The development of an applied whole-systems research methodology in health and social service research: A Canadian and United Kingdom collaboration

Abstract

This paper provides a description of a 'whole system' research model developed in Canada and adapted for use in the United Kingdom. The model tests the assumption that service utilization across the whole system is driven by a complex mix of psychosocial factors, rather than disease characteristics, of the population and, second, that proactive, integrated and communitybased packages of care are equally or more effective and less expensive than fragmented services. The methodology uses large-scale, cross-sectional surveys of a diverse range of population groups accessing health and social services. Data were collected on measures of psychosocial resource, functional ability and service utilization. The relationship between psychosocial resources, functional ability and service utilization is analysed. This paper describes the research model, the theories informing the model and the application of the model to two diverse population groups: patients with chronic obstructive pulmonary disease and single parents on welfare. The article concludes by acknowledging that multi-agency approaches to evaluation using measures of patient need and healthcare outcomes which do not privilege the contribution of any one agency are required to test the cost-effectiveness of inter-agency working. This paper describes the early experiences of replicating this methodology in a UK context in order to test the findings for their generalizability to that context.