The NHS is short on examples of change which provide the full picture – the start point, the interventions and the results, which is what is required to share learning and fast track improvements in health care. In developing and delivering the new care models, NHS England has set out to systematically make this chain more explicit. As part of this, NHS Arden & GEM Commissioning Support Unit was one of the CSUs commissioned to support vanguards in developing the thinking behind their model of care.
Each vanguard was tasked with developing a value proposition, with a clear requirement to embed the theory of change more explicitly within their proposals through the development of logic models. The intention is to promote a better discipline in understanding the changes we are making and the effect those changes are having, so that we can better understand the wider impact within complex systems and the conditions necessary for replicability.
Working in partnership with an internationally recognised partner and academic institutions, we have established an approach to developing logic models which fits with the complexities of the NHS by enabling multiple stakeholders to set out the problem to be solved, planned interventions, outputs and short, medium and long term outcomes. The model seeks to tease out intended and unintended consequences of change to help project teams gain a complete picture about the impact of their work.
Critically, our approach aims to transfer skills in the development and use of logic models to the vanguards themselves, in order that they can maintain and adjust their models as their projects progress.
The purpose of a logic model
The key elements of a logic model are:
- Rationale/situation – the challenge to address
- Activities – the actions to be taken
- Outputs/deliverables – what will happen/change because of the actions
- Outcomes – what those outputs will achieve
- Impacts – the wider implications of those outcomes
While a logic model systematically takes you through the chain of events, its usefulness is partly in its brevity – it’s a plan on a page. In some cases, there will be a nest of logic models to cover different work streams but essentially, it’s a colour coded visual map of activities which shows cause and effect and how the different elements interrelate.
How are we adding value?
Changing a process in a complex system like the NHS brings many challenges and there are plenty of variable. Accurately attributing the impact of a specific activity on outputs and outcomes is very difficult and yet development money must be spent wisely.
When it comes to new models of care, we need a rapid cycle of improvement which allows people to implement change while learning and tweaking their programme as they go. A logic model provides the clear line of sight required to plot exactly what is being done and why, not only to monitor progress but to help identify what needs to change if the outputs or outcomes are not as expected. Building in metrics needs to be a realistic combination of long term and short term indicators to aid the change process.
Does a logic model guarantee success?
Logic models are a useful tool but they are not a silver bullet. We must recognise there will always be softer issues that are harder to measure but which may affect outcomes.
A bit like the chef who tastes and adjusts his recipe as he cooks, implementing innovation should incorporate formative evaluation, testing and learning as you’re going along.
Arden & GEM provides comprehensive planning, evaluation and PMO services to support vanguards and Clinical Commissioning Groups in developing new services. For more details read our case studies.
