Dr Laura G Carrascosa
Director of Health Translation and Strategic Partnerships, Gallipoli Medical Research
Each year, governments, health services, and community organisations fund hundreds of programs aimed at improving the lives of veterans. Many of these programs are built on solid research, delivered by skilled people, and genuinely valued by those who use them. Yet once implemented, consistent measurement and evaluation of whether the programs are producing the intended change can fall short.
This gap is the focus of my work in health translation at Gallipoli Medical Research (GMR). My role involves helping to take knowledge gained through rigorous research out of scientific publications, reports and datasets and place it into effective real-world practice. The challenge I often see is that when evaluation is not built into how programs and services are designed from the start, organisations do not capture the right data to understand what works, for whom, and under what conditions—or, more importantly, how they can continuously improve.
Attendance figures, referral numbers, and participant satisfaction scores are the most frequent metrics that programs gather. These are of course useful, but they do not tell us whether a veteran’s pain reduced, sleep improved, or sense of connection grew. A program can show strong engagement figures and still leave participants no better off. Likewise, a program reaching fewer people might be producing meaningful and lasting change. Without outcome measures collected consistently over time, these two scenarios are indistinguishable from the outside.
The consequence for veterans is real. People managing complex health needs and navigating multiple services are making decisions about where to invest their limited time and energy, often based on peer recommendations or word of mouth rather than accessible evidence about likely outcomes. This is not a criticism of the programs themselves or of the people who recommend them. But it reflects a system that does not yet make that kind of evidence routinely available.
Several factors contribute to this. Research into third sector organisations points to insufficient funding for evaluation activities, limited internal technical capacity, and difficulty identifying appropriate outcome measures from the outset are some of the most common barriers.
A further challenge is that evaluation is frequently designed around the requirements of funders rather than the learning needs to deliver value to users. When evaluation is added at the end of a program cycle rather than built into its design, the data collected tends to be retrospective and narrow, findings are less likely to be shared across the sector, and the opportunity for continuous learning and improvement can be lost.
The result is that programs that produce strong outcomes might have limited means to demonstrate this, and programs that are not working continue to run because the evidence to identify them is not being gathered.
A more productive approach is to build shared evaluation frameworks from the ground up; developed with input from organisations, practitioners, and the veterans who use services. The goal is a learning ecosystem modelled on what the field calls learning health systems, an approach formalised by the National Academy of Medicine and applied within the US Veterans Health Administration through its Quality Enhancement Research Initiative. The core principle is that data generated through service delivery should feed continuously back into improving that care, rather than being collected once and archived.
Central to this is the development of shared benchmarks to protect the quality expected for programs aimed at improving veterans’ wellbeing. Without them, there is no common language for what a good outcome looks like in veteran health programs and no basis for identifying what works well, replicating it, or improving on it. Building that language is one of the things our work at GMR is committed to, and part of that commitment means offering evaluation capability—grounded in research expertise and veterans’ health knowledge—directly to organisations that want to understand whether their programs are making a difference.
The organisations supporting veterans are doing work that matters. Giving that work the measurement infrastructure it deserves is how we make sure it makes its intended impact and continues to improve.
