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Don't just measure. Develop a theory of change

Going beyond ROI to understand "why works"

Mechanisms of change have become a hot topic in healthcare in recent years. In our report, five ideas to enhance patient centricity, we look at how social science thinking can inform how we measure changes resulting from patient centric work, and what to do with the evaluation data collected.

Evaluation is about more than just return on investment. It is a vital step for continuous improvement, ensuring we put our efforts into the things that will have the biggest impact on patient care and our businesses.

Inspiration from social science

Programme theories are a concept from implementation science. A programme theory provides, “an account of the intervention's components together with a narrative about the structures, behaviours, processes and contextual features that will be needed to achieve the aims and actions of the intervention” (1). In many ways, programme theories are similar to theories of change.


What this means for patient centricity

If our organisations are patient centric, we are working with patients to develop products, services or resources that create value in the health system. These resources should improve outcomes and, often, should be scalable from pilot to wider rollout or to different healthcare markets, contexts and stakeholders.

As a first step, we need to identify the outcomes that our work will target (clinical and/or patient and/or service-oriented). We then need to design initiatives or interventions that we believe will improve the outcomes. A programme theory can be developed and refined throughout this process to help understand if and why an intervention works.

Getting started

How should we identify the outcomes to focus on, as we start on the journey to develop a programme theory? There is no standardised approach but for us it’s about:

•        Looking across clinical, patient and service priorities in a disease area

•        Working with stakeholders, especially patients, to know what matters the most

•        Understanding what’s possible i.e. things that can be feasibly measured and analysed

Once you have defined your priority outcomes, a design process can help you think of potential interventions, pressure-test these ideas and develop a prototype. Our report gives you food for thought and an action plan as you embark on this approach.

Make sure the first step in your action plan is downloading the full report


Davidoff F, et al. Demystifying theory and its use in improvement. BMJ Qual Saf. 2015;24(3):228–38.Available at: https://qualitysafety.bmj.com/content/24/3/228.Last accessed 31 March 2021

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