A Route Map using Theory of Change:
Understanding the impact of
the Living With and Beyond Cancer model
for people affected by cancer
Macmillan Cancer Support in partnership with…
Richard Metcalfe - Programme Lead
Hayley Williams - Clinical Pathway Manager
Sarah Allen - Macmillan Evidence Officer
WiFi name: WifiLoveMCR
Password: internet
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using #DrivingChange
Phase 3
Programme aim
“to enable every adult living
with breast, colorectal or
prostate cancer in each of the
eight CCG areas to have
access to the LWABC model
of care from diagnosis
onwards by 2020”
Diagnosis
Risk stratification
• Care pathway based on individual needs
• Identification of options for complex, shared and self-care
pathways
Recovery Package
• Holistic Needs Assessment
• Treatment summary
• Cancer Care review
• Education and support
Supported Self-management
• Enable understanding and management of the consequences of
treatment
• Promoting healthy lifestyles and well-being
• Sign-posting to other services/support
How we
work
together
and make
decisions
Programme priorities
• Clinical Engagement model
Risk stratification in 3 ‘Clinical Delivery Groups’ 150 clinicians &
managers
Lead CNS group
• e-HNA/treatment summary and PROMS (x5 acute trusts)
• Programme Evaluation – testing theories of change, what is the impact
so what? evidence of the RP as a coherent package?
• Communications and engagement strategy
• Engagement with People affected by cancer ……
• Utilising localities intelligence and what we already know from the CPES,
regional and local engagement work
• Principles for engagement with people affected by cancer – consulted
with the public during summer 2016
• Building on co-production experience and skills across the footprint ave.
60 people affected by cancer per locality involved in co-designing solutions
• Specific work via the voluntary and community sector organisations to
engage reach/seldom heard groups
• Using intelligence from conversations with people affected by cancer to
inform a decision making framework
• Development of an Advisory board of people affected by cancer –
representative of the localities to support decision making
• Continued involvement of PABC in recruitment
Themes from across our localities
• Lots of great work, staff and services out there
• Having ‘Conversations’, tools and validation:
person centred conversations with a meaningful shared care plan … the elements of the
LWABC model (e.g.: HNA, Treatment summary, Cancer Care review) are tools/enablers
• Importance of community access, co-ordination and linking PABC to support (navigation)
• Need for diverse access and delivery options e.g.: support, physical activity and information
• It’s not just about specialist cancer services
• Risk stratification
• Cancer Care Reviews – what/how/quality?
• Models of care around GP practices; local communities/neighbourhoods (primary care strategy)
• Workforce development: culture, training, roles
• All tumour sites/x3 tumour sites programme
Locality approach test projects
LWABC model
eHNA/
treatment
summary/
PROMS
(Barnsley)
‘Opt out’
acute to
community
model,
whole
‘system’
(Doncaster &
Bassetlaw)
Programme priorities
Phase 1
CSW roles,
Education,
H&WB,
‘Universal
door’.
Phase 2
Community
(Rotherham)
Phase 1
Community;
CCR,
Education &
Expert Pts.
Phase 2
CSW roles
(N Derbyshire
& Hardwick)
Existing
support
services
testing the
use of
PAM as a
whole
‘system‘
(Sheffield)
Theory of change
what it is and how to use it
Key messages – theory of change
• It aims to provide clarity about what we think a programme
will achieve and how (emphasis on causality and explicit
assumptions)
• It enables stronger programme design, monitoring and
evaluation.
• It should be revised over time as programmes evolve and
evidence becomes available
• It should ideally be developed at design stage but adds value
at any stage of the programme cycle
10
Definition: theory of change
Programme Theory
Driver diagram
Logic model
Impact chain
Theory of change:
A detailed description of how and why we expect change to happen in a given context,
making explicit our assumptions and understanding of causality.
Why do a theory of change?
How?
Change
happens
Why?
For whom?
A theory of change and spheres of
control, influence and interest
•
Inputs
Ac tions
Sp h e re o f
co n tro l
O utc omes :
Chang es in
knowledg e,
behav iour, ac c ess
Impac t:
Signific ant longer
term c hanges in
health, mortality,
to and quality
s erv ic es
quality of life,
effic ienc y, s ys tems
and polic ies
Sp h e re o f
i n fl u e n ce
of
Sp h e re o f i n te re st
In simplest terms
Impact
Changes
Outcomes
----------------------------------------------------------------------Outputs
Actions
Inputs
Improved
communication
between secondary
and
primary/community
and patients and
carers
Primary/communi
ty providers think
care plan is
appropriate,
agree with
referrals
HNA theory of change –
LWABC SYorks Draft (Feb ‘17)
Patients access nonclinical (holistic)
support
Assuming nonPatients’
clinical support
acceptance of the
available across
referral
footprint
If services are
accessible
If service
(distance-cost
providers have
etc)
capacity
Care plans actioned
(referrals to holistic
support)
Changes
(outcomes)
HNA
Actions
(outputs)
And referrers
think they
have quality
services
Professionals have
time to make
referrals and are
aware of services
If care plan well
written
Assumptions
Preconditions
(T2)
Reduction in unplanned
service use
If patients have
the ability to selfmanage
PLWC have reduced
anxiety, improved
confidence
If patients choose
not to use
services
Greater facility to
self-manage
PLWC have
opportunity to voice
concerns and better
meet them
PLWC have greater
understanding of
support available
Care plans shared
with patients,
primary and
community services
Meaningful care plan
(HNA) Personcentred conversation
at appropriate
moment(s)
Training – around
process/conversation,
receptivity/system
readiness
Agreed, validated tool
And… ?
Patient has personal
record to reflect back
on
How change really happens
Time
Source: Ricardo Wilson-Grau (inspired by Jeff Conklin)
3 minute theory of change
• Statement one: ‘We/programme will……(describe what will be done
– where, with whom, how – i.e. actions/outputs)
• Statement two: ‘This will result in…..(direct changes – e.g. changes in
knowledge, behaviour, capacity, access to and quality of services i.e.
outcomes)
• Statement three: ‘Which will contribute to…( higher level, longerterm changes – e.g. health status, system savings i.e. impact)
3 minute theory of change
Example 1: My Party
• I will….buy food and drink, send out invitations, tidy up my house,
pick out music (activities-outputs)
• This will result in …..my friends coming to my party, eating, drinking
and dancing (outcomes – changes in behaviour)
• And will contribute to….. them having a good weekend (impact –
wider change to their well-being)
Richard Metcalfe – [email protected]
Hayley Williams - [email protected]
Sarah Allen - [email protected]