The PEASI methodology is a practical, problem-first approach to designing and evaluating change. It helps individuals, teams and organisations define the problem they are trying to solve, identify the conditions required for change, select defensible activities and specify how success and impact will be recognised.
Most planning processes begin too late.
A problem is noticed, an activity is proposed, and attention quickly turns to implementation. A new programme is established, a training package is commissioned, a digital platform is purchased or a working group is formed. Only much later does someone ask whether the activity addressed the problem that actually needed solving.
This is the Solution Trap: the tendency to move directly from recognising a problem to selecting a solution without doing the diagnostic work in between.
PEASI™ provides a practical way to interrupt that pattern.
What is the PEASI method
PEASI stands for:
- Problem — What is going wrong, for whom, and why?
- Enablers — What conditions must be present for change to occur?
- Activities — What should actually be done?
- Successes — What early evidence will show that the activities are working?
- Impact — What meaningful change should result?
Together, these elements form a causal pathway from the problem being experienced to the impact being sought.
PEASI draws on the established disciplines of programme logic, realist evaluation and Theory of Change. These approaches require planners to make the reasoning behind an intervention visible: why particular activities are expected to work, under what conditions, for whom, and with what consequences.
The challenge is that these methods can require specialist language, considerable time and experienced facilitation. PEASI distils their shared logic into five ordinary-language elements that can be used by individuals, teams and organisations without specialist evaluation training. You can find out more about the antecedent methods to PEASI in this article.
Start with the problem, not the activity
Many apparent problem statements are actually solutions in disguise.
“We need a mentoring programme”, “we need a new position” or “we need better data” may all describe potentially useful activities. But none explains what is being experienced, who is affected or why the situation has arisen.
A useful PEASI Problem statement does not prescribe its own solution. It creates space to investigate the issue before deciding what to do.
This distinction matters because the same visible symptom can have very different causes. Poor access to a service might result from workforce shortages, restrictive funding arrangements, inappropriate referral pathways, limited public awareness or an operating model that does not match population need. Each diagnosis would require different enabling conditions and different activities.
If the diagnosis is wrong, even a well-delivered activity may have little effect.
Define impact before choosing activities
Although the completed PEASI model is read from Problem through to Impact, it is not constructed in that order.
PEASI begins with PIE
Easy PEASI – PIE:
- Draft a provisional Problem.
- Define the intended Impact.
- Return to sharpen the Problem.
Defining Impact early helps a team describe what a genuinely improved future would look like. That clarity often reveals that the original Problem statement was incomplete, too narrow or framed from only one perspective.
Only after the Problem and Impact have been clarified does the process move to Enablers, Activities and Successes.
This creates an important discipline: activities are generated last, not first.
Identify the conditions that make change possible
Enablers are the conditions that determine whether an activity can work.
They may include:
- leadership and authorisation;
- relationships and trust;
- workforce capability;
- funding and other resources;
- policy and regulatory settings;
- information and infrastructure;
- organisational readiness; and
- stakeholder support.
Barriers are incorporated by restating them as missing or necessary conditions. For example, “a lack of delegated authority” becomes “clear delegated authority to make and implement decisions”.
This shifts the question from simply identifying what is obstructing progress to establishing what would need to become true.
Enablers are not a preliminary checklist. They must be reconsidered throughout implementation because organisational, political and funding conditions can change. If a critical Enabler disappears, the original Activity may no longer be viable even though the underlying Problem remains.
Distinguish success from impact
PEASI separates near-term Successes from longer-term Impact.
Successes are observable indications that an Activity is beginning to work. They should be specific enough to detect within a realistic timeframe.
For example, establishing a new referral process is an Activity. Increased appropriate referrals might be an early Success. Improved access, experience and health outcomes may represent the longer-term Impact.
This distinction prevents teams from confusing what they have done with what has changed. It also makes it possible to identify progress well before the final impact can reasonably be measured.
Examine every level of the system
PEASI can be combined with an Individual–Organisational–Global, or IOG, lens.
In this context, “global” means the wider system surrounding the problem. Depending on the project, this may be a health district, sector, jurisdiction, national system or international environment.
The IOG lens asks how each PEASI element looks from three levels:
- Individual: What do people, practitioners, patients or participants experience?
- Organisational: What happens within teams, services and organisations?
- Global: What wider structural, regulatory, funding or policy conditions shape the problem?
The same issue often looks very different at each level. An individual may experience a lack of capability, an organisation may experience a coordination problem, and the wider system may contain funding or regulatory arrangements that repeatedly reproduce both.
A plan that works at only one level is unlikely to resolve a problem produced across several.
Read PEASI backwards as a governance test
PEASI can also be read backwards from Impact.
This turns the framework from a planning method into a governance and authorisation test:
- Is the intended Impact sufficiently important and clearly defined?
- Will the proposed Successes provide credible evidence of progress?
- Are the Activities capable of producing those Successes?
- Are the necessary Enablers present?
- Who has the authority to create or approve the Enablers that are missing?
- Does the stated Problem justify the proposed investment?
This backward reading can reveal why apparently sensible plans stall. The analysis may be coherent, but nobody involved has the authority to approve the funding, change the policy, redirect the workforce or alter the operating conditions on which the plan depends.
A viable plan therefore needs more than stakeholder engagement. It needs a connection to the people and institutions capable of authorising change.
How PEASI can be used
PEASI is designed to work at different levels of intensity.
An individual can use the Canvas to test an idea before committing to it. A team can use it to diagnose a service problem or develop a programme logic. A facilitated workshop can bring together different stakeholder perspectives and convert them into a structured analysis and Theory of Change.
The method also works in digital and distributed settings. Participants can contribute their perspectives independently through a shared online environment before discussing the emerging analysis together. This reduces the risk that the first or most confident speaker establishes the frame for everyone else, and makes asynchronous participation possible.
A completed PEASI analysis can support:
- programme and service design;
- workforce planning;
- organisational change;
- funding proposals and business cases;
- governance decisions;
- stakeholder consultation;
- implementation planning; and
- evaluation design.
PEASI in practice
PEASI was used as part of an international co-design process to develop a shared position on the contribution of allied health to global health-system transformation. Following initial consultation and priority setting, participants used PEASI to examine four interconnected challenges: communication between allied health leaders, the absence of a shared value proposition, limited leadership representation in health-system decision-making, and inequitable access to allied-health-led care.
The analysis showed that these apparently related challenges did not have the same underlying causes. Limited representation, for example, was not simply a leadership-development problem; it reflected the organisational structures, reporting arrangements and authorising environments within which allied health leaders worked. Similarly, the need for a stronger value proposition was reframed as a need for shared evidence and indicators of impact, rather than merely better promotion.
Working through the Problem, Enablers, Activities, Successes and Impact helped convert a broad international conversation into a coherent set of priorities and an actionable Theory of Change. The resulting work informed the Global Allied Health Position Paper and its seven principles for health-system transformation.
The process and its outcomes are described in the published paper, Building a Global Allied Health Collaboration: From Conversation to Collective Voice, by Nicki Atkinson, Susan Nancarrow and Beverley Harden.
What PEASI does not do
PEASI structures reasoning; it does not replace evidence, expertise or meaningful stakeholder participation.
A completed Canvas is only as strong as the information and perspectives brought to it. PEASI cannot determine the true cause of a problem if the relevant people, evidence or system conditions have been excluded.
It is also not a replacement for a comprehensive realist evaluation, formal Theory of Change process or specialist programme evaluation when the time, expertise and resources for those approaches are available. It is a practical entry point into the same discipline and a way to bring that discipline into everyday planning and governance.
Learn more
A full methodological paper describing PEASI’s foundations, architecture, construction process, governance application and limitations is currently being prepared for publication. A link will be added here when it becomes available.
In the meantime, you can explore the PEASI Canvas, try the framework on a current problem, or contact HealthWorX Futures to discuss a facilitated PEASI process.
PEASI™ was developed by Susan Nancarrow. PEASI materials, templates, training resources and facilitated applications are available through HealthWorX Futures.
