Arquitectura

(Target user: lead/members of redesign projects.)

Preamble Successful service redesign projects are those that develop effective, realistic and well-thought proposals/solutions for changing the commissioning of health-care services at a local level. Service redesign teams are more likely to develop such solutions when their decision making processes are well managed andwell informed, that is, backed up with evidence, local knowledge and insights of various experts. In our research, we found that decisions need to be based on different kinds of evidence (universal, trans-local, local, expertise-based). We also identified specific capabilities that can contribute to improving the use of evidence in service redesign decision processes. These are summarised in the attached sheet. The following questionnaire aims to help you assess these capabilities in your own setting so that you can identify areas where your project may be more, or less, ready to use evidence to inform effective redesign solutions.

Area 1: sourcing and evaluating evidence

This set of questions is about how the project team gathers and uses different types of evidence in decision-making.

1a. We have thought about thedifferent types of evidence(local, trans-local, universal and expertise- based) that might be relevant, given the objectives and scope of this project.

1 2 3 4 5

Strongly disagree ⦿ ⦿ ⦿ ⦿ ⦿ Strongly agree

1b. The project team knows how to identify and gather new evidence to inform its decision-making process.

1 2 3 4 5

Strongly disagree ⦿ ⦿ ⦿ ⦿ ⦿ Strongly agree

1c. The project team has explicit criteria (e.g. relevance, applicability) to assess evidence.

1 2 3 4 5

Strongly disagree ⦿ ⦿ ⦿ ⦿ ⦿ Strongly agree

1d. The project team gets together to discuss, debate and assess available evidence.

1 2 3 4 5

Area 2: engaging experts

This set of questions is about the makeup of project teams.

2a. Given the aims and objective of our redesign project, we have carefully considered all possible stakeholders that may be affected by project outcomes.

1 2 3 4 5

Strongly disagree _{⦿ ⦿ ⦿ ⦿ ⦿} Strongly agree

2b. Given the aims and objective of this project, we have identified all individuals who might have relevant insights, information and expertise to inform our decisions.

1 2 3 4 5

Strongly disagree _{⦿ ⦿ ⦿ ⦿ ⦿} Strongly agree

2c. We have carefully consideredwhen and howindividuals with relevant insights, information and expertise will be asked to offer their input and feedback.

1 2 3 4 5

Strongly disagree _{⦿ ⦿ ⦿ ⦿ ⦿} Strongly agree

Area 3: effective framing

This set of questions is about the HOW the project team makes sense of, or‘frames’, their problem and search for solutions.

3a. The aims and objectives of this project reflecta balanced mixof different priorities (e.g. to improve quality of patient care, cost-effectiveness, capacity to delivery health care).

1 2 3 4 5

Strongly disagree ⦿ ⦿ ⦿ ⦿ ⦿ Strongly agree

3b. Given the project objectives, we have gathered evidence on the benefits and drawbacks of different solutions (e.g. adapting what we do now, copying what others do or starting from scratch).

1 2 3 4 5

Strongly disagree ⦿ ⦿ ⦿ ⦿ ⦿ Strongly agree

3c. Available resources for this project might affect our problem-solving efforts.

1 2 3 4 5

Strongly disagree _{⦿ ⦿ ⦿ ⦿ ⦿} Strongly agree

Area 4: managing roles and expectations

This set of questions is about roles and role expectations within the project team.

4a. Given the project objectives, it is critical that everyone knows what is expected of them.

1 2 3 4 5

Strongly disagree ⦿ ⦿ ⦿ ⦿ ⦿ Strongly agree

4b. Every member of the project team understands that bringing new evidence and information to the team’s attention is part of their role.

1 2 3 4 5

Strongly disagree ⦿ ⦿ ⦿ ⦿ ⦿ Strongly agree

4c. We have carefully considered arange of different rolesfor participants; for example, some may offer expertise, others may offer real-world experience.

1 2 3 4 5

Strongly disagree ⦿ ⦿ ⦿ ⦿ ⦿ Strongly agree

4d. Every member of the project team received feedback on the new evidence and information they present that seems relevant to the project.

1 2 3 4 5

Strongly disagree ⦿ ⦿ ⦿ ⦿ ⦿ Strongly agree

Area 5: managing expert collaboration

This set of questions is about how well different experts may work together to achieve the project’s objectives.

5a. Project members have different goals and objectives for this project.

1 2 3 4 5

Strongly disagree ⦿ ⦿ ⦿ ⦿ ⦿ Strongly agree

5b. It is important for all members to declare any conflicts of interest.

1 2 3 4 5

5c. We have considered how we can get key experts (including patients) to share relevant information with one another, even if it might be politically sensitive.

1 2 3 4 5

Strongly disagree ⦿ ⦿ ⦿ ⦿ ⦿ Strongly agree

5d. We can recognise and handle a situation in which a project team member seeks to influence the decision-making process to serve their specific vested interest.

1 2 3 4 5

Strongly disagree _{⦿ ⦿ ⦿ ⦿ ⦿} Strongly agree

Participant answers to the above questions can then be used to generate a radar plot, an example of which is shown inFigure 13.

Organisational conditions

The management literature, as well as feedback from our national workshop, emphasised the importance of noting that redesign projects do not take place in a vacuum.101,102_{Organisational context (e.g. resources} available, organisational culture) may also influence evidence use. Redesign projects are often initiated as a result of boards appraising and approving a business case because it meets organisational objectives (e.g. savings). Organisational context might also impact on sourcing and evaluating evidence. There are often numerous attempts to improve the organisation of health services. Organisations (CCGs) often have a weak memory for these so that learning is not often transferred from old projects. That is, evidence of ‘what worked’and‘what didn’t’at a local level maynotbe mobilised as a result ofpoor organisational memory. Such evidence might be important given the local nature of projects. In addition to organisational memory, organisational culture may play an important role in deciding what and how evidence is used. Prior research suggests that organisations are‘cultural universes’, which place emphasis on, for example, certain values and philosophies.103_{Some organisations value evidence-based decision-making more than} others, and so it can be assumed that employees in this type of organisation will be more likely to pay attention to evidence. It is important, then, to also consider the readiness of the organisation for evidence use. We have developed the following items for our toolkit.

0 5 10 15

Engaging the experts

Managing expert collaboration

Framing the search for a solution Sourcing and

evaluating evidence Managing roles and

expectations _{Capability score}

FIGURE 13 Example of radar plot for team capabilities to use evidence. APPENDIX 5

Assessing how favourable the organisational context is for