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This article reports on an evaluation of the progress of clinical audit in four health-care professions. The project had both a research and a development component. Interviews were held in six sites with practitioners and others with a stake in the outcome of audit. Findings indicated that a wide range of audit activities were in progress, that a diversity of factors could affect this progress, and that negative as well as positive impacts could ensue from participation in an audit. A model comprising four cycles (delivery of patient care, standard setting, carrying out audit, and decision-making concerning change) was developed from existing work, from fieldwork in the six sites, and from a process of evaluation, revision and further evaluation. The final version provided a framework which practitioners could use to analyse current audit activities and guide the planning of future projects. In particular, the model demonstrated ways in which the various factors that affected progress could act as a facilitator or constraint at each stage of the audit and decision-making cycles.

Speeches and Addresses is an occasional feature, not in article format, in which presentations at conferences and other public gatherings are seen as likely to be of interest to a wider audience. Sometimes these speeches and addresses will undoubtedly be contentious, in which case responses and counter-arguments are to be expected and are welcome. Contributions to this section are intended to make accessible relevant material for academic, policy-making and practitioner audiences.

This article's primary concern is with clarifying and, more importantly, developing the nature of 'fourth generation' evaluation coming from the work of Guba and Lincoln (I989). The suggested developments to this evaluatory model are intended to make the approach somewhat more practical and relevant to specific evaluatory concerns. Guba and Lincoln's 'fourth generation' evaluatory process, suitably developed, is advanced as providing the wide-ranging approach for this evaluation. This article describes the nature of this approach, which relies on and encourages all stakeholders' critically discussing the claims, concerns and issues on the focus of interest, leading to action outcomes. By probing into this approach, a number of problems in its design are highlighted. Guba and Lincoln's proposed model is enriched by suggesting possible solutions to the challenges offered by the solipsism of their approach, the implicit privileging of the client and evaluator, the underspecification of the processes of discourse and the accountability of the processes.

Two claims are put forward in this article : (I) practical evaluation, especially practical program evaluation, depends on theoretical assumptions that put its procedures and conclusions at risk; and (2) practical evaluation is unnecessarily and seriously limited because of its failure to use theory as a way to recognize and develop solutions to problems not yet solved in practice. Both claims raise the question of the relation of theory to practice in our discipline, and most of the article concerns this question. The focus of the discussion is the recent Handbook of Practical Program Evaluation. At the end, one possible low-level theory about evaluation-essentially, a conception of evaluation as a discipline-is proposed.

This article deals with the relationship between established political conceptions about government reforms and experiences with reforms and their evaluation, the background being the change in Norwegian reform policy which has taken place in recent years. This change has increased our insight into how reforms are created in the state sector and has also shed light on the different functions of such reforms, highlighting the consequences of topical questions for understanding evaluation and the evaluation strategies which are used.