Talking Points: Personal Outcomes Approach.

Dr Ailsa Cook, University of Edinburgh

Understanding outcomes

• Developing a good understanding of the concept of ‘outcomes’ across the system is critical to successful implementation of personal outcomes approaches

• Common conflation between:– Outcomes, aims, objectives, goals– Outputs and outcomes– Personal and service / national outcomes

• Reflects widespread emergence of concept – Total Quality Management – Person Centred Planning

Defining personal outcomes

• To ensure that the person-centred and enabling potential of an outcomes approach is maximised, personal outcomes should first and foremost be understood as what matters to the person and why (Cook and Miller, 2012)

• Critical that the person involved from outset in– defining their outcomes – determining how they can be achieved, including their

role in working towards outcomes

Process Output OutcomeInputs

What do we mean by Outcomes

From Personal to National Outcomes (Cook and Miller, 2012)

Outcome Level Focus Examples

Personal Defined by individual as what is important to them in life and why

I want to get back to the bowling club to reconnect with friends

Service/project Defined by a project or service as a key focus to work towards with people

We work with older people to improve their ability to get out and about

Organisational Defined by a local authority, NHS board or provider organisation as a key area to work towards with people.

Improve the social inclusion of the older people we work with

National Defined by government to focus activity across sectors and organisations

We live longer, healthier lives Our people are able to maintain

their independence as they get older and access appropriate support as they need it

Talking Points Project• 7 year collaborative project between academic researchers (Ailsa

Cook and Emma Miller), Joint Improvement Team of SG and 70+ partnerships and providers

• Built directly on substantial body of research into outcomes important to people using services– University of York (1995-2005)– University of Glasgow (2004-2006)

• Talking Points approach developed in four stages:– Initial scoping (dissemination workshops with 15 partnerships)– Early pilots and dissemination– Focused early implementation– Mainstreaming

• Constant process of action, evidence gathering and sharing• Ongoing negotiation between research, practice and policy

Talking Points in Policy

• NHS Quality Strategy (2010)• Dementia Strategy (2010)• Carers Strategy (2010)• Reshaping Care for Older People (2010)• Self Directed Support Strategy (2010)• Autism Strategy (2011)• AHP Delivery Plan (2012)

Service user defined outcomes

Quality of life Process Change Feeling safeHaving things to doSeeing peopleStaying as well as can beLife as want and where wantDealing with stigma and discrimination

Listened toHaving a say Respect Responded to Reliability

Improved confidenceImproved skillsImproved mobilityReduced symptoms

Talking Points: Personal Outcomes Approach

• Organisational approach to focussing on outcomes primarily through:– Identification of outcomes important to people using

services / unpaid carers at assessment– Negotiating outcomes focussed care and support

plans– Determining whether outcomes achieved at review,

why/why not and what more can be done– Using information to improve practice

• Conversational approach

AGREE OUTCOMES

User’s view Carer’s view

Assessor’s view Agency’s view

NEGOTIATE

RECORD OUTCOMES

‘EXCHANGE MODEL’ OF ASSESSMENT

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2

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EXCHANGE INFORMATION - Identify desired outcomes

Exchange Model of Assessment

Three core elements

• Engagement with individuals using services and carers about:

– What they want to achieve in life– Assets/strengths they and others bring to achieve this– Extent to which outcomes achieved, what helps and hinders

• Recording of information on outcomes,

– Recorded qualitatively in language meaningful to the person– May be summarised in tick boxes

• Use of information for decision making

– Individual care and support– Service delivery and improvement– Planning and commissioning

Cook and Miller (2012:13)

The personal outcomes circuit

Learning from implementation• Growing body of evidence that focusing on outcomes for

individuals can improve outcomes for people using services and staff

• Can lead to efficiencies and prevent service use• Practitioners report helps them ‘Get back to basics’ • Supports implementation of personalised, person

centred, assets based, co-productive, enabling, preventative approaches

• Requires organisational shift from being service led to outcomes focussed.

• Achieving this demands change in culture, systems and practice

Dimensions of change implementing an outcomes approach

CULTURE

PRACTICESYSTEMS

ImprovementPerformance

Supporting practice

• Focussing on personal outcomes in practice requires skill– Builds on core professional skills– May need to be revisited, supported and potentially restored– For some about engaging in a process of ‘unlearning’

• Staff training needed to:– Help understand concept of outcomes– Support skill development, nb ‘good’ conversations and

recording– Working with people with communication difficulties

• Reinforced through outcomes focussed supervision• Strong leadership giving staff ‘permission’ to practice

differently• Successfully implemented alongside initiatives focussed

on enablement, assets, co-production, personalisation.

Tool development

Practice works best when tools are..• driven by practice • developed in partnership with practitioners• revised over many iterations• outcomes focussed throughout • focussed on capturing narrative information with

tick box summaries• encourage use of everyday language• encourage consistent recording• proportionate

Use of Information

• Co-productive potential of personal outcomes approaches achieved through effective use of information for:– Planning (individual and service)– Service improvement– Commissioning– Performance management

• Good use of data requires qualitative and quantitative data skills

• Requires working with tension between meaning and measurability

• Focus on understanding contribution not attribution

Approaches in Practice

Some resources…

• Practical Guide• Recording outcomes• Supervision guidance• Good conversations• Outcomes Cards• Digital Stories• Outcomes Glossary • IRISS leading for

outcomes• IRISS Qualitative Data

Guide

• http://www.jitscotland.org.uk/action-areas/talking-points-user-and-carer-involvement/

• http://www.iriss.org.uk/category/resource-categories/leading-outcomes