The John Eisenberg lecture: Health services research as a citizen in improvement

Arguably the greatest achievement of academic health services research of the last half-century has created its greatest unmet challenge. The achievement is to have documented beyond doubt the widespread defects in health care, even in wealthy systems. The challenge is to discover what we need to know that we do not now know in order to create much more effective systems of care. Health services research has not yet been sufficiently helpful in meeting the challenge of improving care in part because it has over-constrained both its methods and its favorite topics. The cost of insisting on formal, classical, summative, evaluative experimental designs in an uncertain, poorly understood, nonlinear, system is, unfortunately, to maintain the status quo. When the status quo is harmful, as health care is today, harm is not a theoretical problem. It is real, and it is indecent. Health services research should become more effectively part of the solution. To do that will require that we enrich our portfolio of methods and broaden our agenda of inquiry. The scientific methods that we need to enhance and dignify in academic settings will combine formal classical methods with some pragmatic, immediate, and in many ways more informative forms of learning and investigation. PMC ID: PMC1361142 (April 2005)