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 aims 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 will produce 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 will involve four stages, and we will update the framework as we move through each stage.

1. We will carry 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 will develop version one of the framework from this review.
2. We will carry out an in-depth consultation on version one of the framework by interviewing stakeholders with experience in running complex programmes in the NHS. In this phase we will ask them to share the knowledge they have gained through their involvement in the design, delivery, or evaluation of these programmes, and ask for feedback on the usability of the framework we developed in phase one.
3. We will carry out a wider consultation on the framework, using the thiscovery.org platform, to make sure that it meets 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 meets their needs for usability, acceptability, and actionability.   

Finally, we will test the framework by using a simulation based on a scenario involving a request from government to design a new complex programme. The findings of the simulation will be used to produce draft four of the framework, which will be discussed by the collaboration.

Project team

Professor Mary Dixon-Woods

THIS Institute

Dr Rosie Lindsay

THIS Institute

Have a question?

Rosie Lindsay

Funding and ethics

This study is funded by the Health Foundation. It is a collaboration between THIS Institute, IPSOS and The Health Foundation.