Can PPIE still be meaningful when time is tight? Navigating trade-offs in rapid evaluations

“We were up against a tight deadline to submit an ethics application so that data collection could start on time. The interview topic guide was ready, but we knew it still needed piloting. The challenge was how to gather feedback quickly from people with relevant lived experience while staying within the project timeline.”  [Project lead]

This situation will be familiar to many people working in rapid evaluation. These studies are designed to generate timely evidence for real-world decision-making, often while services are still being implemented or adapted. The timelines are compressed, decisions need to be made quickly, and there is rarely the luxury of doing everything in the order or depth that researchers might ideally choose, while at the same time maintaining rigour in all aspects of the research.

In this context, patient and public involvement and engagement (PPIE) is essential, but tricky to deliver well. There is strong agreement on the value of involving patients, carers and the public in health and care research. The more challenging question is what meaningful PPIE looks like when time is limited, and whether it can still shape research in ways that ultimately improve services and outcomes for patients and the public. 

A new paper from the NIHR Rapid Service Evaluation Team (RSET) draws on our experience of embedding PPIE across rapid evaluations. Since RSET launched in 2018, the team has delivered 13 rapid evaluations across a wide range of health and care services. This blog shares some of the practical learning from that work, focusing on how trade-offs shape the design and adaptation of PPIE in fast-paced studies. 

Adapting collaboration in rapid evaluations

Returning to the example at the start, we adopted different approaches depending on the circumstances. In some projects, we worked with specialist consultancies or charities to gather timely and context-specific input. In others, we sought rapid feedback from our standing PPIE panel while recruiting people with relevant lived experience in parallel for more in-depth involvement later in the project. Where timelines allowed, we built in iterative rounds of feedback on study materials (e.g. interview questions) to strengthen relevance and sensitivity. What distinguishes rapid evaluations is the need to decide quickly which form of collaboration is most appropriate while there are still time and scope to shape key decisions.

Meaningful PPIE depends on how well lived experience is integrated into study design, interpretation and delivery, while recognising contributors’ needs, preferences and availability. This requires flexibility in how involvement is planned and delivered across different contexts.  

The trade-offs in practice

Trade-offs between what is desirable and what is feasible are a central feature of rapid evaluation, including in how we approach PPIE. They are recurring decision points that arise throughout the project lifecycle. This means intentionally creating opportunities for meaningful collaboration, making judgements about where involvement is most valuable, while also seeking to avoid tokenistic involvement. 

We repeatedly encountered the following set of trade-offs in practice:

• Depth vs speed: How deeply is involvement possible without delaying delivery?
• Inclusivity vs practicality: How diverse perspectives can be included meaningfully within time and resource constraints?
• Relationship-building vs time: How to build trust efficiently under time constraints?
• Value vs feasibility: Where involvement is likely to add most value, and where scaling back is justified.

The opening example reflects depth vs speed in practice. Ideally, we would have iteratively piloted and refined the interview questions with people with relevant lived experience. However, the ethics deadline meant we needed a quicker way of gathering input without delaying data collection. 

For relationship-building vs time, trust often needed to be established early in rapid evaluations for effective collaboration. This involved setting clear expectations about contributors’ roles, maintaining regular communication, and closing feedback loops by showing how input had been used. 

For inclusivity vs practicality, we balanced the need for diverse perspectives with time and resources constraints by combining input from our PPIE panel with targeted engagement through trusted partners and community organisations to help strengthen equity and relevance. 

Finally, for value vs feasibility, involvement was prioritised at stages where it was most likely to shape key decisions, particularly early in study design, such as exploring questions that matter to patients and the public.

This is not to suggest our approach represents an ideal PPIE model. In rapid evaluations, we would argue that no single “ideal” model exists. Others working in similar settings often share the sense that more could always have been done, alongside recognition of the realities of rapid work. Acknowledging this tension helps surface both the effort involved and the scope for continued learning.

What this means for practice?

Meaningful PPIE in rapid evaluation is not about involving people as much as possible, but about involving them purposefully, at the points where their perspectives can add most value. Contributions may extend beyond changing a specific research decision and can also strengthen relationships, deepen understanding of context and lived experience, and challenge researchers’ assumptions.

For those designing PPIE in rapid settings, this means being explicit from the outset about where lived experience input is most needed, how it will be used, and how to create meaningful collaboration. It also means making trade-offs visible to both researchers and public contributors to support a shared understanding. Further detail is available in our paper.

As demand for rapid evaluation continues to grow, the challenge is not choosing between speed and involvement but tailoring PPIE to the needs of each project. This requires adequate resourcing and leadership commitment that support a culture of genuine collaboration alongside timely delivery.