The re-engineered system described by Caplan et al 1 involved radically reorganising the role of anaesthetists and surgeons, and enlisting support and cooperation from many other hospital departments. The impact of the new system was then comprehensively evaluated, which is a major achievement in itself. Randomised controlled trials involving a drug or single intervention are relatively straightforward. Evaluating a system presents greater challenges. Wide-ranging research expertise covering epidemiology, social sciences and health economics is required.
Clinicians are an essential part of the research team.
They are often driving the change and, as with a new drug or intervention, they need to know how the changes will affect their patients. It is important to use new or more relevant research methods that serve the scientific question, 3-5 rather than to restrict the scope of the question to fit more conventional research tools. Another challenge is having research which crosses many boundaries recognised by peer reviewers with specialised expertise. Acceptance of research by scientific journals is often determined more by the small size of the P value than by the relevance, importance or originality of the research. Health system research usually requires evaluations of many issues from many perspectives by many methods, including qualitative and quantitative, with investigators from different backgrounds working together to produce an integrated evaluation.