Dataset Information

Telling the story of complex change: an Impact Framework for the real world.

ABSTRACT:

Background

In the National Health Service (NHS) in England, traditional approaches to evidencing impact and value have an important role to play but are unlikely to demonstrate the full value of national quality improvement programmes and large-scale change initiatives in health and care. This type of work almost always takes place in complex and complicated settings, in that it involves multiple players, numerous interventions and a host of other confounding factors. Improvement work is usually emergent, with cause and effect only understood in hindsight; challenges around contribution and attribution can lead the key players to question how they can be certain that the described or observed changes are due to their intervention and would not have happened without them. In this complex environment, there is a risk of oversimplifying the observed impact and focusing instead on those things that are easier to measure, missing that which is important but more difficult to evidence.

Methods

Between 2016 and 2019, an action-orientated approach, drawing on realist and development evaluation approaches, was taken to designing and testing the Impact Framework. First, we undertook a pragmatic review of tools and approaches used by others to capture and demonstrate their impact both within and outside the health and care environment. Following the identification and review of these tools and approaches, and in consultation with national improvement teams in England about their evaluation challenges and aspirations, we developed a set of underpinning principles to inform the design and build of the framework. The principles were informed and finessed following conversations with improvement teams and programme leads in NHS England with respect to the challenges that they were facing and their aspirations in terms of demonstrating their impact and learning as they worked.

Results

The 'Impact Framework' described in this article offers a practical approach to capturing the impact of improvement work at any scale, taking account of unintended outcomes, considering attribution and contribution, and using a narrative approach to uncover the difference made by improvement initiatives in rich detail. In this article, we describe how the Impact Framework has been used with one of NHS England's national programmes, Time for Care, which was delivered between 2016 and 2020.

Conclusions

The Impact Framework continues to be used, developed and further tested by national improvement programmes being delivered by NHS England and NHS Improvement and is updated regularly. The framework has been developed to be accessible to frontline teams and is supported by a set of resources to help improvement teams and individuals to use by themselves (https://www.england.nhs.uk/sustainableimprovement/impact-framework/).

SUBMITTER: Willett J

PROVIDER: S-EPMC8253549 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:Introduction Female adolescents living with Human Immunodeficiency Virus are a unique population facing lifelong challenges in reproductive and sexual health ranging from relational, social and legal-ethical considerations. While HIV prevalence of young females is higher than the males (4.9% versus 1%), evidence show that these adolescents in Malawi initiate sex as early as 15 years mostly with adult partners. Yet, young people are frequently reported to be reluctant to discuss sexual matters and demonstrate avoidance of direct questions on sexual issues during interviews. It is critical therefore that researchers invoke youth-friendly approaches to address these complex issues and enable these vulnerable individuals to articulate and advocate for their preferred futures. Methods This study used an innovative visual qualitative approach known as ‘my story’ book which combined image selection and sentence completion exercises to enable adolescents living with HIV to share their stories through interviews. The study involved 14 cases comprising of 14 female adolescents aged 15 to 19, 14 caregivers and 14 health providers working at HIV multidisciplinary centres in Malawi. Results The ‘my story’ book enabled in-depth exploration of the experiences and issues faced by this vulnerable population. The use of images and sentence completion exercise enabled the researcher to appreciate the type of interactions (or lack of) on sexual issues and status disclosure to significant others including sexual partners. Three themes were revealed, included creating meanings, revealing confirmatory and/or complementary evidence and enabling intergenerational research. Conclusions The ‘my story’ book captured the life experiences and needs of the female adolescents. The book assisted the participants in constructing, communicating, and controlling the articulation of their stories. It positioned female adolescents as a diverse group of social agents able to construct and reflect on their social worlds and real-life issues. This approach was highly effective in creating a youth-friendly context for reflection and revelation regarding sensitive cultural and social issues faced by this group. As such, the ‘my story’ book could be used in one-on-one counselling or provide data to inform intervention development.

Project description:IntroductionIn the modern day busy clinical practice, the communication between patient/relative and caregiver is at a minimal level. The patients and relatives feel apprehensive when advised about surgical/interventional treatment. Storytelling is such a technique of health communication made in common man language and can operate in a virtual environment. This study aims to unveil the efficacy of storytelling technique on patients undergoing Hemithyroidectomy for benign cytology.Materials & methodsA story of a lady (cartoon version), aged 25 years, with a benign solitary thyroid nodule (STN), who underwent uneventful hemithyroidectomy was depicted in this movie including the history, clinical examination, investigations, counseling, and the operative procedure, and the running time of the animation movie is 4 min. For developing this movie, high-end graphic work station and various multimedia authoring tools like Adobe Flash, Photoshop, Captivate, Maya and Final Cut Pro, were used. The story was shown to patients with clinical STN who were provisional candidates for surgery. The patients filled in the evaluation of multimedia animation questionnaire at the time of discharge.Results60 patients participated in the study. One form was disqualified due to incomplete filling. Mean age was 35.45 ± 12.8 years.55 (91.6%) were females. All patients were euthyroid. The mean weight of thyroid nodule was 40.80 ± 20.79 g. The final histopathology was colloid in the majority. All participants found the movie useful. In the questionnaire, the mean score for improved understanding of the disease was 73.9 ± 14.7, better organization of treatment was 78.6 ± 13.1 stimulated interest in the relatives was 70.8 ± 15.8 and saved unnecessary discussion with the consultant was 55.5 ± 7.8.ConclusionStory telling is a useful tool in health communication. With the widespread availability of high-speed internet and affordable mobile computing devices, story telling can be a useful tool to patients and relatives in decision making and in addition, saves valuable time of the treating consultant.