelong, Victoria: Deakin University Press.Google Scholar
  31. 31.
    Kennedy, I. (2001). The report of the Public Inquiry into Children’s Heart Surgery at The Bristol Royal Infirmary 1984–1995: Learning from Bristol (Cm 5207(1)).Google Scholar
  32. 32.
    Kohles, M. K. (1997). Redefining management through redesign of patient care delivery systems. Seminars For Nurse Managers, 5(1), 39–48.PubMedGoogle Scholar
  33. 33.
    Kosa J., Antonovsky A., & Zola K. (1969). Poverty and health: A sociological analysis. Cambridge, Mass: Harvard University Press.Google Scholar
  34. 34.
    Lathlean, J. (1994). Choosing an appropriate methodology. In J. Buckledee, & R. McMahon (Eds.), The research experience in nursing (pp. 31–46). London: Chapman and Hall.Google Scholar
  35. 35.
    Leonard, H., Eastham, K., & Dark, J. (2000). Heart and heart-lung transplantation in Down’s syndrome. BMJ, 320, 816–817.PubMedCrossRefGoogle Scholar
  36. 36.
    Lewin K. (1946). Action research and minority problems. In G. W. Lewin (Ed.), Resolving social conflicts: Selected papers on group dynamics by Kurt Lewin. New York: Harper and Brothers.Google Scholar
  37. 38.
    McDonnell E (2001). When to interfere with nature, rapid response to Leonard, H. Eastham, K. and Dark, J. Heart and heart-lung transplantation in Down’s syndrome BMJ, 2000(320) 816–817.Google Scholar
  38. 37.
    McTaggart, R. (1992). The action research planner. Victoria: Deakin University Press.Google Scholar
  39. 39.
    Masters. (1995). The history of action research, In I. Hughes (Ed.), Action research electronic reader, The University of Sydney, on-line (accessed 16/11/06).
  40. 40.
    McIver, S. (1991). Obtaining the views of users of health services. London: Kings Fund Centre.Google Scholar
  41. 41.
    Medical Research Council. (2006)., accessed 17/01/06.
  42. 42.
    Medical Research Council. (2006). MRC Delivery Plan, MRC, London.Google Scholar
  43. 43.
    Morgan, G. (1986). Images of organization. London: Sage.Google Scholar
  44. 44.
    Mooney, G. (1992). Economics, medicine and healthcare. Harvester Wheatsheaf, Hemel Hempstead.Google Scholar
  45. 45.
    Nandy, S., Irving, M., Goron, D., Subramanian, S. V., & Davey Smith, G. (2004). Poverty, child under nutrition and morbidity: New evidence from India. Bulletin of the World Health Organisation, 83(3), 161–240.Google Scholar
  46. 46.
    Nobel Prize. (2006)., accessed 18/1/06.
  47. 47.
    Noffke, S. (1994). Action research: Towards the next generation, Educational Action Research, Vol. 2, No. 1, 1994.Google Scholar
  48. 48.
    Payne, G., Dingwall, R., Payne, J., & Carter, M. (1981). Sociology and social research. London: Routledge and Kegan Paul.Google Scholar
  49. 49.
    Peckham, M. (1996). The scientific basis of health services. BMJ, 313, 1154.Google Scholar
  50. 50.
    Popper, K. R. (1979). Objective knowledge: An evolutionary approach. Oxford: Oxford University Press. Revised edition.Google Scholar
  51. 51.
    Reason P. (Ed.) (1988). Human inquiry in action: Developments in new paradigm research. London: Sage.Google Scholar
  52. 52.
    Redfern, M. (2001). The Report of The Royal Liverpool Children’s Inquiry, Crown Copyright.Google Scholar
  53. 53.
    Research Councils UK. (2006) Research Councils welcome the Budget’s commitment to science, News Release 24th March 2006, ( , accessed 3/7/07).
  54. 54.
    Rose, J., & Haynes, M. (1999). A soft systems approach to evaluation for complex interventions in the public sector. Journal of Applied Management Studies, 8(2), 199–216.Google Scholar
  55. 55.
    Schulze, W. D., & Kneeze, A. V. (1981). Risk in cost benefit analysis. Risk Analysis, 1, 81–88.CrossRefGoogle Scholar
  56. 56.
    Shumsky, A. (1956). Cooperation in action research: A rationale. Journal of Educational Sociology, 30, 180–185.CrossRefGoogle Scholar
  57. 57.
    Smith, J. (2005). The Shipman report. Crown Copyright.Google Scholar
  58. 58.
    Taket, A. (2002). Facilitation: Some contributions to theorising the practice of operational research. Journal of the Operational Research Society, 53, 126–136.CrossRefGoogle Scholar
  59. 59.
    Taket, A., & White, L. (2000). Partnership & participation—decision making in the multiagency setting. Chichester: John Wiley & Sons.Google Scholar
  60. 60.
    Townsend, P., & Davidson, N. (1982). Inequalities in health: The black report. Harmondsworth: Penguin.Google Scholar
  61. 61.
    Ulrich, W. (1983). Critical heuristics of social planning. Berne: Haupt.Google Scholar
  62. 62.
    UNAIDS. (2006). UNAIDS 2006 Report on the global AIDS epidemic, Annex 2: HIV/AIDS estimates and data, 2005.Google Scholar
  63. 63.
    Wadsworth, Y. (1997). Everyday evaluation on the Run, Allen and Unwin, St. Leonards, NSW, (2nd ed.). p. 97.Google Scholar
  64. 64.
    Wadsworth, Y. (1998). What is participatory action research? Action Research International, Paper 2. Available on-line: accessed 2/7/07.
  65. 65.
    Walsh, M. P. (1999). Towards critical quality. In M. Malek, H. Davies, & M. Tavokoli (Eds.), Managing quality: Strategic issues in health care management. London: Ashgate.Google Scholar
  66. 66.
    Walsh, M., & Hostick, T. (2005). Improving health care through community OR. Journal of the Operational Research Society, 56, 193–201.CrossRefGoogle Scholar
  67. 67.
    Waterman, H., Tillen, D., Dickson, R., & De Koning, K. (2000). Action research: A systematic review and guidance for assessment. Health Technology Assessment 2001, 5, 23.Google Scholar
  68. 68.
    Wells, J. S. (2006). Hospital-based industrial therapy units and the people who work within them–an Irish case analysis using a soft-systems approach. Journal of Psychiatric and Mental Health Nursing, 13(2), 139–47.PubMedCrossRefGoogle Scholar
  69. 69.
    White, L. (2003). The role of systems research and operational research in community involvement: a case study of a health action zone. Systems Research and Behavioral Science, 20(2), 133–145.CrossRefGoogle Scholar
  70. 70.
    Whitelaw, S. Beattie, A. Balogh, R. & Watson, J. (2003). A review of the nature of action research, Welsh Assembly Government, Cardiff accessed 16/11/06.
  71. 71.
    Worz, M., & Busse, R. (2005). Analysing the impact of health-care system change in the EU member states–Germany. Health Economics, 14(Suppl 1), S133–49.PubMedCrossRefGoogle Scholar
  72. 72.
    Yang, W., Arii, S., Mori, A., Furumoto, K., Nakao, T., Isobe, N., Murata, T., Onodera, H., & Imamura, M. (2001). sFlt–1 gene-transfected fibroblasts: A wound-specific gene therapy inhibits local cancer recurrence. Cancer Research, 61(21), 7840–7845.PubMedGoogle Scholar
  73. 73.
    Zuber-Skerritt, O. (Ed.) (1991). Action Research for change and development. Aldershot: Avebury.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Department of Management and OrganisationUniversity of StirlingStirlingUK
  2. 2.Centre for Health and Social Care ResearchUniversity of Sheffield HallamSheffieldUK
  3. 3.Department of Organisational LearningHumber Mental HealthWillerbyUK

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