aes26 International Evaluation Conference

Author: Cally Jennings, Commission On Excellence And Innovation In Health
Change in complex systems rarely fails because of a lack of ideas. It fails because people do not share a common understanding of what needs to change, or why. This presentation describes a pragmatic, participatory process used to develop shared priorities for improving cancer clinical trial start‑up across South Australia.

In 2025, the South Australian Comprehensive Cancer Network, working with the Commission on Excellence and Innovation in Health, led a statewide review of ethics and governance processes for cancer clinical trials across public, private, and regional providers. The aim was to develop a shared understanding of how the system operates in practice and to identify agreed priorities for improvement.

A mixed qualitative approach, which included structured interviews, sponsor surveys, comparative system mapping and facilitated workshops, was used. These methods were selected to identify variation across sites, highlight common bottlenecks, and draw on interstate and international examples to explore what good could look like. The findings were synthesised into a concise set of system‑level insights and tested through collaborative workshops to identify a small number of priorities that formed the foundation of a broader reform program.

The presentation will share three lessons:
1.How participatory process methods can build shared understanding and readiness for change.
2.How participatory approaches can promote ownership but also reveal the limits of readiness for change.
3.Why even well designed, collaborative processes must demonstrate early wins to build and maintain trust.

Designed for a foundational to intermediate audience, the session will invite participants to reflect on balancing rigour with pragmatism, including exploring how early evidence and shared insight can move complex systems from talking about change to taking the first steps.