Cancer strategy - monitoring and evaluation: participatory systems mapping

Executive summary

Background

For the monitoring and evaluation of Scotland’s 10-year Cancer Strategy 2023-2033 there was a need to build evidence on how the Cancer Strategy interacts with the health and care system. To do this, a systems mapping exercise was commissioned to aid understanding of the system itself. This work was carried out with the support and guidance of the Cancer Strategy Monitoring and Evaluation Advisory Group.

Methods

Systems thinking methods (rich pictures and participatory system mapping) were used to efficiently collate and structure perspectives from NHS Scotland healthcare professionals. Views were sought on the current healthcare system as experienced by those affected by cancer, and how healthcare professionals thought that the Cancer Strategy would impact and be impacted by this system.

A series of virtual workshops were organised. 11 individuals took part over the series, representing a range of specialties, job roles and six NHS boards. The virtual setting was well received and allowed for greater participation as individuals were able to dip in and out as needed.

Output

The resulting system map complements previous work on Theories of Change, while adding a depth of complexity which highlights the role of interacting causal relationships. The system map was converted to an interactive visualisation tool intended to support discussions and ongoing analysis. The map itself is a living document that can be updated as new perspectives are gathered, or as the Cancer Strategy ambitions evolve.

While a breadth of perspectives were sought when building the system map, the fact remains that they represent only a snapshot of the system being studied. The system map is true and correct in the sense that it captures the perspectives of the group of healthcare professionals at the point in time at which they were shared. The analysis considers only healthcare professionals’ views of what impacts patient experiences, not patients themselves. Opinions and perspectives are subject to change and nuance which cannot be captured using these methods.

Insights

Clustering analysis of the system map emphasises the healthcare professional focus which naturally arises due to the participants invited. This should be kept in mind when considering insights from the system map.

A wealth of different insights can be explored with the system map. The publication focuses on three factors of high leverage. These include two of the Cancer Strategy ambitions: tackling inequalities and person centred care, as well as a factor for coordinated care.

Firstly, a synergy was identified between the two Cancer Strategy ambitions of tackling inequalities and person centred care, meaning that these ambitions support each other to influence positive change in the system. The synergy between these two policy ambitions relies on the participants’ perspective that the person centred care ambition would improve the availability of single points of contact (SPOC). Participants generally held the view that SPOCs were a good way of supporting people affected by cancer and a core component of person centred care. This in turn translated into the view that widespread, consistent availability of SPOCs would reduce inequalities.

Secondly the factor of highest leverage identified was coordinated care. This factor is closely linked to multiple Cancer Strategy ambitions suggesting that participants believe achieving coordinated cancer care would be necessary for Cancer Strategy success. Participants thought that coordinated care would directly improve access to care, treatment and diagnosis; enable staff to deliver the right care in the right place; and make it easier to share clear information on the patient journey because the journey itself is clearer.