Health System Evidence (HSE) could broadly be categorized in to Research-based, Practice-based and Contextual evidence. However, achieving a reasonable synthesis of these three forms of evidence has been a challenge as most of the existing evidence synthesis techniques are limited scope and methodology. Using the pragmatic approach, we developed a step-wise approach of HSE synthesis defined by the decision point for which the evidence is needed (outcome), the desired output of the synthesis (output), the available evidence that can undergo synthesis (inputs), the synthesis methods (processes), the role of the synthesizer, and the interests and values of the users. Therefore, this paper is intended to explore important perspectives and facets that need to be considered when conducting HSE synthesis using this pragmatic approach.