Evaluation of our Model of Behaviour Change

The Roots of our Model

Our model of behaviour change is rooted in an education programme called Compassionate Connections (2011-2015) designed to support culture change within maternity services in line with government policy (Refreshed Framework for Maternity Care in Scotland).  The scale and scope of this programme offered the luxury of time and resource to build on ideas formed from many years experience of using drama and storytelling to support culture change.

Compassionate Connections was used across further and higher education, health boards and local councils to address a whole range of topics related to compassionate approaches to care (child protection, health behaviour change, strength based approaches, communication, team working and so on).

As the team behind Compassionate Connections, we’ve further refined and strengthened the approach for Storyworlds Life, developing our model of behaviour change.


Over the course of four years, the programme was externally evaluated twice to find out what practitioners thought of the approach and what difference it made to practice.  Both evaluations demonstrated the effectiveness of the approach in transforming practice.

A key strength identified was the use of emotive dramatized stories that connected with individuals, linking values, judgements and behaviours with outcomes. They reflected real-life scenarios which could engage, entertain and challenge learners. In one evaluation, involving 1200 participants, 95% reported enjoying the experience of learning from the stories (SMCIA PCA – Evaluation of Compassionate Connections 2014).

Both evaluations showed that the learning process itself provided a safe environment in which people could discuss sensitive and challenging issues fundamental to culture change and deliver care in a compassionate way (Smith & Harkness 2015). A further case study with Women and Children’s Services, NHS Ayrshire & Arran described how managers and staff had used Compassionate Connections to transform their service. Staff attitudes were challenged as they learnt about the characters and understood how their own judgements shaped their approach to care.  As the Associate Director of Nursing said, the first noticeable change was in the atmosphere in the unit – “you see the conversations changing” – as staff recognised their own power in creating a more compassionate environment for one another as well as for individuals and families coming into the ward.

What did strategic leaders think?

Since Compassionate Connections was a national programme, there was a lot of interest at strategic level – within policy, research, education, health care, social care – in the potential of this approach to meet their respective needs.  A national event in 2015 brought together all those people who had been involved in developing, guiding, implementing and evaluating the approach.  They recognised how the approach could support them to improve relationships between professionals, organisations and the public and build more integrated, collaborative services.

We’ve talked about relationship based care, person centred care, but this actually gives us a way of making those connections with others compassionately. The NHS in England has become quite an alienating organisation and we saw the effects of that through the Francis report. We need empathy with each other and understanding. Compassionate Connections is crucial to that. It is hugely aspirational and inspirational and will have long term effects.  (President, Royal College of Midwives)

A policy leader, Scottish Government:

I don’t think there is much of a choice about us applying this type of methodology. We have all the improvement frameworks we need. We have the policies that we need. It is quite clear that what makes things happen is relationships. Compassionate Connections helps us to think more and more about relationships and link that to outcomes and how we can improve working together and working with children and families.

A University Dean of School of Health and Social Care:

[This approach] has got real potential to help sectors and agencies to work together. We may have shared goals but we have different philosophies, different approaches and often a very different language. We have to use resources like this to help us develop a common language and understand the contribution we all make to the experience pathways and outcomes for women and families.

Next Steps

At Storyworlds Life, our aim is to design Tools for Change that are practical, effective, enjoyable to use and that build on people’s existing creativity, skills and experience.   We took notice of all the evaluation comments about Compassionate Connections – as well as what we know about the use of stories and drama for development – and used those to shape our story based approach to behaviour and social change.

As we go forward, evaluation continues to be a core activity for us and for those who use our Tools for Change.  Organisations who pay an annual license to access all our Tools for Change automatically pay into an evaluation fund which anyone can apply to for support in evaluation.  What we discover we’ll share through our website.


(Practice changes) were identified as actively doing something differently but also adopting a different way of thinking, being mindful of situations and needing to reflect on practice, as well as a heightened awareness of how their response impacted directly on outcomes. The data highlighted that these changes occurred irrespective of role or seniority within organisations.

(Smith and Harkness, 2015)

(this approach) will help us to take a genuine asset based approach to things, to recognise people’s strengths rather than deficits and then to work with them.

Child Health Commissioner, NHS Tayside

The benefit of having everyone participating together using the same thought provoking materials – the health care assistants, midwives and secretary alongside the ward manager who might manage sixty odd staff – the benefit is that it helps them understand and appreciate one another’s roles in the organization.

Midwife, Women and Children's Services, NHS Ayrshire and Arran