How should we evaluate the impacts of policy? The case of Payment by Results and the 18 Week Patient Pathway in English hospitals

Today, qualitative researchers are framing the relationship between qualitative case studies and quantitative evaluation research in positivist terms, seeking dialogue with quantitative researchers on the basis that qualitative case studies hold the potential to develop theory for evaluation programmes and to improve the quality of quantitative research. In the UK health policy literature, however, recent evaluations of major government programmes of reform have been conducted under largely quantitative and econometric strategies involving baskets of indicators, or routinely collected hospital statistics, set against the central stated aims of the programme: namely, to improve quality, efficiency, responsiveness, output and equity. For the wider evaluation literature, we detail the results of a qualitative case study of the impact of two key reforms, the 18 Week Patient Pathway and Payment by Results, on four English hospitals, demonstrating the value of the positivist frame to evaluation research based on its capacity to improve understandings of cause and effect and to direct quantitative researchers towards better measures and data sets. For the UK health policy literature, we demonstrate the value of qualitative case studies to the policy process in terms of their potential to reduce the risks for serious policy mistakes.