Why Health Services Research Fails to Deliver: Complexity and Context

Abstract

There have been many critiques of health services research. Sometimes it has been called ‘academic,’ meaning not of practical relevance or of only theoretical interest. Another criticism that I have heard (and made) that health services researchers prove the obvious. There are several articles that provide so called ‘lessons learned’ or prove the importance of one factor or another and these have been published in “high impact journals.” Some of the factors associated with implementation success have been known for millennia, e.g., leadership, (see Book of Exodus) and the leader’s vision (see Proverbs 29:18). Health services researchers would be more useful if they looked at how to implement something in the face of poor leadership or how to accomplish things when space is a constraint, i.e., we need to examine more carefully and productively the intervention by context interaction. My perspective about health services research concerning interventions is that it must be closely linked to clinical operations; linking research and system improvement would be a good strategy to both provide the answers and improve quality simultaneously, though it doesn’t always work out that way.