Responding to ambiguity, responding to change the value of a responsive approach to evaluation

Loosely organised teams and flexible arranged programs offer a new answer to improve the practice of palliative health care. Given the ambiguity of this care concept and the innovative organisational arrangement it is possible for confusion to emerge over the goals, core activities and target groups. In such a context it is not sufficient to determine the degree to which goals have been attained because the search for goals is part of the developmental process. An evaluation of a palliative team in a Dutch health region shows that it is more appropriate to acknowledge ambiguity and to go on to facilitate the handling of ambiguity as a vital element in dynamic learning processes. The utility of a responsive approach to evaluation, methodological considerations and learning experiences are described. The article is educational for workers in the field of health care but also to scholars and practitioners in an evaluation community. (C) 2000 Elsevier Science Ltd. All rights reserved.