The document discusses evaluation of health visiting practice and how to improve outcomes through evaluation. It provides an overview of the healthy child programme led by health visitors and the six high impact areas that are evaluated. Evaluation approaches are discussed, including the Kirkpatrick framework that measures reaction, learning, impact and results. Improvement science aims to create practical learning to improve patient care based on evidence. The document encourages contributions to evaluation research and improvement science to strengthen health visiting practice.

1. +
Evaluation of Health Visiting Practice
How should we go forward?
Prof. Sally Kendall, Associate Dean Research and Director, CRIPACC,
University of Hertfordshire
Trustee iHV

2. +Current Policy: Why health visiting matters
 In 2011 the Department of Health for England launched the
‘Health Visiting Implementation Plan’
 The Government believes that strong and stable families are the
bedrock of a strong and stable society.

3. +The Healthy Child Programme
The Healthy Child Programme
(HCP) is led by Health Visitors and
consists of a programme of
evidence based activities across
the pregnancy and 0-5 year period

4. +
Effective HCP should lead to…..
 strong parent–child attachment and positive parenting, resulting in
better social and emotional wellbeing among children;
 care that helps to keep children healthy and safe;
 healthy eating and increased activity, leading to a reduction in obesity;
prevention of some serious and communicable diseases;
 increased rates of initiation and continuation of breastfeeding;
 readiness for school and improved learning; early recognition of
growth disorders and risk factors for obesity;
 early detection of – and action to address – developmental delay,
abnormalities and ill health, and concerns about safety; • identification
of factors that could influence health and wellbeing in families; and
 better short- and long-term outcomes for children who are at risk of
social exclusion.

5. + How do we evaluate effectiveness?
Six High Impact Areas for Health Visiting


6. +
Public Health Outcomes Framework:
What is it?

7. +
Public Health outcomes Framework

8. +
Putting the family first
 The families and children must be the first priority in all of what
the health visitors do. Within available resources, they must
receive effective services from caring, compassionate and
committed staff, working within a common culture, and they
must be protected from avoidable harm and any deprivation of
their basic rights.
 Enhanced quality standards to promote improvement
 Public engagement and partnership
 Strong leadership in health visiting and other professions

9. +
Ask Questions, Be Curious
 “Be vigilant, curious and ask the ‘why’
questions, because it’s when you stop
asking questions that things start to go
wrong.”
 Mary Mumvuri, Head of Nursing and Patient
Safety at Hertfordshire Partnership University NHS
Foundation Trust (HPFT), told nursing students at
the University of Hertfordshire.

10. + Enhancing quality standards through
evaluation
Evaluation
 What? Intervention or change in practice
 Who? Family, child, parents, community
 How? What is involved? Break it down to component
parts
 When? At what stage, time, level
 Where? What is the context, home, community, clinic
 Measures? Do they already exist? Where can they be
found?
 Changes? Can the change be associated with the
intervention or practice development?
 Dissemination and communication?

11. +
Improvement Science
 What is improvement science?
 The overriding goal of improvement
science is to ensure that quality
improvement efforts are based as much
on evidence as the best practices they
seek to implement
 Shojania KG, Grimshaw JM. Evidence-based
quality improvement: the state of the science.
Health Aff (Millwood) 2005; 24(1):138-50.Improvement science aims to
create practical learning that can
make a timely difference to
patient care. It is characterised by
its large domain of interest, its applied nature,
and its commitment to generation of practical
learning that can be applied in real-life situations.
Improvement science recognises and integrates many
contributions, similar to the way that engineering science
uses scientific knowledge and theories to address real-life problems
Marshall et 2013 www.thelancet.com

12. + Terms used for improvement science
 implementation science
 science of improvement
 translational research
 translational science
 measurement for improvement
 quality improvement methods
 quality improvement science
 science of quality improvement
 evidence-based practice
 knowledge translation
 research utilisation

13. +
Evaluation approaches
 Kirkpatrick (1988) Framework for Evaluation 4 stages
 Reaction – how do people react, feel, behave in relation to the
process?
 Learning – what have people learned from it and what would
they do differently?
 Impact – what has been the impact on their lives, behaviour,
relationships,
 Results – what change has occurred, is it measurable?

14. +
How would you do this?
 Posing the question
 E.g How effective has my breastfeeding support group been in
enabling breastfeeding to continue?
 Reaction
 How did you feel about the breastfeeding support group? What
made you want to continue with it?
 What was challenging?
 Learning
 What have you learned from the group?
 What supported your learning?
 What would you want to do differently?

15. +
How would you do this?
 Posing the question
 E.g How effective has my breastfeeding support group been in
enabling breastfeeding to continue?
Impact - What difference has attending the group made to your
experience of breastfeeding?
How has it affected your family’s approach to breastfeeding?
How confident are you about continuing to breastfeed?
Results – what has changed as a a result of the programme?
Before and after measures – breastfeeding rates, confidence,
self-efficacy, attachment,

16. +
How can you contribute?
 By being curious about health visiting practice, what makes a difference and why?
 Be systematic and methodical!
 Through engagement with NHS and public health organisations and identifying areas of
local and national concern
 By considering how to implement what is already known and identifying gaps in knowledge
 Taking part in research events such as master-classes, seminars and conferences –
getting ‘out there’
 Engaging with families and the public – how can improvement science address their
concerns?
 Building experience and knowledge through professional development (Masters, PhDs)
and working with teams
 Disseminating your work in good quality journals, conferences and the e-Community of
Practice
 Applying for grants that will stimulate and grow new areas

17. +
Disseminate your findings
 Write for a journal
 or local newsletter
 Conference or seminars
 Blogs, twitter, facebook – use social media!
 Use the e-Community of Practice for Health Visitors

18. +
On-line Community of Practice
The CoP is built around the 6 high impact areas, enabling HVs to build and
share evidence and knowledge in each of the 6 areas within an
on-line community

19. +
One place to build and share
evidence for practice

20. +
Future possibilities
 To achieve real quality improvements in health and health care
should promote, build on and invest in evaluation research that
draws on Improvement Science
 Working with networks such as the the iHV , CLAHRCs, eCoP
enhances opportunities to work more closely with NHS, public
health and social care partners on a larger scale
 We have an opportunity to grow a national and international
reputation if we start to build on current work now