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DownloadEvaluation summary: Race and Health Observatory Learning Action Network Programme Pilot
Evaluation objectives and approach
The Health Innovation Network South London (HIN), in partnership with UCLPartners (UCLP), was commissioned to deliver an evaluation of the Maternal and Neonatal Health Learning Action Network pilot programme (LAN).
The evaluation aimed to:
- Assess the feasibility and acceptability of an anti-racism-focused quality improvement (QI) approach to address ethnic inequalities in maternal and neonatal health.
Identify contextual barriers and enablers that influence project implementation.
To evaluate the overall design and approach of the LAN programme.
To evaluate early outcomes of implementation activities.
The evaluation was delivered over 14 months, adopting a multi-stakeholder, mixed-methods approach, incorporating interviews, focus groups, surveys, documentary analysis and observations of LAN sessions. The evaluation team adapted an evidence-based framework, the Model for Understanding Success in Quality, to incorporate the Race and Health Observatory’s seven anti-racism principles. This framework, termed the Model for Improving Success in Quality, anti-racism (MUSIQ-AR), informed the approach to evaluation data collection and analysis.
Evaluation Findings
Overall, the LAN programme design aligned well with its objectives.
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The LAN approach aligned with the objective of generating and consolidating experiential learning to inform action at scale. Integrating anti-racism principles into the Model for Improvement (MfI) (an existing structured framework for guiding QI efforts) provided a pragmatic data-driven approach that supported QI project implementation. However, the approach did not always align with chosen projects (e.g., those with small target population sample sizes, or those generating outcomes over a longer time horizon than the LAN programme).
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- The programme’s four clinical areas provided a critical mass of learning for change package development in post-partum haemorrhage and maternal mental health; fewer projects tackled pre-term birth and gestational diabetes, which limited alignment with this goal.
- The training and support package provided by the LAN, comprising coaching, webinars, and in-person sessions, was praised by NHS teams for its high quality and relevance to project delivery.
Projects primarily achieved goals related to changing processes and knowledge, including:
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De-biasing protocols, e.g., updating policies and risk assessments to remove racial bias.
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- Culture shifts around increased acknowledgement of racial health inequalities within organisations, including from senior leaders.
- Staff capacity building regarding technical aspects of QI, and empowerment to speak up about inequality and to apply an anti-racism lens to other areas of maternity care improvement.
A full picture of clinical outcomes cannot be provided due to the evaluation timeframe. One NHS team reported a positive impact on post-partum haemorrhage measures, resulting in parity across ethnicities, indicating early signs of effectiveness.
NHS teams reported a series of enablers and barriers impacting QI project implementation. Framed within the five MUSIQ-AR domains, these include:
- Key enablers supporting project implementation:
- QI Project team: multi-disciplinary teams including clinical representation, data, QI and anti- 3 racism expertise, project management support and senior leadership. Dedicated and motivational team leadership and a collaborative team culture.
- Infrastructure: access to quality ethnicity disaggregated data, a resource for patient and public involvement and engagement (PPIE), and local-level funding for project implementation.
- Microsystem: frontline staff engagement and support for project implementation.
- Organisational: existing cultures of QI and/or anti-racism, senior-level buy-in and support, technical expertise from non-team members (e.g., data, translation, research).
- External: QI training and development, interest from commissioners and decision makers at regional or national levels, and external funding.
Key barriers to project implementation:
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QI project team: inability to build project teams with requisite skills, staff turnover, insufficient project team capacity, designing appropriate projects within the confines of programme clinical areas and MfI approach.
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Infrastructure: Limited access to disaggregated ethnicity data, resource deficits (lack of staff backfill, capacity constraints).
Microsystem: lack of frontline staff engagement (e.g., due to capacity constraints, varied cultural competency and lack of buy-in, limited capacity, and staff rotations).
- Organisational: challenges affecting behaviour change, lack of QI and/or anti-racism culture or support, institutional racism, competing priorities and lack of senior support.
- External: challenges of cross-organisation (system-level) working, NHS structure changes, and lack of funding.
Project team composition varied across the cohort, with varying degrees of suitability to deliver anti-racism embedded QI projects.
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Successful teams included a mix of clinical leaders, dedicated QI and data experts, and nonclinical project managers who could maintain momentum. Gaps in specific clinical roles (e.g., obstetricians, anaesthetists) and senior leadership support hindered progress.
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- The ethnic composition of teams varied, with global majority representation seen as critical for anti-racism work. The engagement of people who have relevant lived experience was mostly limited to gathering perspectives and experiences during project planning, though some teams successfully embedded lived experience partners using existing Trust infrastructure.
Programme clinical focus areas did not always align with local priorities or feasible project focus areas.
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Project teams provided mixed feedback regarding alignment between the programme’s four clinical focus areas and the programme duration and approach, as well as alignment to local priorities.
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- Projects focusing on maternal mental health, pre-term birth, and gestational diabetes experienced notable feasibility challenges due to the complex, longer-term, and/or behaviour change nature of associated pathways, which did not always align with the LAN’s timeframe or MfI measurement approach.
Recommendations
Recommendations have been co-developed with programme stakeholders, including RHO and IHI, LAN QI project teams, lived experience partners and maternity and neonatal clinical experts. A full set of recommendations will be published alongside the final evaluation report, which will be available on the Health Innovation Network South London and RHO websites in February 2026.
