Comparing and contrasting a program versus system approach to evaluation: The example of a cardiac care system

This article examines the differences between approaching an evaluation problem from a program perspective and doing so from a systems perspective. The terms program, systems, systems thinking, and systems concepts are first defined. Then, using an actual evaluation of a cardiac care system, it is shown how initial investments in a program theory approach were deemed inadequate to account for the influence of external factors on patient outcomes. It was decided that a systems thinking approach was more appropriate for evaluating the interactions between several agencies comprising the cardiac care system. It is then shown how System Evaluation Theory (SET) was used to systematically apply different systems concepts to define and evaluate the cardiac care system. The discussion compares and contrasts the program and system evaluation approaches, noting the conditions under which each is more appropriate. It concludes by noting scope and cost differences between the two approaches.