Impact Framework

Overview of the Impact Framework

Watch our animation with an overview of the Impact Framework.

As part of our role supporting large scale change programmes within NHS England, the Improvement Capability Building and Delivery team has developed a framework to systematically capture the impact of these programmes of work. The Impact Framework has been developed based on approaches used by others in the field of developmental evaluation, tailored to support improvement work in complex systems.

​This online guide provides a practical resource for anyone who may be looking to apply the Impact Framework to their own work.

The Impact Framework is an evolving approach, being continuously refined and improved based on our experiences in implementing it with colleagues in NHS England’s and NHS Improvement’s Improvement Capability Building and Delivery team and we would welcome any feedback.

The Impact Framework is an evolving approach, being continuously refined and improved based on our experiences in implementing it with colleagues in NHS England’s Sustainable Improvement team and we would welcome any feedback.


What do we mean by impact and value?

We are thinking about impact and value in terms of their everyday, dictionary definition usage:

  • Impact: A marked effect or influence. For example, ‘our regional measures have had a significant impact on unemployment’
  • Value: The regard that something is held to deserve; the importance, worth, or usefulness of something

Why is it important to evidence impact and value?

  • To justify spend
  • To provide assurances to sponsors, commissioners and stakeholders
  • It’s an essential element of all improvement work
  • To maximise our likelihood of success
  • To capture the true benefits felt by people
  • To capture learning to inform future work

Why is it hard to evidence impact and value?

  • Traditional approaches can underestimate impact and value
  • Focus on spend can lead to us to missing some aspects of value
  • System change has multiple players
  • System change takes time
  • Capturing and using evidence well takes expertise and confidence
  • We tend to have a culture of ‘getting on with it’

How the Impact Framework works

The Impact Framework draws heavily on established theory behind improvement methodology, so it utilises a cyclical or iterative approach, which is represented in the diagram below. Each of the steps are inter-related and it is expected that each programme of work would undergo several cycles during its lifetime.

The underpinning principles:

  1. Be clear about what you are trying to achieve and understand what changes
  2. There is no one absolute measure of value- focus on creating a good enough account of value at a point in time
  3. Judgements of value can, and should be made by those involved in the work, not just third party ‘objective’ evaluators
  4. Involve stakeholders in defining and evaluating value at meaningful intervals
  5. Be honest about contribution and attribution
  6. Don’t dismiss the elements of value which are harder to capture
  7. Keep it simple and transparent
  8. Focus on learning, not just accountability

Pages in this how to guide

See the links below for more information and to learn more about how to carry out each step.​​

Optional steps 

  • Capture unintended consequences
  • Attribute change