International Journal of Integrated Care, 20 August 2008 - ISSN 1568-4156
Book review
Evaluating outcomes in health and social care (Better partnership working series)
Helen Dickinson
Bristol: The Policy Press, 2008, pp 126,
ISBN 978 1 847420343
Lia Donkers, Physician Community Medicine, Director of St. Transmuraal Network Midden-Holland, PO Box 1098, 2800 BB GOUDA, The Netherlands

This book provides an introduction to Evaluation of the Outcomes of Partnership. Three words, three mysteries. The author succeeded in unravelling these mysteries into useful frameworks. Therefore, this book is relevant for people involved in integrated care. It is aimed at students, practitioners, managers and policymakers in health and social care. The book is the fifth part of an overall series about better partnership working, but can be used as a guide on its own. The author and publisher are university based. According to them it is as easy to argue the benefits of partnership as it is for those of mother love and apple pie.

The preface introduces the role of partnership in present day health and social care. Services need to work together because people do not live their lives according to the categories the care systems have created. Real life problems are nearly always harder to define and more difficult to resolve than one service can manage. So partnership is not an option, it is core business. Up till now it has not yet been clarified whether partnership really improves service user outcomes. We do know, however, that a lack of effective partnership can be a matter of life and dead. In the past years almost every country has been confronted by a deadly case of child abuse while several surveillance services were in charge. Research showed a blind failure due to confusion and conflict between the organisations.

Chapter one explores the key contours and debates around outcomes and methods of evaluation. Outcomes became more important because today's decision makers and care consumers ask for accountability rather than for ideology. The author illustrates the changes of attitudes to performance measurements by referring to a new paradigm, in the UK known as the new public management (NPM). Chapter two describes some measurable aspects of partnership in order to evaluate its achievements. Unfortunately there is no definition what partnership is and why it exists. Collaboration and partnership are not underpinned by one encompassing theory. Clarity about partnership drivers such as necessity, efficiency, reciprocity, can serve as indicators to measure outcomes. Chapter three identifies the main topic of the book: how best to evaluate partnership? The author lists examples, strengths and limitations of the classic designs of evaluation as method-led approaches. To evaluate multifaceted issues there is a preference for a theory-led approach such as Theories of Change (ToC). ToC is prospective with the evaluator involved in an iterative and ongoing process with those being evaluated. This approach offers a more accurate view of what is happening within partnership but is very process-based. The next step is to evaluate whether partnership produces better services. Little is known about the effect of partnership on clinical and functional indicators, independent living, service user satisfaction, referral rates, speed, source and eligibility criteria. Chapters four and five provide us with useful frameworks and practical recommendation for policy and practice based on what has been said in the previous chapters.

This book is of great value for practical professionals working with other agencies because it starts by describing the look and feel of partnership. For many people partnership is a natural but complex thing to do. By illuminating underlying notions and concepts the author makes partnership more understandable. The book encourages investigation of why we do things in the way we do. To me it is slightly too ambitious to call this book a ‘cookbook’. It just provides insights into setting up an evaluation of partnership. The final design has not yet been invented. But it certainly provides helpful frameworks and a single tool. The author emphasizes the need to find out more about: “Which partnership for which aim?”. To this question I should like to add: “and in which context?”. In this book the mutual influence between partnership and context is underexposed.

The book is well written. Some illustrative examples like NPM are easy recognisable outside the UK. The reflective exercises at the end of every chapter are most helpful to summarize the given information. This book can be recommended to students, policy makers and, last but no least, practitioners to obtain insights into the effectiveness of partnership. I would give this book 4 stars out of 5.


Lia Donkers is the managing director of the Transmural Network Foundation at Gouda. This is a development cooperation of local care providers focused on integration of disease management, e-health, human resource management and health care prevention.