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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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
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