The leap from ROI to SROI: Farther than expected?

Social return on investment (SROI) is a popular method for evaluating the impact that organizations have on society and the environment. It has its roots in finance, where return on investment (ROI) is used to evaluate investments. Over the past ten years, SROI has made the leap from a tool for building private wealth to one that advances the public good. Has it landed us in a better place? To answer the question, I describe the general approach to financial analysis, how it is applied to financial decisions, and how it has been adapted to evaluate impact. I then consider the strengths and weaknesses of SROI, and suggest how, by pushing beyond the constraints of financial analysis, it can give stakeholders voice and provide evidence of success from diverse perspectives. Along the way, I propose a conceptual model for value, a foundational concept in SROI that has been criticized by some as underdeveloped, and I include a technical appendix that identifies potential sources of statistical bias in SROI estimates. I conclude by acknowledging our growing need to incorporate efficiency as one of multiple success criteria and the role that SROI-properly implemented-can play.

What can practitioners learn from theorists' logic models?

In response to previous papers in this issue, I consider the ways that logic models of evaluation theories may improve practice. Our conceptions of how theory informs practice are colored by who we have in mind when we speak of practitioners and theorists. I offer working definitions of these roles. It is also colored by the process we imagine connects theory to practice. I present a theory-based explanation of the factors that may shape practice and describe how theorists, using logic models, may be able to exploit these factors to promote the use of their theories. Throughout, I argue that theorists are primarily responsible for the proper use of their theories just as evaluators are primarily responsible for the proper use of their evaluations. This responsibility is best fulfilled in collaboration with the larger community of evaluators. Recent methods and software allow theorists to conduct large-scale theory-building collaborations that are organized around logic models. I discuss the benefits these advances may have for the field.

Do as I say: curricular discordance in medical school end-of-life care education.

PURPOSE: Prior research indicates that medical students face significant personal and ethical challenges when they perceive differences between what is taught in class (formal curriculum) and what is practiced on the wards (informal curriculum). This study seeks to further describe the educational experience and characteristics of students who perceive curricular discordance in end-of-life care (EOLC) training. METHOD: Self-administered questionnaire among third-year medical students at a large, urban medical school. Statistics to identify the correlates of perceived curricular discordance. RESULTS: Completed surveys were returned by 141 students out of a class of 162 (response rate 86.5%). Student perception of curricular discordance was inversely correlated with student perception of educational quality (p=0.001) and their regard for institutional values (p<0.001). Student attitudes and emotional reactions did not correlate with curricular discordance, nor did student age, gender, ethnicity, or prior personal experience with death of a loved one. Students had limited role modeling and feedback. While student informal curricular experiences did not correlate with a perception of curricular discordance, an increased number of informal curricular EOLC experiences did correlate with a perception of poorer educational quality (p=0.05). CONCLUSION: Curricular discordance is correlated with a perception of poorer educational quality and more negative regard for institutional EOLC values, but not correlated with other features of student experience or characteristics. Importantly, increased informal EOLC experiences are associated with a more negative assessment of educational quality.