Helping PDSA agree a new Theory of Change and Measurement Framework

PDSA (The People’s Dispensary for Sick Animals) was founded in 1917 to provide free veterinary care for the pets of people suffering financial hardship. Over the ensuing 105 years, the charity has grown to 48 pet hospitals providing 1.8million free veterinary treatments a year.

In 2019, the charity wanted to improve its impact reports to its main funders, which include the People’s Postcode Lottery. Their reports had tended to focus on quantitative outputs without necessarily getting across the compelling human impacts that frontline staff witness every day.

In 2021, the organisation went through some radical changes caused by the pandemic. Its vision and mission had evolved, and its previous theory of change needed updating in order to tell a more cohesive and persuasive story to funders (and potential funders).

CORE PURPOSE

As well as treating the pets of those suffering financial hardship, the charity has prevention initiatives to help keep pets healthy and key online resources such as their digital education programme for schools and Pet Health Hub for pet owners. Amongst other things, PDSA also operates high-street charity shops, an awards programme and the PAW Report – the UK’s largest annual assessment of pet wellbeing.

These multiple departments and functions mean there were differing views across the organisation about how to define its core purpose – which was the first stage of Trust Impact’s work with the charity in July 2022.

“We have so much wonderful work going on and because everybody is so passionate, we were probably guilty of wanting to talk about absolutely everything,” said Rebecca Ashman, PDSA’s Veterinary Engagement and Communications Manager.

“It was really helpful to have Trust Impact’s external view and guidance on the core message we should be talking about. They helped us strip everything back, focus on a few things and express those well.”

Trust Impact’s purpose alignment tool helped stimulate rich, healthy and focused debate. Our Lead Impact Consultant, Lara Sinha, reflects: “One of the key questions was, ‘Are you a charity for animals, or people, or both?’ The charity is ultimately about relief of poverty and easing owners’ anxiety about pets falling ill and needing expensive treatment – so it is about helping people by helping their pets. That took a little while to work through.”

After much finessing, the new purpose was defined as: to provide veterinary care for pet owners experiencing financial hardship so that people and their pets thrive together.

Rebecca reflected: “I love it because it covers so many different aspects of our work; how we want to help people thrive with their pets and how, as a veterinary charity, we want pets to be healthy. The phrase ‘thrive together’ covers physical and mental health and wellbeing and the special human-animal bond.”

‘MASSIVE LIGHTBULB MOMENT’

Next, Trust Impact helped PDSA work on its theory of change, starting with developing a clear framework to describe what they do.

Previously, the charity used the acronym P.E.T.S (Prevention, Education, Treatment, Support) to describe its delivery model, but during a series of workshops, the leadership team experienced what Rebecca called “a massive lightbulb moment” in redefining its activities and outputs.

“I couldn’t quite believe how we turned everything on its head and thought about everything differently – and that everyone was in agreement so instantly,” she said.

The epiphany came in the third workshop. It was a realisation that the P.E.T.S acronym was pigeonholing each of the charity’s functions, when in fact they were all interdependent. “We realised that pet owners don’t necessarily know they need prevention without education; some treatments are unnecessary if you have prevention, and if pet owners are educated around prevention, their pets don’t need treatment!” explained Rebecca.

“We realised we had been squeezing these different aspects into boxes and that actually wasn’t the right framework. It didn’t really describe us accurately.”

Instead, Trust Impact suggested that the definition of all of PDSA’s activities should be based on the public health model’s primary, secondary and tertiary categories of prevention.

The charity’s various functions were re-categorised thus:

• Primary Prevention – including PDSA’s online Pet Health Hub, Animal Wellbeing Report, pet insurance and research, policy, campaigns and awareness work
• Early Action – including vaccinations, neutering, worming and microchipping and the PDSA Pet Care Scheme
• Complex Intervention – including the PDSA pet hospitals, medical, surgical and emergency treatment fund

Each of these activities then had several outputs to measure and demonstrate PDSA’s impact in those areas. For example, ‘Primary Prevention’ included the number of awareness events and the value (£) of prevention measures; ‘Early Action’ included numbers accessing the Pet Care Scheme and the numbers and value of procedures undertaken by owners; then ‘Complex Intervention’ outputs included the number and value of emergency treatments.

“I don’t know why we didn’t think of it ourselves!” said Rebecca. “It was massive. This was a different way of thinking about things and articulated what we do in a far more sensible way.”

Lara, who facilitated the workshops, said: “It was a key moment. It really helped PDSA understand what their model was all about and they were able to see things in a different way. It elevated the theory of change to something they were much more comfortable with.”

OUTCOMES

When we next sat down with the PDSA leadership team, we fleshed out the charity’s outcomes for its beneficiaries. This is usually the most protracted part of the process with clients – but also the most important. Charities often have hundreds of KPIs which don’t always tell a compelling story about their impact. Ultimately, telling more coherent stories about how you’ve changed people’s lives builds trust with beneficiaries, gives funders confidence in the value of their investment and helps attract new funders too.

For those reasons, Trust Impact’s philosophy is that a charity should ideally measure between three and five outcomes. After several workshops, PDSA alighted on three (with seven sub-sections):

• Improved owner wellbeing
• Improved pet wellbeing
• Pets are valued more in society

Although its services unarguably reduce costs and financial anxiety for pet owners, there was debate over whether PDSA could prove its veterinary care could be attributed to owners’ general improved mental, physical and social wellbeing. Trust Impact had conducted interviews with beneficiaries and their feedback was the decisive factor in concluding that there was a direct link.

There was also a question on attribution with the third outcome. Pets being ‘more valued’ may sound nebulous, but it was seen as an important outcome of the charity’s primary prevention work on policy, campaigns and raising awareness – and the leadership team felt it was measurable through its research.

“Defining our outcomes in this clear way will help us think about how we talk to clients, bring out their stories and feed that back into our services,” said Rebecca. “It will definitely articulate our impact much better to funders and hopefully open up more avenues to new funders, as funding opportunities in animal welfare are relatively limited.”

WHAT’S NEXT?

The next stage was creating a focused impact framework to measure performance against the outcomes on the new theory of change. This process (which, at the time of writing, PDSA are still undergoing) is called ‘Measure What Matters.’

The process ascertains what data needs to be collected to demonstrate their success in achieving their desired outcomes, how it should be collected, how to report on it and how it will inform their long-term strategy.

Trust Impact is delivering its final report in January 2023. As Rebecca says: “That’s when the hard work will really begin in terms of implementing the recommendations.”

‘A BRILLIANT PROCESS’

“We couldn’t believe how quickly Trust Impact really ‘got’ us as a charity,” reflects Rebecca. “I sent them so much complex information but they were able to get under the skin of the organisation and pull everything together. It’s just been a brilliant process.”

“At the start, you think, ‘How is this process going to work?’ As within every charity, we’ve got lots of different internal departments and competing perspectives. But it has really brought us together and helped us re-set after the pandemic.

“We’ve really nailed down what our core purpose is, where we want to focus our energy in measuring impact and how we talk about what we do. It’s given us lots of clarity, renewed drive and commitment across the organisation. They have made a huge difference. We will be in a far better position to make a difference for pets and their owners.”