Abstract
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.
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References
Aaron, H. J. (2002). The unsurprising surprise of renewed health care cost inflation, Health Affairs, web exclusive, http://content.healthaffairs.org/cgi/content/full/hlthaff.w2.85v1/DC1 accessed 16/11/06.
Ackoff, R. (1981). Creating the corporate future. New York, NY: Wiley.
Altrichter, H., Kemmis, S., McTaggert, R., & Zuber-Skerrit, O. (2002) The concept of action research. The learning organisation, 9(3), 125–131.
Boddenheimer, T (2005). High and rising health care cost. Part 1: seeking an explanation. Annals of Internal Medicine, 142(10), 847–854.
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.
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.
Burrell, G., & Morgan, G. (1979). Sociological paradigms and organizational analysis. London: Heineman.
Chalmers, I. (1990). Underreporting research is scientific misconduct. Journal of the American Medical Association, 263, 1155–1156.
Checkland, P. B., & Scholes, J. (1990). Soft systems methodology in action. Chichester: Wiley.
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, http://www.parliament.the-stationery-office.co.uk/pa/cm199900/cmhansrd/vo000704/halltext/00704h01.htm, accessed 16/11/06.
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, http://www.healthcarecommission.org.uk/_db/_documents/04005371.pdf (accessed 3/7/07).
Darwinian. (2002). Darwin Dons Hit Tabloids, The Darwinian (newsletter of Darwin College), Autumn.
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.
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.
Department of Health. (2005). Feedback on annual report for user centred NHS research programme RWA (RV9) 2004–2005.
Department of Health. (2006). Best research for best health. A new national health research strategy, Department of Health, London.
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).
Dick, B. (2000). Soft systems methodology. Session 13 of Areol—action research and evaluation on line. http://www.scu.edu.au/schools/gcm/ar/areol/areol-session13.html, accessed 6th August 2006.
Friend, J, & Hickling, A. (1997). Planning under pressure—The strategic choice approach (2nd ed.). Oxford: Pergamon Press.
Grant, G, & Ramcharan, P. (2006). User involvement in research. In K. Gerrish, & A. E. Lacey (Eds.), The research process in nursing. Oxford: Blackwell.
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.
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.
Hammersley, M. (2004). Action research: A contradiction in terms? Oxford Review of Education, 30(2), 165–181.
Hart, E., & Bond, M. (1995). Action research for health and social care. Buckingham: Open University Press.
Helman, C. (1990). Culture, health and illness. London: Wright.
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.
Illich, I., Zola, I., McKnight, J., Caplan, J., & Shaiken, H. (1977). Disabling professions. London: Marion Boyers Publishers Ltd.
INVOLVE (1991) http://www.invo.org.uk/History.asp Accessed 31/05/06.
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.
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.
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)).
Kohles, M. K. (1997). Redefining management through redesign of patient care delivery systems. Seminars For Nurse Managers, 5(1), 39–48.
Kosa J., Antonovsky A., & Zola K. (1969). Poverty and health: A sociological analysis. Cambridge, Mass: Harvard University Press.
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.
Leonard, H., Eastham, K., & Dark, J. (2000). Heart and heart-lung transplantation in Down’s syndrome. BMJ, 320, 816–817.
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.
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.
McTaggart, R. (1992). The action research planner. Victoria: Deakin University Press.
Masters. (1995). The history of action research, In I. Hughes (Ed.), Action research electronic reader, The University of Sydney, on-line http://www2.fhs.usyd.edu.au/arow/o/m01/reader.htm (accessed 16/11/06).
McIver, S. (1991). Obtaining the views of users of health services. London: Kings Fund Centre.
Medical Research Council. (2006). http://www.mrc.ac.uk/index/about/about-mission.htm, accessed 17/01/06.
Medical Research Council. (2006). MRC Delivery Plan, MRC, London.
Morgan, G. (1986). Images of organization. London: Sage.
Mooney, G. (1992). Economics, medicine and healthcare. Harvester Wheatsheaf, Hemel Hempstead.
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.
Nobel Prize. (2006). http://nobelprize.org/search/all_laureates_c.html, accessed 18/1/06.
Noffke, S. (1994). Action research: Towards the next generation, Educational Action Research, Vol. 2, No. 1, 1994.
Payne, G., Dingwall, R., Payne, J., & Carter, M. (1981). Sociology and social research. London: Routledge and Kegan Paul.
Peckham, M. (1996). The scientific basis of health services. BMJ, 313, 1154.
Popper, K. R. (1979). Objective knowledge: An evolutionary approach. Oxford: Oxford University Press. Revised edition.
Reason P. (Ed.) (1988). Human inquiry in action: Developments in new paradigm research. London: Sage.
Redfern, M. (2001). The Report of The Royal Liverpool Children’s Inquiry, Crown Copyright.
Research Councils UK. (2006) Research Councils welcome the Budget’s commitment to science, News Release 24th March 2006, ( http://www.rcuk.ac.uk/news/20060324budget.htm , accessed 3/7/07).
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.
Schulze, W. D., & Kneeze, A. V. (1981). Risk in cost benefit analysis. Risk Analysis, 1, 81–88.
Shumsky, A. (1956). Cooperation in action research: A rationale. Journal of Educational Sociology, 30, 180–185.
Smith, J. (2005). The Shipman report. Crown Copyright.
Taket, A. (2002). Facilitation: Some contributions to theorising the practice of operational research. Journal of the Operational Research Society, 53, 126–136.
Taket, A., & White, L. (2000). Partnership & participation—decision making in the multiagency setting. Chichester: John Wiley & Sons.
Townsend, P., & Davidson, N. (1982). Inequalities in health: The black report. Harmondsworth: Penguin.
Ulrich, W. (1983). Critical heuristics of social planning. Berne: Haupt.
UNAIDS. (2006). UNAIDS 2006 Report on the global AIDS epidemic, Annex 2: HIV/AIDS estimates and data, 2005.
Wadsworth, Y. (1997). Everyday evaluation on the Run, Allen and Unwin, St. Leonards, NSW, (2nd ed.). p. 97.
Wadsworth, Y. (1998). What is participatory action research? Action Research International, Paper 2. Available on-line: http://www.scu.edu.au/schools/gcm/ar/ari/p-ywadsworth98.html accessed 2/7/07.
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.
Walsh, M., & Hostick, T. (2005). Improving health care through community OR. Journal of the Operational Research Society, 56, 193–201.
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.
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.
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.
Whitelaw, S. Beattie, A. Balogh, R. & Watson, J. (2003). A review of the nature of action research, Welsh Assembly Government, Cardiff http://www.cmo.wales.gov.uk/content/work/sharp/action-research-lit-review-e.pdf accessed 16/11/06.
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.
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.
Zuber-Skerritt, O. (Ed.) (1991). Action Research for change and development. Aldershot: Avebury.
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Walsh, M., Grant, G. & Coleman, Z. Action Research—a Necessary Complement to Traditional Health Science?. Health Care Anal 16, 127–144 (2008). https://doi.org/10.1007/s10728-007-0064-6
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DOI: https://doi.org/10.1007/s10728-007-0064-6