Strengthening evaluation through interactive problem structuring: a case study of hospital care after attempted suicide

The quality of an evaluation largely depends on the quality of the underlying problem definition and the quality of the problem definition often improves as stakeholder involvement increases. By means of a study on the management of attempted suicides by drug overdose, we explored whether an interactive methodology could be adequate for problem structuring. Despite the fact that a high level of care is often unnecessary, many patients are admitted to the internal ward or intensive care unit. To solve the efficiency problem, some physicians proposed to evaluate the effectiveness of a six-hour observation unit.Although evaluating such a unit was technically feasible, we felt uncertain about the appropriateness of this intervention.The interactive methodology was useful in that it effectively made the divergent problem definitions and underlying normative values transparent. As a result, our research efforts will be better geared to information needs from persons involved and therefore more useful.