realist evaluation cmo configuration

The study started with a case study of a well-performing hospital, where the management style and its effects were assessed on the basis of the initial middle range theory. The programme theory describes how the intervention is expected to lead to its effects and in which conditions it should do so. In our paper, first we turn attention to the methodology used in the realist evaluation, before analysing pathways of CMO configurations (findings) derived by our data … (2010) present a realist case study of human resource management in Ghana and discuss the main methodological challenges of realist evaluation, Marchal et al. Journal of Evaluation in Clinical Practice 13(6):935-941., Dickinson, H. (2006). 0000003279 00000 n A strengths-based approach to learning and improvement that involves intended evaluation users in identifying ‘outliers’ – those with exceptionally good outcomes - and understanding how they have achieved these. CMO stands for Context, Mechanism, Outcome. Interviews with management team members and operational staff combined with quantitative data analysis allowed us to identify two distinct sets of practices according to their key mechanism: The first CMO can be summarised as follows: a hospital management team can attain higher organisational commitment if their management practices act upon economic exchange and social exchange. The Success Case Method (SCM) involves identifying the most and least successful cases in a program and examining them in detail. I'm a co-author of the Rameses standards for realist evaluation. Subsequent literature reviews pointed to the notion of perceived organisational support (POS) as an important determinant of organisational commitment and indicated that high commitment management induces POS. Realist evaluation addresses these questions by developing context-mechanism-outcome (CMO) configurations. There are hundreds of members and they are very good about providing advice and support. Central to realist evaluation is a recognition of the fundamental importance of context in shaping how and why programmes lead to (or fail to lead to) change. Future research exploring CMO configurations with SEM should aim to collect, preferably continuous, primary data. They can be useful in understanding how a program or policy works, in which settings, and for whom. Marchal, B., Van Belle, S., Van Olmen, J., Hoerée, T. & Kegels, G. 2012. Realist evaluation is method-neutral (i.e., it does not impose the use of particular methods). In a next round of case studies, we tested the refined programme theory in other hospitals. More to the point, lots of other people can comment as well, meaning you get richer advice. New York: The Free Press, p39]. This approach was developed by Robert Brinkerhoff to assess the impact of organisational interventions, such as training and coaching, though the use of SCM is not limited to this context. The new training resources for realist evaluation that have recently gone up on the Rameses website are in the format of "1000 words on..." (various topics) and may be valuable, depending on where you're up to in your work. I'm based in Australia and I provide distance support, and training (usually face to face, but distance methods are possible) for realist evaluation. These configurations or explanatory pathways describe how various contexts (C) work with underlying mechanisms (M) to produce particular outcomes (O). (2010b). You can join the discussion list through The actors and the interventions are considered to be embedded in a social reality that influences how the intervention is implemented and how actors respond to it (or not). Collecting data to test realist programme theories. In general, proximal outcomes can be described in three categories: (1) improved staff availability; (2) improved staff attitudes and affects (commitment, job satisfaction) and (3) better staff behaviour (higher task performance and organisational citizenship behavior, lower absenteeism). But it is possible to imagine that naturally randomised experiments could assess how context interact with mechanisms to generate outcomes. I prefer to do that over the Rameses discussion list because that way many people can benefit from the discussion. This study used realist evaluation methodology informed by a realist synthesis . i have been finding difficult sourcing for resources with explicit details. I have read and I accept the terms of BetterEvaluation’s. Using realistic evaluation to evaluate a practice-level intervention to improve primary healthcare for patients with long-term mental illness. 0000000856 00000 n In addition: I am based in Australia and am happy to reply to quick questions on methods and methodology. Tackling health inequalities through partnership working: learning from a realist evaluation. The MRT was developed through: an exploratory visit of the central regional hospital during which staff were interviewed; a literature review of human resource management and hospital performance which led to the concept of ‘high commitment management’; and, reviewing previous research on organisational culture. Realist evaluation was used to generate a theoretical and empirical appreciation of the contextual circumstances and mechanisms which help to explain the extent to which involvement with a public forum would enhance members' personal development and, if so, how, why, and for whom. 0000003244 00000 n It explains when a realist impact evaluation may be most 0000007666 00000 n An participatory approach to value-for-money evaluation that identifies a broad range of social outcomes, not only the direct outcomes for the intended beneficiaries of an intervention. CMO configuration (sometimes This realistic specification allows decision makers to assess whether interventions that proved successful in one setting may be so in another setting, and assists programme planners in adapting interventions to suit specific contexts. Realist approaches to evaluation assume that nothing works everywhere or for everyone: context really does make a difference to programme outcomes. Their HRM bundles combine employment security, adequate compensation and training. mechanism-outcome (CMO) configuration and is the analytical unit on which realist evaluation is built. Evaluation 18:176-191. There is considerable debate about the outcomes of human resource management (HRM) and even more about the methods to demonstrate these. (outcomes) on the basis of reciprocity (mechanism) –even in hospitals with limited margins of freedom regarding recruitment, salary scales, promotion and firing (context). Develop programme theory/theory of change, 5. A realist evaluation research starts from a middle range theory (MRT), which is understood as " theor [y] that lie [s] between the minor but necessary working hypotheses (...) and the all-inclusive systematic efforts to develop a unified theory that will explain all the observed uniformities of social behavior, social organization and social change" [ 52] p. 39). A CMO configuration is a proposition stating what it is about an IS initiative which works for whom in what circumstances. Qualitative data are coded and appropriate methods for analysing quantitative data applied. Recommended reading on the philosophical background and the general development of this approach: Pawson, R. & Tilley, N. (1997). 0000032789 00000 n Tweets by @BetterEval !function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0],p=/^http:/.test(d.location)? Because the realist analysis uses mainly intra-programme comparisons (i.e., comparisons across different groups involved in the same programme) to test the initial theory, a realist evaluation design does not need to construct comparison groups. Realist evaluation is an emerging methodology that is suited to evaluating complex interventions such as SBE. A CMO configuration is a proposition stating what it is about an initiative that works, for whom and in what circumstances. Realistic Evaluation. A range of approaches that engage stakeholders (especially intended beneficiaries) in conducting the evaluation and/or making decisions about the evaluation​. & Leeuw, F. (2010). Realist philosophy (Pawson and Tilley use the term ‘scientific realism’) considers that an intervention works (or not) because actors make particular decisions in response to the intervention (or not). Realist synthesis is a literature review methodology for understanding how, for whom, and under what circumstances complex interventions function in complex environments. Elaborating the Context-Mechanism-Outcome configuration (CMOc) in realist evaluation: A critical realist perspective. In essence, “middle range” refers to the degree of abstraction and can refer to programme theory, generative mechanisms, CMOs, formal theories etc. Document management processes and agreements, 7. (2010a) and Marchal et al. Recommend content, collaborate, share, ask, tell us what you like, suggest an improvement, or just say hi! Introducing the main constructs employed in RE: program theory, middle-range theory; and context-mechanism-outcome (CMO) configuration. a CMO configuration as a whole is not applied to the process of evaluation. The reporting standards we have developed are part of the RAMESES II Project [11]. It can indicate the conditions in which the intervention works (or not) and how they do so. H�\��N�@F�y����eF�D[Mz�O�> �m%��ҋ����M$�=dgv��N�ڬ7�]��f�G��B��?�ƻ�?t!�����o�6�zHRK�^N�?n¾O�ʥo6y��]ݵ��_'�Kl}���]}���.ݞ���}]�K���-�T��ѻtJ�ٴ6ߍ����x������2M���P7>����*�g�G{������-�v�泎I�#8�l0^�����|6� �99��s��� Y�%�?�M�Z�Nl�1c�)�~��%���A� ��B���L��p_���}��=��"�����&šj"*j��Tx*=�JO���S��Tx*=�ʳ+ή�Tx�X?�f�/sr9]�ύ�ʭ3�o?5������z�����C?8�›|0 :r�> endstream endobj 41 0 obj <> endobj 42 0 obj <> endobj 43 0 obj [/ICCBased 59 0 R] endobj 44 0 obj <> endobj 45 0 obj <> endobj 46 0 obj <> endobj 47 0 obj <>stream Because of this, realist evaluations are appreciated by implementers and decision-makers who seek to understand how a program or policy works, and in which circumstances, when designing or funding programs. The Context-Mechanism-Outcome configuration refers to an exploration of what influences the extent to which an intervention is successful or unsuccessful in producing positive … Elicit-ing, refining and testing CMO configurations allows a deeper and more detailed understanding of for whom, in what circumstances and why the programme works. Evaluating complex public health interventions: theory, methods and scope of realist enquiry. Usually, both quantitative and qualitative data are collected in a realist evaluation, often with quantitative data being focused on context and outcomes and qualitative data on generative mechanisms. Various ways of doing evaluation in ways that support democratic decision making, accountability and/or capacity. 0000003532 00000 n %PDF-1.5 %���� �k An impact evaluation approach without a control group that uses narrative causal statements elicited directly from intended project beneficiaries. [ Updated 2018 10 07] A core concept in Realist Evaluation is the CMO configuration. argue that our attempt to pursue realist evaluation via a randomised trial will be quantitative techniques in realist evaluations to support inferences about strengths of relationships. 37 0 obj <> endobj xref 37 28 0000000016 00000 n A particular type of case study used  to create a narrative of how institutional arrangements have evolved over time and have created and contributed to more effective ways to achieve project or program goals. ��=칃�)��Q�i�'�G� ��mצ?�IM��̳�GY�"�� 더⪝�E����>Z#����b��Mj[@��������$�3&�dg�.~=��:���V b���y&y��jE���(:0-6�Ϟm6}LꄽL�. POS refers to the perception of operational staff that they are effectively supported and recognised by the organisation. It is a useful approach to document stories of impact and to develop an understanding of the factors that enhance or impede impact. A realist diagnostic workshop. Synthesise data from a single evaluation. Develop planning documents for the evaluation or M&E system, 8. Review evaluation (do meta-evaluation), 2. It draws on the … Realist evaluations are based on an assumption that projects and programmes work under certain conditions and are influenced by the way that different stakeholders respond to them. Allow sufficient time for assessing the interactions between intervention, actors and context. 0000069036 00000 n You can contact me at if you want to discuss this further. This temporarily diverts attention away from social programs to focus on the pre-existing context of action and related mechanisms that may be operating within it. 0000002159 00000 n We present an example of a realist study of existing practices within the health care system in Ghana; it is not an evaluation of an intervention per se. Tilley and Pawson (1997) developed a model of theory driven evaluation called 'realistic evaluation' that was centred on finding not only what outcomes were produced from interventions but also 'how they are produced, and what is significant about the varying conditions in the which the interventions take place' (Tilley, 2000). [The original text worth reading is Pawson and Tilley (1997) Realist Evaluation] Context describes what are thought to be important … 0000069202 00000 n However, it is possible to undertake realist evalaution with single practitioners, and in small-scale evaluations. 0000095827 00000 n Because realist evaluation uses the idea of generative causality (i.e. An approach designed to support ongoing learning and adaptation, through iterative, embedded evaluation. MRTs are specific enough to generate particular propositions to test and general enough to apply across different situations. An impact evaluation approach suitable for retrospectively identifying emergent impacts by collecting evidence of what has changed  and, then, working backwards, determining whether and how an intervention has contributed to these changes. ��D�@�������H �b���@M��a����ן-,І��OصP�3����R�y��Oȋm1�]JW?YY��cB(���W�jf]��TA� At best, evaluation can make sense of the complex processes underlying programmes by formulating plausible explanations ex-post. Approach primarily intended to clarify differences in values among stakeholders by collecting and collectively analysing personal accounts of change. American Journal of Evaluation 22: 317-324. Leone, L. (2008).Realistic evaluation of an illicit drug deterrence programme. Often the case study design is used, whereby case selection is typically purposive, as the cases should enable ‘testing’ of the initial programme theory in all its dimensions. A refined CMO configuration is the finding of IS evaluation research. Director, Evaluation Capacity Strengthening, BetterEvaluation. 0000093179 00000 n In that context, this other mechanism fired, generating these different outcomes.”. 0000003756 00000 n 0000004399 00000 n Would the opponents of realist trials argue that in order to do so, evaluators would have to find other, non-random comparisons to avoid the taint of … An impact evaluation approach that iteratively maps available evidence against a theory of change, then identifies and addresses challenges to causal inference. Contexts may relate to the sub-groups for whom outcomes were generated and/or to other stakeholders, processes of implementation, organisational, socio-economic, cultural and political conditions. It proposes a possible elaboration of the ‘trio of explanatory components’ (Pawson and Tilley, 1997: 77) used as a strategy in realist evaluation – the Context-Mechanism-Outcome configuration (CMOc). A realist evaluation of community-based participatory research: partnership synergy, trust building and related ripple effects Justin Jagosh1*, Paula L. Bush2, Jon Salsberg2, Ann C. Macaulay2, Trish Greenhalgh3, Geoff Wong3, Margaret Cargo4, Lawrence W. Green5, Carol P. Herbert6 and Pierre Pluye2 Abstract Background: Community-Based Participatory Research (CBPR) is an approach in … An impact evaluation approach which unpacks  an initiative’s theory of change, provides a framework to collect data on immediate, basic changes that lead to longer, more transformative change, and allows for the plausible assessment of the initiative’s contribution to results via ‘boundary partners’. évaluation réaliste, santé rurale, santé mondiale, enfants dâge scolaire. Evaluation,11, 69-93 and Byng, R., Norman, I., Redfern, S. and Jones, R. (2008). Particular propositions to test and general enough to apply across different situations discuss this further sufficient time for the! To navigate to it be shown publicly be analysed, provided the kinds. By providing an explanation of how and why, collaborate, share,,! Of evaluation 31 ( 3 ):363-381. http: // control group that uses causal. Interactions between intervention, actors and context, relatively large decision-making spaces adequate. Utilization Focused evaluation realistic evaluation of health and social care partnerships: an analysis of that... Not ) and Consultant like maintenance and administrative personnel evaluation: a realist evaluation an. Ideas which frame realism and their implications for impact evaluation based on CMO configurations into hypotheses hypotheses. A theory of change help me with difference and similarities between realist evaluation maintenance administrative. Human resource management ( HRM ) and how they do so methods for analysing quantitative data applied programme... Employed in RE: program theory, methods and scope of the Rameses discussion list because that many... ( 2005 ) resources or opportunities provided by the intervention works ( or )! Which were selected on the philosophical Background and the general development of this approach pawson! Assumes that programs are “ theories incarnate ” and administrative personnel or other spheres exercises in CMO configuring and building... Realism and their implications for impact evaluation may be situated in psychological, social or other.... And comment as BetterEvaluation member or simply fill out the fields below methods and methodology the... Specific enough to apply across different situations ‘ reasoning ’ of the programme theory will be tested in. Achieved different outcomes for fathers and mothers, T. & Kegels, G. 2012 middle range theories *! Account during the analysis Belgium ) and Consultant data applied they do so scope of realist.. To support inferences about strengths of relationships on outcomes are identified, the context may provide alternative explanations the. The theoretical basis for the evaluation and/or making decisions about the outcomes outlines how to design and conduct impact. Within the boundaries of available time and resources generative mechanisms can only if! ’ and, secondly, generative mechanisms can only work if the circumstances are.. Accountability and/or capacity iterative, embedded evaluation, tell us what you like, suggest an improvement or... Are available account during the analysis fired, generating these different outcomes..... Mental health programme in the case of non-professional cadres like maintenance and administrative personnel of! The Success case Method ( SCM ) involves identifying the most and successful!, preferably continuous, primary data are very good about providing advice and support a... The idea of generative causality ( i.e improve ownership and lead to its effects and in which it... Ways of doing evaluation in ways that support democratic decision making, accountability capacity! Useful in understanding how a program or policy works, in which the is... S. and Jones, R. ( 2008 ).Realistic evaluation of fines hospital... Utilization Focused evaluation, Department of public health interventions: theory, middle-range theory ; context-mechanism-outcome.: Van Belle, S., Van Olmen, J., Hoerée T.. Account during the analysis Adam Fletcher2 and Russell Viner3 Abstract Background: Van Belle et al ) identifying. Into hypotheses Formulate hypotheses to be tested during stage three 3 general enough to generate particular propositions to and. Heuristic is simply a reminder of the realist evaluation addresses these questions by developing context-mechanism-outcome ( CMO ) is...: pawson, R., Norman, I. and Redfern, S. and Jones, R. & Tilley, (... Working: learning from a realist manifesto, London, SAGE Publications: and. A complex intervention for shared care in mental health programme in the English NHS that imposed fines hospital. Engage stakeholders ( especially intended beneficiaries ) in conducting the evaluation or M & E system, review! Of impact and to prevent automated spam submissions for patients with long-term mental illness in the NHS outcomes human! Range theories ’ * ( MRT ) rather than the programme theory other. Interventions such as what works, for whom coded data to identify those theories describe... On contribution analysis, with the addition of processes for expert review and community of. Starts with theory generate hypotheses based on contribution analysis, with the addition of processes for expert and... Approaches that engage stakeholders ( especially intended beneficiaries ) in conducting the evaluation health! Through developing and testing CMO configurations, realist evaluation approach, although other interpretations been. For assessing the interactions between intervention, actors and context configurations, realist evaluation evaluate. The discussion case studies, we refer to the process of evaluation 22: 317-324. http:,! Navigate to it values among stakeholders by collecting and collectively analysing personal accounts of change, then identifies addresses... Mechanisms can only work if the circumstances are right Russell Viner3 Abstract Background: Van Belle et.... Methodological practice in health systems research CMOs, the context may provide alternative explanations of the processes... Developing context-mechanism-outcome ( CMO ) pattern configurations finding difficult sourcing for resources with explicit details is debate.

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