Ireland Puts a New Evidence-Checking Tool for Health Policy to the Test

When governments make decisions about health care, the stakes could hardly be higher. Vaccine schedules, screening programmes, hospital funding models and pandemic responses all rest on evidence, yet the machinery that connects research to policy often remains invisible, improvised and unexamined. A study published in Health Research Policy and Systems has now taken a rare, close-up look at that machinery, reporting the first process evaluation of a methodology designed to assess how well countries turn research evidence into health policy. The findings suggest that the method, known as the Rapid Evidence Support System Assessment, or RESSA, can be delivered with remarkable precision, but that its success depends as much on relationships, governance and communication as on scientific rigour.

RESSA was developed by the Global Commission on Evidence to Address Societal Challenges, an international initiative convened to strengthen the use of evidence in decision-making at every level of government. The tool is not designed to evaluate a single policy decision. Instead, it assesses the entire evidence support system of a country or jurisdiction: the institutions, networks, processes and products that together determine whether policymakers have timely access to high-quality research when they need it. As evidence-informed policy-making has gained prominence worldwide, the commission and its partners have argued that such systems deserve the same scrutiny as the policies they inform. Until now, however, systematic process evaluations of system-level assessment methodologies have been scarce, particularly in the complex, politically charged environments where they are most needed.

The Irish assessment provided an ideal test case. It involved an unusually broad coalition of national institutions: the Department of Health, the Health Research Board, Evidence Synthesis Ireland, Cochrane Ireland and the Global Commission on Evidence itself. Researchers led from the University of Galway, including Marie Tierney and Declan Devane, conducted the process evaluation alongside the RESSA itself, asking three linked questions. Was the assessment delivered as intended? Did the stakeholders involved find it acceptable? And what did their experiences reveal about how such assessments should be run in future?

Methodologically, the study was a qualitative process evaluation with quantitative elements, framed by the Medical Research Council’s guidance on evaluating complex interventions. Three participant groups were recruited: key informants from the Department of Health and affiliated organisations, members of the project’s Oversight Group, and the RESSA lead who carried out the assessment. Delivery fidelity was measured in two ways. The research team qualitatively explored the RESSA lead’s preparedness for the task, and quantitatively compared the delivered assessment against the published RESSA protocol, checking whether each specified component had been implemented as written. Qualitative interviews were analysed using a hybrid inductive-deductive thematic approach anchored in pre-specified process evaluation domains, while acceptability findings were interpreted through the Theoretical Framework of Acceptability, a validated model covering constructs such as affective attitude, burden, perceived effectiveness and ethicality. Reporting followed the Consolidated Criteria for Reporting Qualitative Research, and the study received ethics approval from the University of Galway Research Ethics Committee in March 2024, with written informed consent obtained from all participants.

The headline result is striking in its simplicity. The RESSA was delivered with complete fidelity: all eight protocol components were implemented exactly as specified, a score of eight out of eight, or one hundred percent. In the world of complex interventions, where implementation drift is the norm rather than the exception, such perfect adherence to a published protocol is noteworthy. It suggests that the RESSA methodology, despite operating in the messy reality of a national policy environment, is specified clearly enough to be reproduced faithfully by a trained assessor. Equally important, the assessment proved acceptable to stakeholders across all three participant groups, indicating that the process did not feel extractive, opaque or burdensome to those whose system was being examined.

Beneath those headline findings, however, the qualitative analysis surfaced three cross-cutting themes that the researchers argue are essential to understanding how such assessments actually succeed. The first concerns internal advocacy and governance structures. Stakeholders’ engagement with the assessment, its implementation and its potential impact were shaped by whether champions inside the organisations involved could advocate for the process and whether governance arrangements gave it legitimacy and traction. An assessment of an evidence system, in other words, is not a neutral technical exercise dropped into a vacuum; it lands in an institutional landscape where sponsorship, authority and accountability determine whether its findings are absorbed or ignored.

The second theme centred on communication. Clear, sustained communication supported stakeholder understanding of what the RESSA was and why it was being conducted, fostered engagement throughout the process, and influenced the assessment’s potential to drive change. This may sound obvious, but in practice system-level assessments involve many actors with different expectations, vocabularies and levels of familiarity with evidence terminology. Misalignment at any point can erode trust and blunt the assessment’s usefulness. The third theme concerned relational dynamics: the patterns of trust, collaboration and interpersonal connection among stakeholders were described as central to successful implementation. Where relationships were strong, the assessment could surface candid information about how the evidence system worked; where they were fragile, the process risked becoming superficial.

Taken together, these findings carry a message that extends well beyond Ireland. The researchers conclude that the RESSA can be implemented with high delivery fidelity and in a manner acceptable to stakeholders within complex policy environments, which is precisely the context in which such tools must function. But they also conclude that successful implementation depends not only on methodological fidelity. Organisational context, governance structures, communication practices and stakeholder relationships all shape whether an assessment of an evidence support system delivers meaningful insight. For countries considering a RESSA, the practical implication is that preparation should extend beyond training the assessor and assembling documents: it should include mapping internal advocates, establishing clear governance, and investing deliberately in communication and relationship-building from the outset.

The study also fills a methodological gap. Process evaluation is well established for clinical and public health interventions, but it has rarely been applied to system-level assessment methodologies in the policy sphere. By demonstrating that fidelity can be measured against a published protocol, that acceptability can be systematically assessed using an established theoretical framework, and that qualitative themes can be rigorously derived and reported, the Irish team has provided a template that others can adapt. The authors offer practical recommendations to support the adaptation of RESSA-style assessments across diverse policy settings, from ministries of health in high-income countries to evidence units in low- and middle-income contexts where the Global Commission on Evidence has focused much of its attention.

There are, of course, limits to what a single process evaluation can establish. The study examined one assessment in one jurisdiction, with a small number of participant groups, and the findings about relationships and governance are context-dependent by nature. The research team was also transparent about competing interests: several authors are employed by the Health Research Board, which funded the work, and by the Department of Health, although the design, analysis and decision to publish were led independently by the research team. Even so, the study’s core contribution stands. It shows that the invisible infrastructure connecting research to health policy can be examined systematically, and that when it is, the most important variables may be human ones. As governments worldwide commit to evidence-informed decision-making, the Irish experience suggests that the tools to audit that commitment now exist, and that using them well requires as much attention to trust and communication as to protocol and method.

Subject of Research: Process evaluation of the RESSA methodology for assessing evidence support systems in Irish health policy-making

Article Title: Process evaluation of the Rapid Evidence Support System Assessment (RESSA) methodology for health policy-making in Ireland

Article References: Tierney, M., Byrne, P., Whelan, B., Burke, N. N., Creely, C., Gill, C., Horgan, M., Lavis, J. N., Maguire, T., O’Neill, J., Toomey, E., Waddell, K., & Devane, D. (2026). Process evaluation of the Rapid Evidence Support System Assessment (RESSA) methodology for health policy-making in Ireland. Health Research Policy and Systems. https://doi.org/10.1186/s12961-026-01533-x

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01533-x

Keywords: RESSA, evidence-informed policy-making, health policy, Ireland, process evaluation, delivery fidelity, acceptability, knowledge translation, evidence support systems, Global Commission on Evidence, Health Research Board, governance