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
What do we mean by Outcomes
Inputs
Process
Output
Outcome
From Personal to National Outcomes (Cook and Miller, 2012)
Outcome Level Focus
Personal
Examples
Defined by individual as I want to get back to the bowling
what is important to
club to reconnect with friends
them in life and why
Service/project Defined by a project or We work with older people to
service as a key focus
improve their ability to get out
to work towards with
and about
people
Organisational
Defined by a local Improve the social inclusion of the
authority, NHS board
older people we work with
or
provider
organisation as a key
area to work towards
with people.
National
Defined by government to We live longer, healthier lives
focus activity across Our people are able to maintain
sectors
and
their independence as they
organisations
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 safe
Having things to do
Seeing people
Staying as well as can
be
Life as want and
where want
Dealing with stigma
and discrimination
Listened to
Having a say
Respect
Responded to
Reliability
Improved
confidence
Improved skills
Improved
mobility
Reduced
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
Exchange Model of Assessment
1
EXCHANGE INFORMATION
- Identify desired outcomes
2
User’s view
Carer’s view
NEGOTIATE
3
AGREE
OUTCOMES
Assessor’s view
4
RECORD
OUTCOMES
Agency’s view
‘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
Performance
SYSTEMS
Improvement
PRACTICE
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
Conversations
around groups
of cases
Qualitative
analysis of
selected
records
Evidence for support
planning, service
improvement
Quantitative
analysis of all
records
Evidence for planning,
commissioning,
performance
Some resources…
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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/talkingpoints-user-and-carerinvolvement/
• http://www.iriss.org.uk/cat
egory/resourcecategories/leadingoutcomes