Impact! Public Involvement! Improvement! Tying these 3 concepts together…. 


by Christine Smith

Three questions.  How do we capture the impact of public involvement?  How do we figure out which public involvement processes work and which don’t?  And how can we do this in health service research programmes like ARCs?

I know this isn’t exactly uncharted territory.  Millions of words have been written about what ‘impact’ is.  But as a Public Involvement Lead in the Yorkshire and Humber ARC, I’ve found myself becoming a tad obsessed.If you’re interested in the millions of impact words I’d recommend this website, which is a good starting point.  Similarly, a gateway into the millions of words about public involvement is available online here.  But despite all these words, it is still not clear how to plan and measure the impact of involvement. 

In ARC YH we decided about a year ago to tackle these questions by taking an Improvement approach.  ARC North-West London had published a paper in 2019 that talked about using Patient Public Involvement & Engagement (PPIE) Strategies to ‘generate theory, capture learning and evaluate effectiveness at the same time’.  Which sounded great – a three-fer.  So after talking it through with one of the authors, we decided to give it a go.

At the time Improvement was new to me and I’m still pretty much a novice.  However, I’m lucky to be working with Claire Marsh and the Improvement Academy who think about this stuff all the time.  So it occurs to me that a first answer to the questions is to work with people who know about the approach you want to use.In ARC YH most activities and resources sit with the research teams themselves – our PPIE support function is small so it needs to empower others to understand and enhance their own impact, by providing light-touch guidance and inspiration from the Core Team.  This adds an extra dimension – distance, the ‘remoteness of management’ – into the mix of questions.

Our Public Involvement Strategy for ARC YH has incorporated our Improvement ethos.  I asked Claire to explain: “Simply put, this means being transparent at the outset about the logic behind the involvement support we provide, as a PPIE Leadership and Support Team, to our researchers so that we can regularly reflect and revise our approach as we learn more about what really works in practice.  We’re going to use logic models (a visual depiction of the assumptions behind what we are doing) to try and unpick the links between the aims (‘push/pulls’); the people, time and things needed (‘resources’); what is planned (‘activities’); what happens as a result of these plans (‘outputs’); how this affects all those involved (‘outcomes’) and ultimately what difference it makes (‘impacts’) to the original aims.”

This opens the door for learning about the PPIE process to be recognised as just as important as learning about the impacts on research.  Indeed, as was described in a recent paper, learning should be viewed as an ambition of any PPIE and therefore involvement leads crucially need to support this learning.  An improvement approach responds directly to this need.”In our PPIE strategy, we outline 4 priority areas that we are supporting across the ARC: good governance; effective communications with the public; networked learning; capacity building, with cross–cutting principles of diversity and influence running through each.  To put these priorities to work we intend to undertake a ‘Deep Dive’ every year.  This will be a 12-month learning process into a specific PPIE issue, where we can track the journey between priority and impact. 

In Year 1 an informal version of a Deep Dive evolved by itself.  We received many requests for information and guidance on engagement during the COVID pandemic so, as part of our ‘deep dive’ into this issue, we worked with our regional PPIE Voices team to collate some resources.  We shared this resource with our research teams and used it as a reference during mentoring sessions.  Towards the end of the year, we asked our research teams how they had used the resource and what difference it had made.  Right now we are working up a logic model about virtual engagement during a pandemic.  Our plan is to share our learning with our networks in this blog, and on social media so that we can reach as wide an audience as possible.

In Year 2 we are focussing on Priority Setting.  We’ve taken the informal process that evolved in Year 1 and developed it into a more formal schedule of activities and events that are linked to our ARC’s existing governance ‘touchpoints’ (when we are due to draw reporting evidence and learning from our researchers anyway). In this way, we aim not to overload our teams with extra work.

By the end of ARC in 2024 we will have a logic model for 5 Deep Dives, informed by evidence collected along the way about what actually happened – and hopefully that will be a helpful contribution to understanding PPIE impact in holistic terms.

So, to answer my own questions, I’m going to be working with people who know what they’re talking about and use logic models as part of an improvement approach to understand the links between our PPIE aims and what we (hopefully) achieve.  Which is pretty exciting!  Watch this space…

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