Naturalistic approaches to health care evaluation: the case of a teenage cancer unit

The commitment of the NHS to pursue clinical excellence and to make more overt decisions concerning the funding of services has precipitated a raft of quality initiatives, including the establishment of National Service Frameworks, the National Institute for Clinical Excellence and the Commission for Health Improvement. Integral to the functioning of these bodies is the availability of evidence concerning the effectiveness of treatments/services/strategies. Within this climate, evaluation research takes on an increasingly important role. Traditional evaluations are based on experimental methodologies, but other approaches embedded in the naturalistic/interpretative paradigm have been proposed. These latter approaches purport to capture 'process' rather than just outcome, encompass pluralistic stakeholder viewpoints, and provide in-depth 'rich' descriptions of context. This paper discusses naturalistic evaluations using, as an example, an evaluation of a teenage cancer unit. It concludes that, despite having drawbacks, naturalistic evaluations have a valuable role to play in health service research