Improving Health Services

Improving Health Services

Background, Method and Applications

Walter Holland

This insightful book describes how Health Services Research (HSR) can be developed and used to evaluate, advance and improve all aspects of health services. It demonstrates the need for good HSR to avoid the continuation or development of ineffective or cost-inefficient services.

Chapter 8: Key questions

Walter Holland

Subjects: economics and finance, health policy and economics, politics and public policy, public policy, social policy and sociology, health policy and economics


Many difficulties arise in the conduct of HSR. One fundamental problem is how to ensure that those involved in commissioning such research and implementing its findings fully understand its nature – what it can and cannot do. Researchers in this field are equipped to tackle precise rather than general questions.On the matter of manpower substitution, for example, those involved in policy formulation might want to know whether nurses could be used instead of doctors in the primary care setting. This question is far too vague and general to form a productive avenue for research. A nurse would be well equipped to deal with some primary care contacts, such as minor injury or simple triage of abdominal pain in a child. But that nurse might not be able to decide whether the abdominal pain required laparotomy or was indicative of acute appendicitis. So the research question must be specific – can nurses rather than doctors be used to handle patients with respiratory tract problems or with abrasions, and what back-up is required for them to be able to identify, for example, a serious fracture underlying an abrasion? Since the number of questions asked is infinite, it is crucial that the researcher is involved in determining the objective of a piece of research.

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