Thinking Beyond Measurement, Description and Judgement: Fourth Generation Evaluation in Family-Centered Pediatric Healthcare Organizations

Abstract

Background: Although pediatric healthcare organizations have widely implemented the philosophy of family-centered care (FCC), evaluators and health professionals have not explored how to preserve the philosophy of FCC in evaluation processes. Purpose: To illustrate how fourth generation evaluation, in theory, could facilitate collaboration between evaluators and families and uphold the philosophy of FCC in evaluation. Exploration focuses on describing the ways in which fourth generation evaluation is consistent with FCC and outlining a strategy for implementing it within pediatric healthcare organizations. Discussion: Current evaluation practices used in healthcare organizations reflect what some describe as the first three generations of evaluation: measurement-, descriptive-, and judgment-oriented evaluation. While these generations encourage evaluators and health professionals to use systematic and rigorous approaches and techniques, they negate opportunities to explore issues that may surface in more flexible evaluation processes and do little to promote FCC in evaluation. Fourth generation evaluation is based on the constructivist paradigm, and its hermeneutic dialectic process moves beyond these generations, as well as the problems associated with them, to reflect the FCC notions of family participation, partnership, collaboration, respect, and joint decision-making. Conclusion: The collaborative and dialogue-oriented environment of pediatric healthcare organizations provides an ideal context for fourth generation evaluation. Although this evaluation approach is consistent with the philosophy of FCC, more research is required to understand the strengths and limitations of using it in these organizations.Keywords: family-centered care; pediatrics; fourth generation evaluation; constructivist paradigm