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Case Study: The Arthritis Society

“Our theory of change serves as a touchstone document for the organization. We are now more aligned on the impact we seek and where to focus. It will continue to guide our thinking for the next 3-5 years.” – Joanne Simons, Chief Mission Officer & Executive Director - Ontario, The Arthritis Society

The Arthritis Society is an organization that provides leadership and funding for research, advocacy and solutions to improve the quality of life for Canadians affected by arthritis. It is the largest non-government funder of arthritis research in Canada. The Arthritis Society’s vision is for individuals to live well while creating a future without arthritis. 

Strategic Challenges

In the summer of 2014, The Arthritis Society was seeking to more specifically define success for the organization within the next 5 years. It wanted to look at its work more holistically and to better understand both where to focus its activities and how to allocate its scarce resources to deliver the greatest impact for Canadians living with arthritis. The team was seeking advice with respect to the appropriate framework and tools to assess its current mission-related activities and to provide direction for the future. There were two central questions The Society was seeking to answer:

  • How do we define success in relation to the stakeholders we engage?
  • How do we translate these success measures into a focused, intentional set of activities?

Developing a Theory of Change

Innoweave coach Robin Cory of Colbeck Strategic Advisors worked with a team of senior leaders at The Arthritis Society, including CEO Janet Yale, over a three-month period in fall 2014. Through this process, the team addressed their strategic questions through the development of a Theory of Change. Robin then continued to support some key aspects of their work to bring that framework to life throughout 2015.

Defining The Arthritis Society’s Intended Impact

The first phase of work with The Arthritis Society was to determine the stakeholders that would be the focus of its efforts, and the outcomes it aimed to achieve over the next five years for each group: 

In addition to confirming the groups it would engage through its work (in the table above), the team also clarified the groups that would not be the primary focus of The Society’s efforts over the next three years. These included: employers, families of people with Arthritis and General Practitioners (GP).

The team looked to available data to help inform some of these difficult trade-offs. For example, the evidence indicates that people with arthritis are 5 to 8 times more likely to seek advice from their pharmacist than their GP or specialist. That led them to recognize the opportunity to train pharmacists and other front-line healthcare professionals with whom these consumers are most likely to interact. The Society also reviewed data regarding the supply of rheumatologists over the next five years. In looking at the average wait times to see a specialist, they concluded there was an important role for The Society to play in increasing the number of rheumatologists in Canada. This led to a decision to focus on building incentives for internal medicine residents to choose rheumatology as a specialty.

This thinking was captured in The Arthritis Society’s intended impact statement:

By 2020, as a result of the work of The Arthritis Society, Canadians with arthritis will live well because:

  • The number of empowered self-managers* will have doubled,
  • They will have increased access to care* provided by arthritis-trained healthcare professionals*
  • Public policy will better reflect their need*, and
  • Discoveries* will have advanced the understanding and treatment of arthritis.

Glossary of Terms

To support this statement, the team defined the key terms (those with an asterisk). These definitions enabled the organization to align its language and become clear on the articulation of the outcomes they seek.

  1. Empowered self-managers:

    i) Know where to get and have ready access to current, evidence-based knowledge about arthritis and the management of arthritis, and its symptoms and impact and/or

    ii) Know where to find community, supports and tools that enhance their ability to self manage, and/or

    iii) Have the confidence to make self-management decisions and provide input to others who have power over their ability to live well.

  2. Access to care: Our goal is to increase the number of arthritis trained healthcare professionals so that people with arthritis will have access to cure in their community.
  3. Arthritis-trained healthcare professionals: 5,000 Pharmacists, PT's, OT's, Nurses and Chiropractors will be better equipped to identify arthritis and apply evidence based practice relevant to their scope. Ninety-five new internal medicine residents choosing rheumatology.
  4. Public policy will better reflect their needs: Government will respond to policy recommendations proposed by The Arthritis Society and implement new policies that will benefit individuals with arthritis.
  5. Discoveries: New knowledge or insights into the causes, manifestations and/or treatments of arthritis.

“The Arthritis Society now has clarity of purpose with respect to our mission focus for the next 5 years. Everyone in the organization knows and understands the outcomes we are committed to delivering and their role in achieving our intended impact to improve the lives of people with arthritis. In turn, this facilitates choices about the allocation of scarce resources and enables organizational alignment around what matters most to our success.”

– Janet Yale, President & CEO, The Arthritis Society

Theory of Change

Using the content in its intended impact statement as the frame, the team articulated what The Society aimed to do to achieve those outcomes in the form of a Theory of Change framework. 

Near-Term Implications

Following this work, The Arthritis Society made several key decisions about its programming and direction for the future.

  1. The team revised or eliminated programs that were not effective or did not drive towards its intended impact. The Society became clearer as to where to focus its activities and resources.
  2. The team determined that it was important to expand the channels for the delivery of The Society’s self-management programs. The Society decided to improve its reach through the training of pharmacists and other front-line health care professionals, through the implementation of wellness programs in the workplace and through the expansion of its online tools and resources.

Where are they now?

The Arthritis Society is currently using its Theory of Change as a means to ground decision-making in a number of key areas.  Most importantly, the organization is using the framework to develop evaluation tools that will allow it to determine the efficacy of its activities.  For each program, The Society is developing measures of program effectiveness as well as specific impact metrics.  Collectively, these will serve as the ‘mission impact’ bottom line and allow the organization to report on its progress towards its 5-year goals as well as identify opportunities for improvement.  

The Society has also developed an infographic that clearly and simply articulates its Theory of Change and intended impact in terms of its “Cure, Care and Community” focus.