For nearly ten years, the Health Foundation has been working with the NHS to deliver improvement through service and staff development programmes.
In a unique contribution to advancing the field of improvement, the Health Foundation has ensured that each of our improvement programmes is evaluated. We evaluate our programmes to provide sound evidence of their impact, and to better understand how it has been achieved.
In 2011, a team of researchers undertook a synthesis of learning from 14 of the Health Foundation’s improvement programme evaluations and set the learning in the context of the wider literature. They looked at the factors that affected the likelihood of improvement methods being applied and new interventions adopted.
The researchers organised their analysis within three broad themes:
- design and planning
- organisational and institutional contexts, professions and leadership
- sustainability, spread and unintended consequences.
Within these themes, they identified 10 key challenges to improvement that consistently emerged in the programmes evaluated:
- convincing people that there is a problem
- convincing people that the solution chosen is the right one
- getting data collection and monitoring systems right
- excess ambitions and ‘projectness’
- the organisational context, culture and capacities
- tribalism and lack of staff engagement
- balancing carrots and sticks – harnessing commitment through incentives and potential sanctions
- securing sustainability
- considering the side effects of change.
This report explores these challenges, and suggests ways to overcome them. It shows that if you take the time to get an intervention’s theory of change, measurement and stakeholder engagement right, this will deliver the enthusiasm, momentum and profound results that characterise improvement at its best.