Getting to Impact: An Evaluation Framework for Performance Improvement

Getting to Impact: An Evaluation Framework for Performance Improvement

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A performance improvement evaluation plan for Health Indicators need not be complicated. But, it must be built into the intervention at the outset.   The evaluation framework for performance improvement is organized around three sets of inter-related questions:  

  • Are you doing the things needed to do the intervention? (PROCESS)
  • How is it going? (PROGRESS) 
  • What difference is it making? (IMPACT)  

Tracking and reviewing key things as the intervention is happening helps you manage the effectiveness of what you are doing.  


Process Measures look at what is happening with your intervention so that you can spot a problem and make any needed changes.   Some of the things you may want to know:

  • Are you reaching the clients on your registry?  Documenting the attempts to reach clients on your registry (who, when, and what happened) is important information.   If after several weeks you see that only a handful of clients have been reached, it is time to change approaches.  
  • Is the intervention activity happening as planned?  Is the exercise class, health lecture, or blood pressure monitoring activity occurring?  If not, what is the problem?  Space? An absent or unreliable lecturer? Vacation break for the nurse? Knowing there is a problem when it happens will make it possible to address before valuable time has passed.  Learning about it six weeks later can result in lost momentum as interested clients drop out if a problem is unresolved.
  • Are you tracking what is happening?  If your intervention includes a weekly blood pressure monitoring activity, is weekly attendance by intervention participants being recorded?  Is each participant’s blood pressure recorded every week so that change over time is documented?  Can you read the handwriting of the person completing the tracking sheet?   


Progress Measures capture how things are going with your intervention.

  • Are the things you are seeing, what you expected?    
  • Are the clients on your registry enrolling in the intervention?  
  • Are they consistently participating in the intervention activity?
  • Are clients on track to complete the intervention? If not, why not

Tracking your progress along the way helps identify any problems that need to be addressed before it is too late.


Impact Measures will document if the intervention has helped your clients. Understanding what has changed (improved) will require, in most instances, administering a set of specific questions before the intervention begins and after the intervention period has ended (pre and post intervention).  In some instances, the pre and post questions will come from the Health Indicators survey that was administered  to identify the risks to healthy aging. 

Depending on the intervention you are doing, questions from the survey about exercise (Q.30 and 31), blood pressure control (Q.49) or diabetes control (Q. 43) are good questions to administer post intervention.  How clients rate their health (Q.41) is generally a good measure to use pre and post with all clients.  

Whichever impact measures you use, be sure the impact measurement questions have been administered and recorded for each intervention client before he/she begins and after the intervention (or the set time period) has ended.  Without a before and after measurement for each client, you will not have the data you need to see if there has been an improvement.  


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