Tuesday 28 June 2022
On the eve of the launch of integrated care boards, senior consultant Sue Newell asks how we can support people and communities to have a strong and influential voice.
Now is a golden opportunity to codesign an approach to evaluation for working with people and communities – one that can match local Integrated Care Board (ICB) priorities and support them with being transparent and accountable to local communities for this area of work.
We know that evaluation for this kind of work is often lacking, unable to tell a compelling story of the difference involving people and communities makes to systemic change.
Over the last 18 months Traverse has been working closely with Hampshire and the Isle of Wight integrated care system to coproduce ambitions for people and community involvement and develop a formative evaluation approach to demonstrate impact. Noel Martinez Miranda, consultant, shares how we applied theory of change and formative evaluation approaches to develop frameworks for learning and insight.
With the introduction of Integrated Care Systems (ICS) seeking to strengthen the relationship between the multiple organisations that serve health and care needs, Hampshire and the Isle of Wight ICB has focused on developing a foundational community involvement approach that brings together and builds on the expertise and good practice already existing across the area.
This supports organisations across the health and care system footprint in better meeting the needs of the communities it serves and tightens the relationships between community involvement actors across the region to better deliver and showcase their impact.
Hampshire and the Isle of Wight ICB took another step in the development of the approach by working with Traverse in the summer of 2021 on the design of an ambition statement and a set of principles for its community involvement, accompanied by recommendations and suggestions for next steps.
The ambitions statement and principles were co-produced with input from interviews and workshops. Among the recommendations that emerged from this work was the creation of task groups to develop the community involvement approach, including an evaluation group, which focused on the development of a common but flexible evaluation approach for community involvement across the ICS.
In January 2022, Hampshire and the Isle of Wight Integrated Care Board and Traverse began working on the development of the community involvement evaluation approach. Over three workshops, members of the evaluation group worked on the development of a theory of change, a formative evaluation framework, and a tool to support evaluation efforts. The discussion built on the work of the previous stage, particularly on the agreed ambition statement and set of principles.
The evaluation group and Traverse produced a theory of change that captured the desired objectives for community involvement at ICB level. The theory of change is expected to:
Additionally, the evaluation framework describes the suggested evaluation approach at ICB level, while the evaluation tool supports the development of more program-specific evaluation approaches at place and neighbourhood level. The tool can inform evaluation efforts of different scales and be easily adapted to local circumstances by people with different levels of experience.
One of the tools we use to do this is a theory of change. This is a visual representation of an organisation’s overarching ambition, principles, and outcomes. The theory of change diagram for Hampshire and the Isle of Wight ICS illustrates the path from the current situation to the desired one and considers the necessary resources, activities, and outputs to get there.
The top level of the theory of change describes the agreed ambition statement or goal of community involvement for the ICS. The next level describes the principles that will underpin community involvement work, and the key outcomes or desired changes.
The outputs level describes tangible things that need to be achieved to support the outcomes. The activities level shows the most important actions needed to produce the outputs and support the outcomes.
The inputs level describes the resources that might be required to implement change through activities and outputs. In this way the theory of change describes a series of pathways to moving from the current situation to the desired one.
The theory of change diagram can be used as a communications tool, to inform management and strategic discussions, to help demonstrate impact, and to keep track of the progress toward achieving key goals at ICS level.
For organisations at place or neighbourhood level, the theory of change can serve as a summary of the key objectives at ICS level and can support discussions about how community involvement efforts at place or neighbourhood level can support the broader outcomes of community involvement across the system.