Getting started
Key points to consider when starting on the outcomes journey
September 2010
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What is an ‘outcome’?
An outcome is the impact or end result of services/support on a person's life. For
example if someone receives support to attend college there may be a number of
outcomes resulting from this such as the person having:
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greater social contact
improved confidence and self esteem
greater skills and knowledge
One service or piece of support can lead to one or more changes to the person’s life.
Outcomes-focused services and support aim to achieve the aspirations, goals and
priorities identified by service users and carers. The starting point for such services
and support is therefore ‘what do you want to achieve and/or change? And how can
we support you to do this?’
It is crucial to be clear on the difference between an outcome and an output. In the
above example of supporting an individual to attend college the output would be the
person completing the college course and gaining a particular qualification, or it
could also be counted in the number of days the person successfully attended the
course. An example that is often used to help clarify the differences between
outputs and outcomes is that of making a birthday cake. In this example the cake
itself is the output while the happiness of the child with the birthday cake is the
outcome.
The outcomes journey
Many organisations/services that are working to implement an outcomes approach
have described it as ‘a journey’, one in which the destination may be clear and highly
desirable, but where there are also challenges to be overcome. In many ways the
organisational journey towards achieving clear outcomes mirrors that of the
indvidual’s journey towards achieving their outcomes – there needs to be clarity over
what you are trying to achieve (the outcomes), how you are going to achieve it
(staffing and processes), how you are going to know when you have achieved it
(monitoring and reviewing) and what you are going to do as a result (using the
findings). The aim of this paper is to provide you with a summary of the key points on
this journey so that you can begin to consider how you would prepare your
service/organisation to move to an outcomes approach.
A whole systems approach
Taking an outcomes approach impacts on all aspects of an organisation – it is a
whole systems approach. It is crucial not to underestimate the scale of the change
that may be required, as you consider taking an outcomes approach. By
understanding and preparing for this change, the change itself will be smoother.
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1. Defining your outcomes
 In order to adopt an outcomes approach you need to be clear what outcomes
your organisation can support people to achieve. If you are an organisation
with a range of services then you may have overall organisational outcomes
which are adapted or added to for particular services within your organisation.
The key question to address is ‘what can we support people to change or
achieve?’ The ‘Talking Points: Personal Outcomes Approach’ centres on two
frameworks of outcomes, one for people who use community care services,
and one for unpaid carers. These are attached as an appendix to this paper
and are a very useful starting point for discussions. (Further information on
Talking Points can be found at http://www.jitscotland.org.uk/actionareas/talking-points-user-and-carer-involvement/)
 Another crucial aspect of defining your outcomes is to involve staff. This
serves two clear purposes. Firstly it is the staff delivering the service and
support who will have the best understanding of what the support they provide
changes for people ie. the outcomes. Secondly it engages staff from the very
beginning of the process of moving to an outcomes approach. This
engagement will be essential if staff are to embed outcomes into their day to
day practice.
 There is also the issue of ‘whose outcomes are they anyway?’ This question
reflects the reality that the outcomes will be used at a number of levels.
Firstly and crucially in defining what the individual receiving the support
wishes to change and/or achieve. Secondly at an organisational level they
need to reflect what you can actually support people to change and achieve.
Finally at a strategic level the outcomes you define will need to link to key
local and national strategies as this will be important to commissioning and
funding agencies. So it is important to consider how the outcomes you are
developing map across to these different levels.
2. Supporting staff
2.2 Front line staff
Organisations which have taken an outcomes approach have generally found
that a significant change in thinking and practice is required by staff, and that
this needs to be supported through:
 Involvement in the process of change eg. defining the outcomes
 Training – both initial and ongoing
 Regular support and supervision
Staff need to be supported to make the shift from service-focused support to
outcome-focused support, and from recording outputs to outcomes. So for
example rather than the starting point of contact with the individual being a
conversation about the support the organisation can offer, the conversation
should focus on what the individual wants to change or achieve. Staff can
then focus on the role that the person themselves will play as well as
considering how the organisation can support the person to achieve this.
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It is common for both staff and managers to underestimate the scale of the
shift in thinking required and it is therefore important to think about how you
will support staff to make it and how you will prepare them for the change.
2.2 Managers, Administrative staff and Boards
It is crucial to involve all staff in the process not just front line staff. This
includes administrative staff who will often play an important role in inputting
and collating data recorded by front line staff.
Depending on the size of the organisation this can also include senior
managers, finance, other departments and the Board of
Directors/Management Committee – again it is important to remember this is
a whole systems approach and front line staff tasked with delivering the
support need to know that they are supported in their outcomes focused
thinking by the organisation.
3. Recording systems
Just as important to the process of change is ensuring that your systems and
processes are outcomes-focused. This means that from the first point of
contact between the individual and the organisation to the last point of contact
the process needs to be outcomes-focused. It is therefore important to
consider how your current systems need to be changed to be outcomesfocused. This can include looking at such issues as:
 How do we record the outcomes identified by the individual? This might be
through adapting your assessment systems.
 How do we reflect the changing nature of the outcomes the individual wants to
achieve? Outcomes are not static. The individual’s circumstances can
change and as a result their goals and aspirations may change. This might
be through adapting your monitoring systems.
 How do we find out and systematically record the individual’s experience of
what outcomes have and have not been achieved, and why? This might be
through adapting your monitoring and review systems.
Again it is important to involve staff in this process – frontline, managers and
other departments – this has the double benefit of using staff’s knowledge and
expertise to develop the systems whilst also developing their knowledge and
understanding of outcomes-focused thinking.
4. Analysing your data
As a result of having the above systems to capture the impact of the
outcomes-focused practice the next stage is analysing the information
received to see what it tells you. Depending on the systems you currently
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have in place this may involve adapting databases or other data recording
and storage systems. In doing this you need to think about:
What do we, as an organisation, want to know? This is likely to include
looking at what impact the support offered by the organisation has had on the
outcomes for people using the service. Depending on the size of the
organisation you might want to be able to break this down in a number of
ways eg. by services, localities.
What do our funders want to know? Are there particular outcomes that they
are interested in or particular groups or areas?
What do our partners agencies want or need to know? This could include
information on the impact that their support has on the people to whom you
provide a service.
The data you will get from outcomes-focused practice is very rich and detailed
and having a clear idea of what you want to find out and understand from the
data is crucial.
5. Using the findings
Once you have captured and analysed your data the findings can be used to
develop and improve the support you offer to help the organisation/service to
achieve its outcomes eg. a particular training course works more effectively
than others. This may lead to further questions which you can ‘mine’ the data
to answer. The data will give you direct information from people using your
services on what the support received has helped them to achieve in relation
to the outcomes identified.
What next?
As previously stated the aim of this paper is to provide you with a summary of the
key points on the journey towards implementing an outcomes approach. It is a
starting point for discussion within your organisation/service about how you would go
about this change. If you would like more information and support there are a
number of resources available via the Joint Improvement Team website at
http://www.jitscotland.org.uk/action-areas/talking-points-user-and-carer-involvement/.
Julie Gardner
September 2010
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Appendix 1
The Talking Points: Personal Outcomes Approach
Table 1: Outcomes Important to Service Users
Quality of Life
Process
Change
Feeling safe
Listened to
Having things to do
Having a say
Improved
confidence/morale
Improved skills
Seeing people
Treated with respect
Improved mobility
Staying as well as you can
Responded to
Living where you want/as you want
Reliability
Reduced
symptoms
Dealing with stigma/discrimination
Quality of life
for the cared
for person
Quality of life
for the cared or
person
Table 2: Outcomes Important to Unpaid Carers
Quality of life for
Managing the
Process
the carer
caring role
Maintaining health
and well-being
Choices in caring,
including the
limits of caring
A life of their own
Positive
relationship with
the person cared
for
Freedom from
financial hardship
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Valued/respected and
expertise recognised
Having a say in services
Feeling informed/
skilled/equipped
Satisfaction in
caring
Partnership with
services
Flexible and responsive
to changing needs
Positive relationship with
practitioners
Accessible, available
and free at the point of
need