Let’s Talk Evaluation of Improvement

Let’s talk evaluation of improvement.

Why is it that we still struggle to do this? Why do we need to?

The need is never more important. Despite decades of improvement work, we still struggle to evaluate its impact. Yet doing so has never been more important, given today’s pressures on finance and performance and our shared responsibility to sustain a culture of curiosity and compassion.

In August 2009, I saw the development of a Balanced Evaluation Framework (BEF) supported by  great mentors and experts –  which came from either the field of improvement and/or lived experience (who clearly articulated that lived experience is often forgotten when designing improvement interventions), and yet I can see that this is still of urgent need to be applied in  October 2025,  as this will support the impact of improvement to be evaluated and sustained.

Figure 1.0 The BEF Framework.

Read the 2013 published article on its development.

Over recent months through much discussion and collaboration I have revisited this  framework and its publications I have dusted it off and I believe there is more that can  become of the research and development that saw the BEF created, and tested which has applicability to a wide range of health and social care settings, along with other organisations, to demonstrate success of improvement and also more importantly notice when improvement is failing, course correct, learn and continue  because, without learning from what works and what doesn’t, improvement becomes activity without progress

The Journey to Here.

The drive to improve services and products and to achieve “improvement” in organisations that deliver them is relentless  and  permeates  all  walks  of  life.

Since the mid-1990s,  both  in  the   USA  and  UK   there  has  been  increasing  interest  in  service  improvement  within  the  healthcare  sector.   Following its  introduction,  the  iterative  components  of  improvement  theory  (Deming,   1994)  have  been  adapted  for  use  in  healthcare.  Early improvement  frameworks  were   developed  from  manufacturing,  for  example,  European  Foundation  Quality   Management  (EFQM,  1999)  and  Process  Redesign  (Hammer  and  Champey,  1993),   which  focused  upon  mechanistic  processes  more  suited  to  industrial  settings.    The   adaptation of such frameworks excluded the humanistic aspect of change, therefore, lacked evaluation.    This highlights the deficiency of “fit‐for-purpose” evaluation frameworks that may not fully recognise the human elements of improvement. This research and framework addresses these deficiencies through the inclusion of a more human relations oriented core component to the practice of service evaluation. The study involved expert participants as well as practitioner clinicians who were involved in change projects

What’s next?

With all this in mind, as the Chief Executive of Advancing Quality Alliance (Aqua) in collaboration with partners we are further developing the BEF so it can be used by all involved in change. Watch this space as we progress this work, and make it digitally enabled for individuals, teams and organisation to maintain and sustain their improvement efforts through the application of right intervention for right outcome.

Join us! We want to hear your thinking, test it, add to it, challenge and support it, so that we can deliver true value through improvement. You can contact me on communications@aqua.nhs.uk or connecting with me on LinkedIn.

Dr Susy Cook
Chief Executive