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Evaluating complex interventions and policies is challenging. This is particularly true for the identification of unintended consequences, whether negative or positive. This article uses data from a workshop with policymakers and evaluators to explore the evaluation of unintended consequences. We identify three main challenges for policymakers and evaluators: being able to identify and evaluate unintended effects, to avoid creating unintended effects and being able to explain these effects. We discuss practical, political and ethical issues for each of these challenges and identify recommendations for evaluators who want to consider unintended consequences. First, use a broader range of methods to explore how policies play out; second, use theory to plan evaluations; and third, discuss both methods and theory with relevant stakeholders to make these as useful as possible. We offer novel insights into recent debates about theory-led and co-produced interventions and policies.

Evaluating complex interventions and policies is challenging. This is particularly true for the identification of unintended consequences, whether negative or positive. This article uses data from a workshop with policymakers and evaluators to explore the evaluation of unintended consequences. We identify three main challenges for policymakers and evaluators: being able to identify and evaluate unintended effects, to avoid creating unintended effects and being able to explain these effects. We discuss practical, political and ethical issues for each of these challenges and identify recommendations for evaluators who want to consider unintended consequences. First, use a broader range of methods to explore how policies play out; second, use theory to plan evaluations; and third, discuss both methods and theory with relevant stakeholders to make these as useful as possible. We offer novel insights into recent debates about theory-led and co-produced interventions and policies.

BACKGROUND: Public health policies sometimes have unexpected effects. Understanding how policies and interventions lead to outcomes is essential if policymakers and researchers are to intervene effectively and reduce harmful and other unintended consequences (UCs) of their actions. Yet, evaluating complex mechanisms and outcomes is challenging, even before considering how to predict assess and understand outcomes and UCs when interventions are scaled up. We aimed to explore with UK policymakers why some policies have UCs, and how researchers and policymakers should respond. METHODS: We convened a one-day workshop with 14 people involved in developing, implementing or evaluating social and public health policies, and/or evaluating possible unintended effects. This included senior evaluators, policymakers from government and associated agencies, and researchers, covering policy domains from public health, social policy, poverty, and international development. RESULTS: Policymakers suggested UCs happen for a range of reasons: poor policy design, unclear articulation of policy mechanisms or goals, or unclear or inappropriate evidence use, including evaluation techniques. While not always avoidable, it was felt that UCs could be partially mitigated by better use of theory and evidence, better involvement of stakeholders in concurrent design and evaluation of policies, and appropriate evaluation systems. CONCLUSIONS: UCs can be used to explore the mechanisms underpinning social change caused by public health policies. Articulating these mechanisms is essential for truly evidence-informed decision-making, to enable informed debate about policy options, and to develop evaluation techniques. Future work includes trying to develop a holistic stakeholder-led evaluation process.

The "new public management" (NPM) wave in public sector organizational change was founded on themes of disaggregation, competition, & incentivization. Although its effects are still working through in countries new to NPM, this wave has now largely stalled or been reversed in some key "leading-edge" countries. This ebbing chiefly reflects the cumulation of adverse indirect effects on citizens' capacities for solving social problems because NPM has radically increased institutional & policy complexity. The character of the post-NPM regime is currently being formed. We set out the case that a range of connected & information technology-centered changes will be critical for the current & next wave of change, & we focus on themes of reintegration, needs-based holism, & digitization changes. The overall movement incorporating these new shifts is toward "digital-era governance" (DEG), which involves reintegrating functions into the governmental sphere, adopting holistic & needs-oriented structures, & progressing digitalization of administrative processes. DEG offers a perhaps unique opportunity to create self-sustaining change, in a broad range of closely connected technological, organizational, cultural, & social effects. But there are alternative scenarios as to how far DEG will be recognized as a coherent phenomenon & implemented successfully. Tables, Figures, References. Adapted from the source document.