A framework to guide early planning (“the front end”) of large-scale change programmes in health and healthcare (4 March 2026)

Summary

Large-scale programmes are a major feature of health systems worldwide, and the origins of problems often lie in the very early stages of their design and planning. They can play a valuable role in driving improvement and innovation, helping to decrease unnecessary variation, inequities and waste. But, as with other sectors, large-scale programmes in healthcare can produce mixed results and can face common challenges.

To support better practice, THIS Institute has collaborated with Ipsos and The Health Foundation to develop a framework for designing large-scale complex change programmes in health and care – major initiatives run by national organisations aimed at securing improvement or service change.

This framework is designed to guide early-stage planning (“the front end”) of large-scale change programmes in health and healthcare. It helps programme teams think rigorously and systematically before major decisions are made, with the aim of reducing avoidable failure and improving chances of success. It draws on evidence from the literature on large projects across multiple sectors, national guidance and reports, interviews with experienced programme leaders, and stakeholder testing with real policy teams.