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A Different Way of Thinking about Research

Posted on November 15, 2011

John A. Øvretveit considers how the medical field could benefit from drawing from other fields in exploring a range of different research and evaluation methods.


Well, for better or worse, the title of my job description is Professor of Implementation, Improvement and Evaluation, and at the Karolinska Institutet, which is a kind of high-end medical research university, our unit was set up really to be able to put some of the research into practice.

So a year ago there was a meeting of us from the health sector, implementation and spread research meeting, and then I'd also come across Dean Fixsen's and that group's work, which is largely outside of our sector, but found it very interesting and valuable in the synthesis they did.

Another thing that I've found particularly valuable is, in the medical field, we're very strongly wedded to really high strength of evidence like the hierarchy of evidence, randomized control trials.

So, for example, Cochrane Reviews, you will typically read the conclusion that says, "Well, there's only two good enough quality randomized control trials, and here are the flaws and weakness with those studies, so we really can't say a lot about this particular intervention. More research is needed." And I'm getting fed up with those.

And what I've found is that people from other sectors like child welfare, even prison services, education are more flexible in their approach to a range of different research methods, evaluation methods, and in many ways more innovative or prepared to try out different approaches to doing research and studying these complex programs over time.

And we don't have that history in health so much. Our history and our culture is about randomized control trials of drug treatments that are very inappropriate to a lot of the implementation programs and other things that we're doing here.

So I like looking at the kind of research done in these other fields and sectors to see how they've approached it and the strengths or weaknesses of using those sorts of methods, and we can use some of that thinking, some of those papers, some of their methodology in the kind of research that we're doing on long-term programs.

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Excerpted from interview with Dr. Øvretveit at the 2011 Global Implementation Conference in Washington, DC. Dr. Øvretveit is a professor of implementation, improvement, and evaluation at the Karolinska Institute in Sweden.


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