Evaluating Healthcare Reform: The Challenge of Evaluating Changing Policy Environments

Evaluators in the health sector struggle to develop effective mechanisms with which to evaluate healthcare reform programmes. Evaluation of these programmes is difficult because they are entangled in complex, inherently political processes and often shift away from their original aims and objectives as a result of policy changes within the health system. This article describes the evaluation of a healthcare reform process occurring in South Australia and discusses some of the methodological challenges encountered in evaluating a case study of continuous change with shifting policy objectives. It describes how the evaluators have attempted to address these challenges through a flexible and dynamic action-research approach. The article concludes by discussing the role of the evaluator, as intelligent observer, in reflecting on and documenting change in the highly political and complex field of healthcare reform.