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Title: De invloed van evaluatie door mechanismen op individueel, interpersoonlijk en collectief niveau: Een meervoudige casestudy naar de organisatie van de wachtdiensten van Vlaamse huisartsen.
Authors: Torfs
Keywords: Keywords: evaluation influence, health care organization, process use evaluation, mechanisms
Issue Date: 18-Jun-2014
Publisher: Open Universiteit Nederland
Abstract: Influence of evaluation through mechanisms on individual, interpersonal and collective level: a multiple case study on the guard duty of the Flemish general practitioners. Keywords: evaluation influence, health care organization, process use evaluation, mechanisms During the last decade research towards the organization of healthcare became more important, due to the high costs in healthcare. We will study the KCE (federal knowledge center for healthcare) evaluation ‘Which solutions for the guard duties of the general practitioners?’ (Jonckheer et al., 2011), by looking at the influence of this evaluation on the changes within the general practitioners circles in Flanders. Legally, the responsibility of the organization of the guard duties of the GP’s, and primary health care, is in the hands of the GP-circles. However, our GP-circles face more and more difficulties to meet this obligation, due to ageing GP’s, more female doctors and the safety issues in urbanized areas, which enhances the workload on guard duties. Hence, the GP’s have asked for a solution to these problems. Until recently, literature investigated use of evaluation. Melvin M Mark and Henry (2004, p. 46) take the step to a conceptual model that represents the influence of an evaluation in terms mechanisms. Process use is the base of the concept and involves participative evaluation, collaborative evaluation and authorized evaluation. Henry and Mark (2003, p. 298) divide the mechanisms in three levels: individual, interpersonal and collective. Different mechanisms can play a role in the change process toward the ultimate goal. Based on Johnson et al. (2009), 3 factors came up that were not investigated enough: participation in the decision, participation in the personal characteristics and participation in the information needs; i.e. timeliness of the study, ownership of the information and provided information. The relevant mechanisms of Melvin M Mark and Henry (2004, p. 41) give a pathway that goes from elaboration to changed attitudes (individual level). Therefrom to persuasion and the arising of a change agent (interpersonal level) who will implement a local policy change. (collective level). The interpersonal persuasion will lead to agenda setting. Some GP-circles have participated in the KCE evaluation and collected data; hence this can be called a participative evaluation (process use). The research question is how evaluation through mechanisms on individual, interpersonal and collective level can have an influence on the guard duties of the Flemish GP’s. We will have a multiple case study with 4 research units (GP-circles), having a different participation level. At each GP-circle, the chairman and the GP in charge of guard duties were interviewed. The information from the interviews as well as some documents the GP-circles put at our disposal, was put in an information database per case. Afterwards the 4 databases were put next to each other to be compared. This study revealed that the pathway was only true in some cases. Information for elaboration was not retrieved from the KCE evaluation, which was not timely. Problems with the guard duties were encountered much earlier and GP-circles were forced to search for information in literature and abroad. One GP-circle made a proposal for an organized duty center (ODC) and proposed it to the government for support. They received permission to implement. Immediately the government has supported this initiative financially for all urban GP-circles. Based on the KCE evaluation results some adjusting to the organization of the ODC has been done afterwards. This raises the question whether this was meant to be imposed use of the evaluation. (Weiss, Murphy-Graham, Petrosino, & Gandhi, 2008) Some GP-circles that participated showed an enhanced credibility towards the results of the KCE evaluation, but only there, where they were able to collect data in a structured environment. On a certain moment, there were enough ODC’s and when our last investigated case underwent a change in the organization, they relied more on the information of the nearby GP-circles then on the KCE evaluation, although the results of that evaluation where published by then. (Melvin M. Mark, 2011, p. 113) Henry, G. T., & Mark, M. M. (2003). Beyond Use: Understanding Evaluation’s Influence on Attitudes and Actions. American Journal of Evaluation, 24(3), 293-314. Johnson, K., Greenseid, L. O., Toal, S. A., King, J. A., Lawrenz, F., & Volkov, B. (2009). Research on Evaluation Use a Review of the Empirical Literature from 1986 to 2005. American Journal of Evaluation, 30(3), 377-410. Jonckheer, P., Borgemans, L., Dubois, C., Verhoeven, E., Baudewyns, A.-M., Rinchard, E., . . . Paulus, D. (2011). Welke Oplossingen Voor De Wachtdiensten Van Huisartsen ? Health Services Research (HSR). Brussel. Federaal Kenniscentrum voor de Gezondheidszorg (KCE). KCE Reports 171A. Mark, M. M. (2011). Toward Better Research on--and Thinking About--Evaluation Influence, Especially in Multisite Evaluations. New directions for evaluation(129), 107-119. Mark, M. M., & Henry, G. T. (2004). The Mechanisms and Outcomes of Evaluation Influence. Evaluation, 10(1), 35-57. Weiss, C. H., Murphy-Graham, E., Petrosino, A., & Gandhi, A. G. (2008). The Fairy Godmother—and Her Warts Making the Dream of Evidence-Based Policy Come True. American Journal of Evaluation, 29(1), 29-47.
Appears in Collections:MSc Management Science

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