A realistic evaluation of fines for hospital discharges: Incorporating the history of programme evaluations in the analysis

Programmes and policies transform over time and locations. Evaluation projects can apprehend only temporal and contextualized sections of the social world. This article uses a realist evaluation of financial incentives in English hospital discharge policy to illustrate how previous evaluations of the same programme theory were inspected for evidence to construct context, mechanisms and outcomes. Following the discharges of a reduced number of patients with a case study approach, the preliminary programme theory (‘fines reduce delays’) was modified into a redefined theory on how fines operate locally in practice. This identified other mechanisms contemporaneous to the fines which are more or as likely to reduce delays. This article aims to contribute to the development of the realist evaluation strategy by introducing programme’s transformations as key evidence when trying to understand how complex interventions work in particular contexts.