News blog readers will know that I have argued strongly that intervention descriptions should not be highly detailed, nor try to describe all the things that will have to happen for the intervention to work. [1] I have argued this on the following grounds. First, it is quixotic to pretend that all the essential components or ingredients can be identified in advance, as though intervening in complex services is like following a recipe. Second, the intervention components that are necessary are eclectic, varying by context. Thirdly, overly prescriptive interventions are disempowering and fail to exploit local knowledge and insights.

We have argued for a more disciplined approach based on the essence of the intervention. That is to say, the essential or critical ingredients of the intervention theory should be identified and promulgated. These critical features should, of course, be described in detail. For example, in the case of a financial incentive, the factors that would trigger the incentive payment and its quantum should be specified.

Powerful endorsement of this point of view now comes from the Health Foundation.[2] Their recent report seeks to loosen the description of an intervention by focusing less on specifying the details of each component and more on the need for adopters to formulate their own versions for their own setting. This conclusion is based on interviews with adopters around the world, who do not generally favour a prescriptive approach. The ability to intervene is the managers’ stock in trade. Let’s get rid of this detailed description and replace it with a description of the necessary detail.

Richard Lilford, ARC WM Director

References:

1. Lilford RJ. Health Service and Delivery Research – a Subject of Multiple Meanings. NIHR CLAHRC West Midlands News Blog. 30 November 2018.
2. Greszczuk C. Implementing Health in All Policies. London, UK: Health Foundation; August 2019.