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Systems and culture
Developing a framework for designing large-scale complex change programmes in health
Background
National programmes are major initiatives run by national organisations aimed at securing improvement or service change across the NHS. These programmes are typically complex and can involve multiple interacting parts, often require significant resource, and sometimes need to be customised for different situations. Even seemingly simple programmes benefit from careful planning to define the best approach, and how to implement and evaluate it.
Guidance on programme design and planning is likely to be helpful for national policy makers and those involved in initiating and delivering programmes. The UK government has published generic guidance around the management of large programmes. A body of research on large-scale programmes is also available. People who have worked on complex national change programmes can also offer valuable insights into why some programmes work well and others don’t, and how we can make them more effective. But there is limited specific, published advice for policymakers to support the design of complex programmes in health-related fields that brings the literature and learning from experience together.
This project aimed to co-design practical guidance, in the form of a framework, to help design complex national change programmes in healthcare. Asking “what does good look like when designing complex national service change programmes in healthcare?”, it produced a framework in a practical format.
Though the focus is on programme design, the framework is also intended to support effective delivery and implementation. It will be based around existing guidance on good practice, the knowledge and expertise of people who have been involved in complex and large programmes, and broad consultation.
Approach
The project involved four stages, and we updated the framework as we moved through each stage.
- We carried out a literature review – a summary and analysis of existing research – to scope and pull out principles from major sources of guidance and learning on how effective complex national change programmes in healthcare should be designed. We developed a version of the framework from this review.
- We carried out an in-depth consultation on a version of the framework by interviewing stakeholders with experience in running complex programmes in the NHS. In this phase we asked them to share the knowledge they had gained through their involvement in the design, delivery, or evaluation of these programmes, and asked for feedback on the usability of the framework we developed in phase one.
- We carried out a wider consultation on the framework, using the thiscovery.org platform, to make sure that it met the needs of the people likely to use it (or to be involved in programmes that have been guided by it) and to explore whether it met their needs for usability, acceptability, and actionability.
- Finally, we tested the framework by using it an event using a simulation and it was also tested by a policy team. The findings of the event and testing were used to produce a final draft of the framework, which was discussed by the collaboration.
Funding and ethics
This study is funded by the Health Foundation. It is a collaboration between THIS Institute, IPSOS and The Health Foundation.