Guest Blog: Do we need another framework? (TLDR: yes!)

banner featuring icons from the quality framework: signposts, a key, music, a leaf, an eye, a question mark and a pie chart
part of the Creative Health Quality Framework design, by Jennie Ives

CHWA Non-Exec Director Rosie Dow reflects on how our new Creative Health Quality Framework complements and adds to other frameworks and toolkits now available to the sector.

I started working in creative health in 2012, when I was taken on by a cancer charity to set up a large network of choirs for people affected by cancer.

Being 28 years old and having never come across a project like it, I was pretty much going in confidently clueless. Luckily the charity had already piloted one choir, so that gave me a bit of a roadmap for approaching the next 17 (!), but my team and I were largely on our own when it came to figuring out how to make the choirs a good experience for members. The considerations were vast: choosing songs, recruiting choir leaders, working with vulnerable people, maintaining harmonious (and melodious) groups, management, funding, research, engaging health partners… and so on. We did it all pretty much by instinct, learning as we went and taking all the grey areas day by day: we felt our way through it. Looking back, that was a huge leap of faith. And we didn’t always get it right.

Things are – happily – quite different now. For a start, local and national networks like CHWA now exist, offering connection points that help practitioners in this field navigate these grey areas in a collective and collegiate way. This gives us space to learn from and support each other and help us articulate and advocate for what we do.

There are also lots of frameworks and toolkits available now to help practitioners, project managers, and health professionals design and develop projects. Notable are Dr Daisy Fancourt’s book Arts in Health: Designing and Researching Interventions, Nesta/Arts Council of Wales’s HARP Approach / Playbook and The Beaney’s Health and Wellbeing in Museums Toolkit – to name but a few. These all offer valuable practical advice, step-by-step guides and collaboration tools that help set projects up for success. (CHWA’s website has a longer list of resources like this here.)

For health leaders, funders and policymakers there are the National Centre for Creative Health’s Toolkit for Creative Health Champions, the HARP Recommendations and CHWA’s Thriving Practice Model. Again, all offer very practical steps these groups can take to help practitioners and project managers build successful, sustainable projects. This includes advice on investment, promoting diversity, and growing the evidence base.

But there’s more to creative health work than just what we do. Plans, strategies, and partnerships are crucial, of course, but it’s also about how we do things. About the values, care, and consideration we put in to make sure the experiences we create are accessible, enjoyable and of course beneficial and for the people we want to support. This combination of the ‘what’ and the ‘how’ is what I would call quality.

To use the choirs example, we had many amazing musicians apply for the choir leader roles, all of whom could teach novice groups to sing to a good standard. However, the ones we employed also had empathy, diplomacy, approachability, and a whole host of other interpersonal skills that made them great for the job. In time, we developed a peer learning scheme for the choir leaders in which we expressly articulated this combination of skills in the three values: fun, fulfilment, support.

But that was just for one project: how do you translate that to something that spans all creative health work?

Clearly the intricacies and individualities of our work in creative health make quality a subjective concept that’s difficult to articulate, but I still think it’s important to try, for several reasons. First, because we can all imagine the harm it could do if quality isn’t there in a creative health project.  Secondly, because of the strong relationship between quality, impact, and evidence. Thirdly, because it will enable health partners, funders and policymakers invest in creative health with more assurances and clarity about the work they are supporting.

That’s why I think the launch of CHWA’s new Creative Health Quality Framework is so significant. It builds on the frameworks that have gone before but underpins the ‘what’ with a set of eight guiding principles for ‘how’ to approach quality in creative health work. It then gives clear guidance about how all partners involved can live and breathe these principles in practical terms. Far from being a checklist for accreditation, or a set of binary markers of good and bad, this grounding in principles means the Framework can guide us towards offering the best possible experiences and supporting people in an inclusive, safe way. It’s also something that can be adapted and applied to different projects and settings, and used for evaluation.

Furthermore, the Framework will also help health partners and funders to better understand their role in supporting quality, and knowing what quality looks like. This helps us all to manage risk and avoid pitfalls whilst focusing on what’s exceptional about what we do. Of course, we’ll always be taking those leaps of faith  - that’s what’s so special about creative health work  - but at least now we have this Framework to help support us through the leaps. Now that’s something I really wish I’d had back in 2012!

Congratulations to Victoria, Jane and the Steering Group who informed the Framework’s development.


By Rosie Dow, Arts and Health Consultant and Non-Executive Director of CHWA

Rosie's consultancy work includes mentoring and coaching, strategy, income generation and data/evaluation for creative work in health settings. Her background is in creative health leadership and research, having developed Tenovus Cancer Care’s ‘Sing with Us‘ programme in Wales then gone on to lead Military Wives ChoirsBreathe Arts Health Research and the ‘HARP‘ innovation and funding programme for Nesta/Arts Council of Wales. Most recently Rosie oversaw engagement and policy for Dr Daisy Fancourt's Research Group at UCL. Her current clients include Arts Council of Wales, WAHWN, NHS Charities Together, the National Arts in Hospitals Network, the Global Cultural Districts Network and Breathe Arts Health Research. Rosie is also a musician and community choir leader.