ANNEX EIGHT: CASE STUDY 7: LOCALISING SERVICE IMPROVEMENT: USING APPRECIATIVE INQUIRY TO EVALUATE THE CANCER SERVICES COLLABORATIVE IMPROVEMENT PARTNERSHIP
The Cancer Services Collaborative Improvement Partnership ( CSC' IP') initiative was designed to improve cancer services and patient outcomes across England. It is a national NHS Programme that supports local cancer service teams or networks to improve their services and has worked with all 34 cancer networks in England since April 2001. It aims to achieve the objectives of the NHS Cancer Plan 2000 for all cancer and associated services by focusing on reducing waiting times for consultation, assessment and treatment, and improving the patients' experience of care 40.
The Collaborative had adopted a range of research and evaluation techniques to explore and learn from its achievements and developments, including quantitative and qualitative methods. These evaluations had produced data on the outcomes of initiatives, such as shorter waiting times and smoother consultation processes, with the overall conclusion that the Collaborative had contributed towards some welcome changes to services. This previous work answered a particular range of questions about effectiveness and impact, but it was felt that this would be complemented by an evaluation that looked explicitly at process, in other words how these outcomes had been achieved.
As a result, an Appreciative Inquiry ( AI) evaluation was commissioned to identify lessons for future service development, and organisational change within and beyond cancer services 41. This also went some way towards countering some of the problems inherent in evaluations, whether carried out by an external agency or by team members. Evaluations often convey a sense of audit or of being criticised, which makes many of them difficult and unproductive for those concerned. Many people's experiences of evaluation are uncomfortable, and ultimately unproductive. People often feel unappreciated, disempowered and unenthusiastic about change and development.
Appreciative Inquiry ( AI) is an approach to organisational development and evaluation, which starts from the premise that, in order for organisations to move forward, they need to learn about what has worked in the past, and build on this. AI focuses on achievements, rather than problems. Identifying and analysing problems can be a useful step in development, but it can also prove a 'dead end' - a focus on the extent and severity of problems can often paralyse rather than energise. Focusing on successes and how these have been achieved recognises that people find ways round problems, and that no situation is without some achievement, however modest. In order to move forward it is, therefore, important to explore and appreciate these achievements, so that we can do more of what works. From identifying achievements, AI moves on to exploring the circumstances that enabled them to occur. Finally, AI is used as a change tool and builds on this to plan for the future.
A mixture of personnel involved at different stages of the Collaborative and different levels of seniority were interviewed. This included staff from medical, nursing, managerial and other clinical groups from across the country. Eighteen telephone interviews were conducted with key staff involved in the CSC, and the data analysed for themes and lessons learned. Participants had chance to see the questions in advance of the interview, which gave them the opportunity to reflect on their experiences and consider examples of change. This was done because being asked to describe achievements is an unusual experience for many - it is more often the case that they are asked to discuss problems, with no opportunity to challenge the way in which these are defined.
AI is a relatively new approach to evaluation which has not been extensively used in health care in the UK. This study offered the opportunity to gain an understanding of the Collaborative developmental process in an innovatory way, and to explore the use of AI in this particular setting. The open and non-judgmental nature of the approach was able to explore issues of change in a way which could contribute to future developments.
The detailed findings are likely to be of interest to other NHS improvement programmes. However, the AI approach to evaluation and organisational development may also be more widely useful in other health, social care and public service delivery contexts.
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