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Gabriel M. Leung, Improving Health Services. Background, Method and Applications, Journal of Public Health, Volume 37, Issue 2, June 2015, Page 353, https://doi.org/10.1093/pubmed/fdu020
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Walter Holland is an indisputable giant in health services research (HSR) in the UK, a field that has flourished for much of the past half century. He is therefore eminently qualified to write what is essentially an autobiography of the field as reflected through the work of his unit at St Thomas'.
At 238 pages, the compact volume is very readable in one sitting, even for the HSR novice. It is part historical archives, part standard introductory text, but above all a gripping account of how HSR has weathered the ebbs and flows of the larger socioeconomic transformations of the National Health Service, and writ large Whitehall and Westminster since 1962. At that the book is completely UK centric, or even specific to England mostly, save for a short comparative chapter with the USA at the beginning.
Understanding the background to the rise of a nascent field is useful, although HSR at 50+ has begun to show signs of a middle-age identity, if not altogether existential, crisis. Disrupting the balance and entering the ecoscape as potential substitutes have been the quantitative scientists specifically economists, modellers, operations researchers and statisticians. Coupled with the tendency towards ‘Fordism’ in disaggregating and perfecting component parts of the research enterprise generally, which is per se an inevitable and positive development to do better science, HSR as a generalist discipline grounded in applying the first principles of epidemiology, biostatistics and clinical decision analysis has been feeling the squeeze.
Holland acknowledges few of these concerns, rather highlights more content-specific and practical challenges for the future along the same vein of classical HSR. To this author at least, there remains a necessary niche for the type of HSR as described and done by Holland at St Thomas', but methodological innovations from other disciplines must be proactively incorporated into the framework of engagement in order for the field to continue thriving.
A series of companion volumes describing HSR, or as American readers will call it, health policy and management, in other health systems with a different context will benefit students of the subject everywhere. In population health, the organizing unit is the underlying system and only through comparative examination can we learn from the errors that others have made along the way and that we can and should hopefully avoid.