Development of a new balanced evaluation framework for service improvement.

The study of service improvement within healthcare is no longer in its infancy. A plethora of books and journal publications have presented their own interpretations of the meanings, significance and application of service improvement. Despite such endeavours, there are still few studies that look at how we measure the impact of such service improvement to quantify the practical effect of improvement. At organisational level, organisations and project leaders often undertake evaluation in a piecemeal way, as part of a project or initiative. Whilst this can help assess the benefits or otherwise of a particular piece of work, the findings of the evaluation often remain within the project and are not disseminated across the wider organisations. This, in turn, means that opportunities for learning are diminished. This project builds on previous work and adds a new and unique contribution to the body of service improvement knowledge. It critically reviewed existing evaluation frameworks to inform the development of a unique balanced framework for service improvement initiatives, which is accessible and usable for change agents and their colleagues to evaluate effectiveness. The project began with an examination of the political environment surrounding the evaluation of service improvement, followed by a review of both existing service improvement evaluation frameworks. The review yielded few resources and highlighted a gap in the body of knowledge. Following this, primary data was collected from the organisation, which led to the following research questions:
– What is understood by measurement and evaluation?
– Are measurement and evaluation, interdependent, or mutually exclusive?
– What elements are missing from the current evaluation models presented?
– Could an evaluation framework model work in practice?
This led to a qualitative action research, which used focus-group meetings and one-to-one discussions to provide observation, reflection and feedback, in order to develop an understanding of measurement and evaluation, in relation to organisational improvement and to provide a robust evaluation framework for organisational use. The findings were analysed, using thematic analysis and revealed the need for an evaluation framework that is user-friendly, replicable and incorporates the views of users and carers. On the basis of the findings, recommendations are made for the improvement of practice and also the need for further longitudinal research, in relation to embedding and evaluating the impact of the framework within the organisation.

A project submitted to Middlesex University in partial fulfilment of the requirement for the degree of Doctor of Professional Studies (Health).