Exploring the possibility of explicitly combining realist and system thinking: an exemplar

Realist evaluation has gained momentum in the last decade as key mixed methods to understand and engage with socially complex systems. As this interest grows, there is also increasing interest in its possible combination with other complexity oriented approaches. We suggest that the epistemology of Soft System Methodology (SSM), with its focus on constructing models to account for the phenomenon being examined, complements that of realist evaluation, which provides theory driven explanations of what lies beneath complex social programmes. In SSM, models are built and compared to the real world using stakeholders’ descriptions of complex programmes based on structured thinking. Realist evaluation places emphasis on stakeholder engagement to enhance understanding of how complex programmes work. In this presentation, we argue that SSM can support the development of theory driven explanations of complex phenomena. Exemplar: SSM maps were used within a realist evaluation of an Integrated Care Pathway (ICP) for patients with palliative care needs in North East England. In this study, the maps were co-created with service developers and implementers over a series of focus groups in order to visualise and detail the pathway and its varied resources. Chains of causality were hypothesised and tested through qualitative and quantitative data collection. The project provided theory based explanations of how, why and in which circumstances the care pathway was most effective. We conclude that using SSM with realist evaluation can provide; a) a systematic approach to understanding complexity within programmes; b) a framework for stakeholder involvement; c) explicit identification of contextual intricacies. The combination of SSM and realist evaluation presents an innovation in mixed methods research designs, which can serve a key role in advancing understanding of complex social issues. We hope this presentation will stimulate debate and open up the possibilities of explicitly combining realist and system thinking.