I recently heard from an experienced research colleague that commissioning bodies need to 'kick evaluators out of their comfort zone'. He proposed that evaluators and researchers deliver less than they could because funders are not really engaged, interested, or skilled enough to ask for more.

As with any relationship between a client and service provider, balance must be sought between being an invisible client, who commissions an evaluation largely as a paper exercise, and being a micro-manager, who does not let the evaluation team get on with their work.

Because they have power as purse-holders, funders, donors or commissioners (whatever you want to call them) have the responsibility to lead the way for all involved.

Passion for improvement

It is easy to throw around industry buzz-phrases such as "active funders" or "intelligent commissioning", but what do they really mean? First and foremost, they mean taking evaluation seriously and embedding it centrally in our work.

At the Health Foundation, we are passionate about improving healthcare. We want to help reduce the gap between actual and best practice, identify what works in quality improvement, and contribute a body of evidence about effective quality improvement approaches and methods.

Our demonstration projects represent a key part of our approach and aim to develop and test approaches to quality improvement.

We want to maximise the potential for evaluation to generate evidence and learning to help us achieve our mission. We design new programmes with evaluation considerations firmly in mind; we commit a considerable percentage of our funding to initiatives on evaluation (typically 10 per cent); we think hard about the design features required of any evaluation; and we are demanding about what this funding buys.

Tough questions

It is not enough to know that an initiative is delivering; we want to know why it is delivering, how it could deliver better, and how it can be used as a model for others in the healthcare system.

These answers are not easy to come by, and the responsibility for finding them does not rest solely with commissioned evaluation teams. The roles of the agencies that receive Health Foundation awards, our technical providers, and the foundation itself are all fundamental. Everyone involved in the design, delivery and experience of the initiative needs to contribute.

Evaluators need to work closely with us, but we do not want them to get too close and lose their objectivity. On the contrary, we want them to generate evidence that can stand up to external scrutiny. At the same time, we do not want them to be so far removed from the intervention that we lose real-time learning about the progress and achievements of our award-holding organisations and individuals.

Having funders closely involved with their commissioned evaluations, if managed well, has distinct advantages. It can lead to faster resolution of issues that invariably occur with complex programmes, better communication, the early development of a strategic approach to dissemination and influencing, and access to expert advisers and policy makers. We think this a good approach for all involved.

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