Evaluation Programme theory Quality improvement Theory of Change Training

Developing a Theory of Change for the quality improvement training programme at King’s College Hospital

Quality improvement (QI) is a systematic approach, where people use specific tools, methods, and data to solve problems and improve the quality and experience of care for patients and staff. Training in QI tools and methods provide staff with the knowledge, skills, and confidence to identify and understand problems, find solutions, and implement and monitor change.

Many NHS Trusts across the UK have developed organisation-wide training programmes to give their staff the knowledge and skills to do quality improvement. These programmes have been linked to NHS trusts achieving higher ratings in quality assessments and improvements in the processes and safety of care.

Despite such improvements, precisely how these programmes work has not always been clearly and explicitly outlined. This can make it difficult to replicate these programmes and to know what needs to be in place for the programmes to sustain their success.

In collaboration with the QI team at King’s College Hospital (KCH), the research team are developing a Theory of Change (a type of programme theory) to clearly outline how the QI training programme at KCH could reach its improvement goals. A Theory of Change is a visual illustration that acts like a road map for how we get from the inputs of a programme to its ultimate goals.

A Theory of Change outlines everything that needs to be in place including resources, training and the short, medium, and long-term outcomes needed to reach the goals. This map and other information gathered in this study will be used to inform the QI programme and its evaluation

Project aim

The aim of the study was to develop a Theory of Change outlining the resources and training activities needed, and how the QI training programme will be embedded across the organisation to build QI capacity and achieve improvement goals at King's College Hospital (KCH).

The research team also gathered information on any rationales and assumptions underlying the change process, and key contextual factors that could influence the programme’s implementation.

How the study was conducted

The study used qualitative research methods and followed the guidance in the Aspen Institutes Community Builder’s Approach manual to develop the Theory of Change. Specifically, the research team ran workshops and conducted interviews with staff, QI team members, and patient and public members at KCH to develop the Theory of Change. During the workshops and interviews, the research team asked questions and used different types of tasks to gather information on what the Theory of Change should look like for KCH. Between workshops and interviews, the Theory of Change was gradually updated. The research team then analysed all the information gathered in the study and developed a final Theory of Change and accompanying text, which will be distributed to study participants, the QI team and beyond.