The EFRM
The Evidence Future Ready Model
An organisational capability assessment derived from the Build. Transform. Last. philosophy. It identifies where the gap exists between understanding what good service design looks like — and having the structures, culture and behaviours to do it reliably.
What the EFRM is
Understanding a philosophy does not automatically create capability.
An organisation can know what good healthcare service design and delivery looks like without yet being able to do it consistently. Knowledge sits with individuals. Capability sits in organisations. EFRM assesses the gap between the two.
Where BTL provides the philosophy and principles, EFRM provides the organisational capability lens — asking not whether an individual can apply the principles, but whether the organisation has the structures, culture and behaviours to do so consistently, repeatedly and independently of the people who first introduced them.
"An organisation may achieve excellent outcomes today while possessing vulnerabilities that threaten future success. EFRM helps organisations understand what they are likely to achieve next — and why."
The EFRM Wheel assesses capability across eight domains, each derived directly from the BTL principles. Each domain is scored from 1 (Reactive) to 5 (Evidence Future Ready). The aggregate score places the organisation within one of five maturity bands.
The eight domains
Each domain translates a BTL principle into an organisational question.
The question is not whether an individual can apply the principle — it is whether the organisation has the structures, culture and behaviours to do so consistently.
Pathway Understanding
Does the organisation understand the whole pathway before redesigning individual parts of it? Are problems identified from the patient perspective, not from within individual service boundaries?
Learning & Adaptation
Does the organisation support learning, adaptation and continuous improvement both during and after implementation? Is implementation treated as a beginning, not an endpoint?
Co-Design & Adoption
Are those closest to the work — patients, carers and frontline teams — genuinely involved in designing solutions and creating the ownership that drives adoption?
Evaluation Capability
Does the organisation design evaluation at the beginning of every service and build evidence deliberately and consistently over time? Is the future evidence problem addressed by design, not by default?
Stakeholder Alignment
Does the organisation have a clear and shared understanding of its stakeholders, their needs and the problems it is trying to solve? Are the right people consistently involved before solutions are designed?
Problem Definition
Does the organisation have the structures, leadership and discipline to define problems clearly before designing solutions? Is complexity pursued only after clarity has been achieved?
Value Demonstration
Does the organisation use evidence to demonstrate the value of its services, secure their future and create credibility with decision-makers? Can it defend what it has built when investment decisions arrive?
Reproducibility & Scale
Does the organisation have the capability to repeat, scale and sustain what works, and to transfer its learning — including the thinking, not just the model — to future service design?
Future Evidence Design — Separate Diagnostic Tool
Sits alongside the EFRM Wheel as a dedicated service-level diagnostic. It assesses whether evaluation has been built into a specific service from the outset — treating evidence as a design activity rather than a measurement activity. The Future Evidence Design Checklist is available separately through EFRM Consulting Ltd.
The mapping
BTL principles and EFRM domains.
Each domain was derived directly from the BTL principles — translating what practitioners need to do into a question about what organisations need to be capable of doing consistently and repeatedly.
| BTL Principle | EFRM Wheel Domain |
|---|---|
| BUILD — Principles 1 to 4 | |
| Principle 1: See the Whole Pathway | Pathway Understanding |
| Principle 2: Assume Nothing | Learning & Adaptation |
| Principle 3: Design With Those Closest to the Work | Co-Design & Adoption |
| Principle 4: Design Evaluation at the Beginning | Evaluation Capability |
| TRANSFORM — Principles 5 and 6 | |
| Principle 5: Ownership Drives Adoption | Stakeholder Alignment / Problem Definition |
| Principle 6: Implementation Is the Beginning, Not the End | Learning & Adaptation |
| LAST — Principles 7 and 8 | |
| Principle 7: Evidence Secures the Future | Value Demonstration |
| Principle 8: Repeat, Scale, Sustain | Reproducibility & Scale |
| BTL Original Concept | |
| The Future Evidence Problem | Future Evidence Design (Separate Diagnostic Tool) |
Score your organisation
The EFRM Wheel
Rate your organisation on each of the eight domains, from 1 (Reactive) to 5 (Evidence Future Ready). Score honestly, ideally with colleagues, and base each score on what your organisation does consistently, not on its best example. Your wheel and aggregate score out of 40 build as you go.
The EFRM Wheel appears in Build. Transform. Last. Your scores stay in your browser and are not sent to us. Make a note of your aggregate score before you request the guide.
Maturity levels
What does your score mean?
Your aggregate score out of 40 places your organisation in one of five maturity bands. The purpose is not judgement. It is organisational insight. The EFRM Interpretation Guide explains what each band means, the risks it carries, and your priorities for moving up.
Interested in applying the EFRM?
The EFRM is being developed as a consulting offer. If you're interested in exploring what it could mean for your organisation, get in touch — early conversations are welcome.