Hi Janet,
I was also involved in the large systems transformation review Trish
references...one of the keys to that review process in terms of stakeholder
involvement was that we were lucky enough to have the top health bureaucrat
for that jurisdiction (a Deputy Minister) as our principle 'knowledge user'
(Canadian funder parlance). This meant that we had intensive involvement of
staff and a fair amount of confidence that the review would get utilized. I
think that the process of realist reviews can often be rewarding
experiences for stakeholders as they find time to critically reflect on
their own work processes and engage in dialogue with the researchers.
However, one has to be clear about how much engagement is feasible
depending on the level of support from senior management (where that is
relevant)....ideally, of course, you have a situation like we had, but
perhaps more often you have lower levels of support and engagement and this
can cause tensions, particularly when it comes to how useful the review is
in its capacity to help transform the systems that stakeholders are
embedded in. Nevertheless, I think experience is showing that more
determined processes for stakeholder engagement are proving essential
features of realist (and meta-narrative) reviews, and whatever the level of
engagement, some seems better than none!
ps. the character of the engagement process of our review is addressed in
more detail in the article Trish attached.
Cheers, Simon
On Wed, Feb 26, 2014 at 9:11 AM, Janet L Harris <
[log in to unmask]> wrote:
> Hi all
>
> Thanks for these answers. Or ruminations. I'm interested because we just
> completed a review of community engagement that pointed out a basic tension
> between what the researchers and commissioners fund (e.g. empirically
> tested or empirically-valued programme theory) and what the people on the
> ground describe as what-they-actually-do-and-why-it-works (e.g. culturally
> supported programme theory). These were quite different. Leading me to
> wonder wehther we get external [in]validity because stakeholders aren't
> included in the early stages of designing some programmes.
> So - did Trish's originally 'dumb' question actually produce a better
> situated review because the process for formulating the original problem
> not only included the key stakeholders, but had them calling the shots?
> How did Mark's team sort and prioritise stakeholder theories if they
> appeared to differ from what was published (competing epistemologies)?
> Is Soo's review producing competing lists of 'crucial' elements in C and M
> - as well as disagreement about what outcomes matter (we certainly had
> contested Os in our review)
>
> It seems to me in realist reviewing that depending on the topic, these
> process issues might be just as important as what's published.
> So, if that makes sense, it would be good to hear what you think.
>
> All the best
> Janet
>
>
> On 26 February 2014 16:46, Pearson, Mark <[log in to unmask]>wrote:
>
>> Hi all
>>
>>
>>
>> Janet's right to highlight the lack of detail there often is about how
>> stakeholders are involved in reviews. Our realist reviews have done the
>> following:
>>
>>
>>
>> Intermediate Care (service managers, commissioners and practitioners):
>>
>> 1) sharpen the *focus* *of the review* so that it is of relevance to
>> those directly involved in managing or commissioning such services
>>
>> 2) *understand how things actually work*, in a service setting, so that
>> we can explore this further in the literature
>>
>> 3) *shape the presentation* of the review's findings to ensure they are
>> of use to people commissioning and providing services of this type
>>
>>
>>
>> Implementing health promotion programmes in schools (teachers, school
>> health leads, academics):
>>
>> 1) help refine the focus of the review
>>
>> 2) discuss emerging findings
>>
>>
>>
>> So, in realist terms you might say that the stakeholders:
>>
>> · contributed to prioritising and sense-checking of the
>> programme theories to take forward
>>
>> · contributed some of their own programme theories
>>
>> · brought some insight into the fog of contexts by sharing their
>> own experience and knowledge
>>
>> · grappled with what might be the key mechanisms (and with what
>> a mechanism actually might be)
>>
>> · commented on how findings could be presented in a usable form
>>
>>
>>
>> We've found our half-day meetings to always be lively and constructive
>> affairs. This might give the impression that we have somehow got this lark
>> sorted - which we haven't, in my view, by a long long way. But that is why
>> the question Janet asks is so important - we need to share, discuss,
>> improve at it.
>>
>>
>>
>> Hope this is helpful.
>>
>>
>>
>> Mark
>>
>>
>>
>> Mark Pearson PhD
>>
>> PenTAG, University of Exeter Medical School
>>
>> E: [log in to unmask]
>>
>> T: 0044 (0) 1392 726079
>>
>> Twitter: @HSRMarkP
>>
>>
>>
>>
>>
>> *From:* Realist and Meta-narrative Evidence Synthesis: Evolving
>> Standards [mailto:[log in to unmask]] *On Behalf Of *Trish Greenhalgh
>> *Sent:* 26 February 2014 08:52
>> *To:* [log in to unmask]
>> *Subject:* Re: How much do your stakeholders participate?
>>
>>
>>
>> Janet
>>
>>
>>
>> To kick off this brilliant question here's a paper by Best et al
>> (including a cameo part from me), where the team was HIRED by a
>> 'stakeholder' (the state health department) to answer a very specific
>> policy question ("how can we transform the system?"). My own recollection
>> of the process was that I personally thought this was was a dumb question
>> (insufficiently focused, grandiose, slippery) but the 'stakeholder' was in
>> this case the 'client' so we had to knuckle down and answer it. I never
>> thought we'd produce a usable review, let alone one that was published in a
>> major journal and become widely cited. I still wonder if the fights about
>> the "dumb question" were what produced the key creative tension.
>>
>>
>>
>> Trish Greenhalgh
>>
>> Professor of Primary Health Care and Dean for Research Impact
>>
>> Barts and the London School of Medicine and Dentistry
>>
>> 58 Turner St
>>
>> London E1 2AB
>>
>> UK
>>
>> +44 20 7882 7325
>>
>> [log in to unmask]
>>
>> @trishgreenhalgh
>>
>>
>>
>>
>>
>>
>>
>> *From: *Janet L Harris <[log in to unmask]>
>> *Reply-To: *"Realist and Meta-narrative Evidence Synthesis: Evolving
>> Standards" <[log in to unmask]>, Janet L Harris <
>> [log in to unmask]>
>> *Date: *Wednesday, 26 February 2014 07:56
>> *To: *"[log in to unmask]" <[log in to unmask]>
>> *Subject: *How much do your stakeholders participate?
>>
>>
>>
>> Dear All
>>
>> I'm looking for descriptions of how stakeholders are involved in realist
>> review. There seems to be wide variation, and I'm wondering if the process
>> influences the identification of programme theory.. At what points in time
>> are you involving stakeholders, are there key points where you need their
>> input, and what sorts of relationships do you have with them?
>>
>> Would be grateful for any examples.
>>
>> Best wishes
>> Janet
>>
>>
>> --
>> Janet Harris
>>
>> Senior Lecturer & Course Director
>>
>> MPH in International Health Management & Leadership
>>
>> School of Health and Related Research (ScHARR)
>>
>> 30 Regent Street
>>
>> Sheffield S1 4DA
>>
>> England
>>
>>
>>
>> (44) 114 222 2980(44) 114 222 2980
>>
>> Call
>>
>> Send SMS
>>
>> Add to Skype
>>
>> You'll need Skype CreditFree via Skype
>>
>
>
>
> --
> Janet Harris
> Senior Lecturer & Course Director
> MPH in International Health Management & Leadership
> School of Health and Related Research (ScHARR)
> 30 Regent Street
> Sheffield S1 4DA
> England
>
> (44) 114 222 2980
>
