High Impact Change and keeping it real – how qualitative information can support improvement

What is the High Impact Change Model?

It’s a self-assessment tool to help councils and the NHS assess how they manage transfers of care.  By working with our co-production group, NCAG, the LGA demonstrated its commitment to measure what matters to people rather than just concentrating only on measures that the system thinks are important or measures which only tell you about outputs rather than impact.

In my dual roles for TLAP and ADASS, I am fortunate enough to see both sides of the self-assessment coin.  What I personally see is adult social care taking a sector led improvement role (lighter touch but equally as effective) and health taking more of a rigid performance management approach.  In my experience, the health approach focuses on hard scrutiny and accountability and adult social care more of a peer to peer sector led approach. Both approaches are equally of value if applied in the right way.  Performance management, assessment or self-awareness, whatever you wish to call this, should be based on good rounded evidence (both qualitative and quantitative), which is actually what HICM is aiming to achieve.  This approach gives an honest reflection of what’s happening on the ground and I’d argue moves away from a blame culture to a reflective culture. It shows good leadership!

 Listening to what matters to people

The LGA have taken positive steps towards including people’s voices and what matters to them within their revised High Impact Change Model framework (soon to be released).  Therefore, it now not only looks at the flow within an acute system but also what matters to people during their stay in hospital and on discharge from hospital. 

It’s my view that if you use the Making it Real  I/We statements to check the delivery of national frameworks as well as traditional ‘hard’ data requirements, as the LGA have done, you end up with a far richer evidence base.  The I statements help to focus on what matters to the individual. The We statements encourage commissioners and providers across the health and social care sector to work together to ensure an effective service focused around the individual.  The framework supports good conversations. 

The I/We statements within the High Impact Change Model are common sense and good practice.  The statements can be used in any performance/self-assessment framework and help to keep it grounded in people’s lived experience.   For example, to what extent are the following true within a person’s journey through the often spaghetti junction care and support system?

  • When I move between services, settings or areas, there is a plan for what happens next and who will do what, and all the practical arrangements are in place before change happens.
  • We make sure that staff working in short-term setting or situations understand people’s care, treatment and support requirements and work in a person-centred way.

I would urge you to use Making It Real to ensure a collective and collaborative approach around what matters to people.  It has been co-produced with commissioners, providers and people with lived experience. Using it will make a significant impact for everyone and contribute to sharing power. The framework is easy to adapt and can be used across all situations.  Are you willing to give it a try?


National Co-production Advisory Group 


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