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 Outcome Inputs What do we mean by Outcomes

From Personal to National Outcomes (Cook and Miller, 2012) Outcome LevelFocusExamples PersonalDefined 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/projectDefined 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 OrganisationalDefined 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 NationalDefined 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 ( ) –University of Glasgow ( ) 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 lifeProcessChange 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 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 Conversations around groups of cases Qualitative analysis of selected records Quantitative analysis of all records Evidence for support planning, service improvement Evidence for planning, commissioning, performance

Some resources… Practical Guide Recording outcomes Supervision guidance Good conversations Outcomes Cards Digital Stories Outcomes Glossary IRISS leading for outcomes IRISS Qualitative Data Guide uk/action-areas/talking- points-user-and-carer- involvement/ uk/action-areas/talking- points-user-and-carer- involvement/ egory/resource- categories/leading- outcomeshttp:// egory/resource- categories/leading- outcomes