Can social franchising deliver impact at scale in health and care?

As part of the Exploring Social Franchising programme, with the Health Foundation and four carefully selected teams, Spring Impact set out to explore whether social franchising approaches could enable local-level health and care initiatives to improve care for more people across the UK.

IRISi, PINCER, PROMPT and Pathway have all completed the design stage of Spring Impact’s five-stage replication process. Each team has designed its own bespoke social franchise model, considering aspects such as who adopters will be, what support they will need to provide and how they will manage quality. The teams are creating systems and documents that will enable them to put their bespoke model into practice and hope to pilot them soon.

A different approach

The programme's aim is to discover if, and how, a social franchising approach can be used in health and care in the UK. We’re starting to understand what makes this approach to scale different for health and care.

A defining feature of the approach is that it tackles the question of scale from the perspective of impact, rather than only reach. Just as a commercial franchise wouldn’t judge success purely on the number of branches it opened, but would look at the profit and profitability of each branch, a social franchise in health and care should be judged on its ability to deliver excellent health care to patients at scale, not just how many locations it has been rolled out to.

How can social franchising deliver impact at scale?

Many features of social franchising make it an innovative and potentially effective approach to scale in health and care.  In the design process, two features were highlighted as distinctive to the team’s previous approaches:

• identifying and replicating an initiative’s core elements
• being selective about who can adopt the initiative.

Identifying the core

Every initiative has elements that are essential if it is to deliver impact at scale. At Spring Impact, we call this the ‘core’, and during the design process we helped projects to identify their core.

PINCER is a pharmacist-led intervention that aims to reduce high-risk prescribing in general practice. The intervention involves using an IT tool to identify patients at risk from prescribing and drug-monitoring errors. Pharmacists, trained in the PINCER approach, work with each general practice to develop an action plan to address the issues identified and support the general-practice staff to implement the action plan. The PINCER trial demonstrated that the intervention is effective at reducing a range of medication errors in primary care. It also showed that, to achieve its intended impact, an essential part of the intervention was that it was pharmacist-led. This became part of PINCER’s core.

PROMPT is an intervention that improves multi-professional working in maternity units and with the aim of reducing preventable harm to mothers and babies. The team had previously focused on scale through a train-the-trainer model, enabling units to run local training days. However, as we discussed with the PROMPT team, outcomes are only achieved when the principles from this training are implemented on a day-to-day basis, so replicating the behaviours and tools need to be part of PROMPT's core. 

Selectivity

Social franchising’s focus on impact requires selectivity. It is important to find adopters who fit the profile and characteristics needed to implement the core. Selectivity is a step away from traditional dissemination models that allow anyone to replicate an intervention, even though they may not be able to replicate its impact. For innovators, it may mean saying ‘no’ to some prospective adopters so they can focus on adopters who have the potential to deliver impact at scale.

IRISi is a social enterprise established to promote and improve the health care response to gender-based violence. The IRISi team realised that, to improve the identification of women experiencing domestic abuse, they would need partner organisations to engage with IRISi and local stakeholders for multiple funding cycles. Suitable implementation partners would only be those committed to doing this and working towards long-term impact. Critically assessing the network of current partners through this lens may mean that some current partners do not meet the full requirements for the new direction. However, IRISi recognises that, even though this may mean the network doesn’t expand in the short-term, it will ultimately create more impact.

Pathway is a charity running a ‘homeless-team-in-a-hospital’ programme. The team has received interest in their model from clinicians, commissioners and public health professionals across the country, but the Pathway core model is only suitable for locations with high levels of homelessness. Pathway will therefore only select franchisees from locations that need Pathway’s core model, targeting time and resources to where the intervention has the most potential for success.

What next?

Designing for impact at scale, rather than just reach, is a key mindset change for the teams. Effective solutions are coming up against systems and structures that incentivise reach rather than impact. Making the search for scale more about impact will be a wider challenge for health and care. 
It’s an exciting time for the teams and we look forward to continuing the journey together. 

We welcome anyone who is interested in taking part in this conversation to contact us.

Martha Paren is Director of Health at Spring Impact