In my career, I have managed to avoid the path of specialization. Though, looking back, it’s not too surprising – part of the reason I chose to study anthropology is that I appreciated that it had a “four field approach” that allowed me to learn about science, culture, language, and social systems.
Basically, anthropology has proven to be the perfect foundation for becoming a polymathic systems thinker which has enabled me to learn about a range of methodologies, many of which are “tried and true” in the industries, sectors, or fields in which they were developed, and yet still largely confined to them.
I recognize that many things limit the spread of useful methodologies to new spaces – from specialization leading to lack of exposure, to high cost and access barriers for acquiring knowledge and training, risk-aversion about the new to having no urgency or seeing no need when the status quo is good enough. But, I believe that there are great opportunities being missed and squandered, because applying “tried and true” methodologies to new contexts is a form of innovation can lead to positive outcomes for organizations and collaborations that do it thoughtfully, and for the people and communities they seek to benefit.
Recently, I was reminded of this by an experience with an amazing client, the University of California, San Francisco’s PLUS: Pediatric Leaders Advancing Health Equity Residency Program. PLUS is preparing the next generation of doctors to advance health equity for children. It does this by delivering a full-time medical residency program, while also building the residents’ leadership skills and practical knowledge through community projects relating to advocacy, academic research, and program delivery.
PLUS delivers all of this training with a very small, dedicated staff (2 people – both of whom wear a lot of other hats at UCSF) and a smartly networked approach that draws upon their Center for Community Engagement, medical faculty, a Community Advisory Board, nonprofit partners, program alums, and, of course, patients.
So, when I was brought in to advise PLUS on how they could evaluate the effectiveness and impact of their community partnerships, what became clear really quickly, is that PLUS needed to be able to explain how all the pieces of the program fit together and how those pieces would result in medical residents who were prepared to be leaders in advocating for health equity.
We ended up working together to develop a Theory of Change (TOC). For those not familiar with this methodology, a theory of change is “a comprehensive description and illustration of how and why a desired change is expected to happen in a particular context. It is focused in particular on mapping out or “filling in” what has been described as the “missing middle” between what a program or change initiative does (its activities or interventions) and how these lead to desired goals being achieved.”
Now, I suspect that some of you who have worked in the nonprofit sector or philanthropy might be guffawing at the notion of a theory of change as an innovation, because it is a “tried and true” methodology that is widely used in your fields and it has been around since at least the 1990s.
However, innovation is often relative.
The PLUS program had been operating for over a decade, however prior to developing their theory of change, it had never fully articulated its outcomes, methodology, curriculum, and interventions, or the assumptions that underpinned all their work.
My work with the PLUS staff team was advisory, as I am not an evaluation expert, but have managed evaluations for programs I directed in the past. So, during the first half of 2018, I met with the PLUS staff every few weeks, shared some relevant resources on developing a theory of change, outlined a process by which they could design a TOC for their work, provided feedback on drafts and answered questions, and – excitingly – helped to incorporate the feedback they received on the TOC from community partners, residents, and faculty.
The PLUS staff did the heavy lifting, spending lots of time between our check-ins developing the theory of change, meeting with program contributors to get their feedback, and then prioritizing and translating the pieces of the TOC into survey questions so they could gather feedback, learn, and improve.
It’s a credit to PLUS’s staff that they recognized there would be great value in developing a theory of change, even though it is not their area of expertise (and they hadn’t seen it done among their peers). As we dug further into the process, the staff recognized that it could be used to:
- promote a shared understanding among the stakeholders involved of the whole program and their contribution to it,
- engage new community partners and funders in their work,
- provide a foundation for evaluating and continuously improving the effectiveness of the PLUS program’s assumptions and interventions, and
- share their methodology with other medical education institutions as a strategy to expand the infrastructure training medical residents as health equity leaders.
As a result of this work, PLUS’s Director, Dr. Jyothi Marbin has become a wonderful evangelist for the power of a theory of change. She’s been urging her colleagues who run different medical education programs that they should develop them too. And when she recently presented a draft of the PLUS TOC to her colleagues for feedback, one faculty member encouraged her to write and publish about the process of developing the TOC (which is academic speak for – this is important, useful, and innovative)!
While for me, developing a theory of change seemed like a common approach because of my experiences in the nonprofit and philanthropic worlds, in the world of medical education, it is an innovation. And what I love about that, is through my work with the PLUS staff, the process not only opened them up to some new understanding and possibilities, it did for me too!