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Many of us will be familiar with the parable of the blind men and the elephant, beautifully retold by the 19th century American poet John Godfrey Saxe.1 In this tale, each man in turn describes the small part of the elephant they are touching (the flank, the tusk, the trunk, etc.), declaring with confidence that they know the true nature of the object (‘It's a wall!’, ‘A spear!’, ‘A snake!’). Saxe ends with the moral of the tale:So, oft in theologic wars
The disputants, I ween,
Rail on in utter ignorance
Of what each other mean;
And prate about an Elephant
Not one of them has seen!1
This seems to be a fair summary of where we still too frequently find ourselves in health services research and delivery. Though the rise of extensive, multi-method programmes of work evaluating complex, multi-stranded services is a prominent feature of recent years, we often remain uncertain about the true nature of the beast we have been studying, and challenged by how we might tame or improve it. …