Outcome Mapping (OM) is an approach to evaluative thinking and practice, arising from a holistic and interconnected understanding about development and social change.
Sustainable Change in Focus
Outcome mapping's design represented a paradigm shift away from conventional planning, monitoring and evaluation approaches, which are typically linear, and reductionist in terms of understanding cause-and-effect. The philosophy behind the method grew out of the global sustainability movement of the 1990’s that defined the rights of people to be involved in shaping the development of their economies and to centred be leaders in safeguarding their common environment. Outcome Mapping assumes that development happens through behavioural change and sustainability requires changes in the behaviour and relationships of actors across a system. OM is in part an approach that supports envisioning and facilitating continuously evolving relationships and interactions between the key actors in our systems to encourage sustainable change. In essence, OM strengthens participatory empowerment and collaboration processes where people, groups, organizations and networks embrace different perspectives and build their own collective well-being.
The method is dynamic and continuously being adapted for purpose by practitioners in over 155 countries. Since 2005, an independent global network of changemakers, the outcome mapping learning community, continue to evolve and adapt the practices and tools.
Discovering the tools to facilitate Outcome Mapping was a game changer for me. It introduced me to a theory of change based on advancing people and groups to envision their ideal future, and to deeply imagine the enabling supportive system partnerships they want to see in place. OM provides the steps to partner and influence the changes in relationships, actions and practices that demonstrate observable progress toward the ideal future systems. Working for over 5 years with rural community radio broadcasters in Indonesia and Kenya had taught me to appreciate the seemingly insignificant encounters and undervalued changes in people’s relationships that can nourish community empowerment processes. I understood that transformative change can happen through relationships when there is also accountability to the people and groups experiencing barriers, from poverty to all forms of discrimination and bias. This blurry picture from a rural development project in Nicaragua, is a community members’ drawings about connections between the community and the municipality before and after the campaign to promote birth registrations. What we see is that there are specific people and interactions at the end of the project, instead of buildings with lines between them at the beginning.
How we understand and support sustainable system change and specifically what we value, and measure is crucial. It is one thing when individuals in a neighbourhood show up to your women’s self-help meetings, and another thing all together for the women to organize and hold their own on-going meetings. Sustainable change is built by people and their self-driven and on-going actions and interactions. I could never understand why in evaluation we often only ask, “Did we accomplish what we planned?”, and exclude our own changes in understanding and beliefs as impacts and key results. We can’t be system change makers without being critically reflective about our own practices and relationships, and without continually learning and adapting ourselves. For sustainable system change the unintended and nuanced transformations in relationships are system outcomes and cannot continue to be discounted in our evaluation methods as less valuable “process” results.
Sustainable Changes in Equity and Inclusion in Health Care
To evaluate the transformational changes underway in the health system to achieve equity and inclusion we need learning-oriented and adaptive methods that strengthen the change processes associated with building a culture of equity. This requires using equity informed planning and evaluation approaches, including the capacity to routinely collect relevant socio-demographic data and conduct disaggregated, intersectional analysis of data to understand and overcome health disparities. For example, we disaggregate health care data about people’s access, experience and health disparities using intersections of race, gender, sexual orientation etc. Getting people to gather the right data and use the data effectively for improvement is important.
However, a culture of equity also requires designing and evaluating large-scale organizational changes using systems thinking as adaptive challenges. We need to adopt methods to help us to see changes in our systems that are unexpected or unplanned and allow us to monitor and evaluate who specifically is changing, and in what ways the changes demonstrate significant patterns of progress. Outcome Mapping can be a preferred method for organizational change processes in circumstances where the context is complex and the pathways to success are unpredictable. Such is often the case with building organizational capacity for equity and inclusion in the health care system. The organizational culture (stereotyping, bias, privilege) and the practices of inclusive leadership and cultural humility are dictated by the context and the needs of each organization.
The organizational practice changes include new inclusive structures and mechanisms, and also require leadership from diverse perspectives and ongoing critical reflection, humility and learning. This organizational equity and inclusion work can be challenging to predict and to evaluate, and the transformational journey cannot be mapped in linear and incremental ways. Those in positions of power are unlikely to know the steps out of a system that is biased by historical discrimination, conscious racism and privilege.
Here is where the Outcome Mapping philosophy and tools can help shift the focus to systems thinking by:
- Envisioning equity and inclusion primarily through the perspectives and motivations of people and groups with experiences of oppression and inequity;
- Co-designing, monitoring and evaluating changes in the on-going relationships that matter most to the people and groups facing barriers and inequities in the health system.
Learning and Evaluating On-Going and Interconnected Relationships
Next year marks twenty years since the Canadian International Development Research Centre (IDRC) introduced Outcome Mapping. It is still considered amongst the groundbreaking international development methods used to support system change in complex contexts. Outcome Mapping, and its ally Outcome Harvesting, developed by Ricardo Wilson-Grau for monitoring and evaluating unplanned and continuously evolving social change work, share unique core concepts. These common concepts focus on following outcomes of changed relationships, practices, and policies of system actors within a particular sphere of influence, rather than focusing on monitoring and evaluating the activities, outputs or even the longer-term impacts of interventions. When used in combination, Outcome Mapping and Outcome Harvesting are uniquely positioned for equity-focused and participatory design, monitoring and evaluation of systemic change initiatives.
Outcome Mapping’s intentional design process helps us to make system level decisions about who to include and partner with, based on our intervention's limited sphere of influence, and grounded in prioritizing equity perspectives about what matters most and what outcomes are significant in our on-going journey to an equitable future. As I learned in my early use of OM fifteen years ago for building respectful relationships and community empowerment, we need to use new tools that help us pay attention to our own learning, and value the nuanced qualities of our system change efforts. In health care this means combining the drive for disaggregated and intersectional health equity data with intentional design and accountability to outcomes as changes in on-going relationships and power with people and groups with differing experiences of privilege, inclusion and discrimination
Take Your Learning Further
Explore Outcome Mapping
Learn more about Outcome Harvesting
For an overview of these methods visit Better Evaluation
Outcome Harvesting principles to enhance equity and Inclusion in health care organizations
Read Strengthening Evaluation Literacy – participatory and collaborative evaluation
Read What we know so far: Sets of Principles for Evaluating Systems Change Efforts
- Join Tamarack in Vancouver for our new Participatory Evaluation workshop