Results Based Accountability Workshops Older People Co-ordinators 20 th, 22 nd & 30th June 2011 Ffynnon Knowledge Management & Business Change Programme

Agenda Concept of Results Based Accountability (RBA) The Language Trap RBA Elements RBA Definitions Population Accountability Performance Accountability Fitting it together Summary and Benefits Measuring impact not quantity…

Why use an outcomes based approach? Align all individual processes and activities with the delivery of key outcomes Measure progress against impact (effectiveness) not just quantity Understand the best use of resources in the delivery of key outcomes and the impact of any potential cost reductions moving forward Ensure decisions are informed by an understanding of their potential impact on key outcomes (utilising appropriate evidence & information) Ensure corporate and service reporting & business planning are aligned Enable a joined up view across the organisation (and wider) and a reduction in duplication and activities of limited impact to be identified Explore how the delivery of population outcomes can be supplemented by the performance of partners Ensure the approach is sympathetic to, complementary with, and meets all wider corporate requirements

Outcomes v. outputs Operational outputs relate to process – how much did we do? – and can be directly influenced and are easy to measure. Social outcomes relate to impact – what change did we effect? – and can’t be directly influenced and are harder to measure. “The government spends £1.2 billion a year on measures aimed at tackling problem drug use, yet does not know what overall effect this spending is having.” “The commissioning process feels like a bureaucratic exercise without sufficient focus on outcomes.” “We found…a case where one family was receiving more than 20 separate interventions by different public services…the various separate interventions were effectively maintaining the family in its current situation…offering no prospect of helping the family to move out of that situation into one which would be more fulfilling for them – and less expensive to the public sector.” “Departments have struggled to develop reliable metrics that would indicate their progress from improved capability to improved outcomes.” Outcome-Based Government Paper – Centre for Social Justice

Challenges of managing performance Challenges: Imposed process, driven from the centre, creating disconnect between corporate and service silos Seen as burden by services due to lack of perceived ‘local’ value Output focused / internally facing / activity monitoring – no link with impact No clear link to operational activities and business planning Driven by timescales and objectives of supporting IT implementation Result: Seen as tick box exercise Focus on quantity not impact Drives dysfunctional behaviour (“hit the target, miss the point”) Reaction: Do more (or less) of the wrong thing

Elements of RBA “Start with ends and work back to means” Population Accountability Whole populations in a geographic area Outcome A condition of well-being for the population (indicators that help quantify the achievement of an outcome) Performance Accountability For services, agencies & service systems Measure A condition of well-being for the customer population (measuring the effectiveness of the organisation, service, or system) Results-Based Accountability™ (RBA), as defined by Mark Friedman in the book Trying Hard is Not Good Enough

THE LANGUAGE TRAP Too many terms. Too few definitions. Too little discipline. Benchmark Target IndicatorGoal Result Objective Outcome Measure Modifiers Measurable Core Urgent Qualitative Priority Programmatic Targeted Performance Incremental Strategic Systemic Lewis Carroll Center for Language Disorders

Definitions Children born healthy, Children succeeding in school, Safe communities, Clean Environment, Prosperous Economy Rate of low-birth weight babies, Percent 16 yr. olds with 5 A-C GCSE’s, crime rate, air quality index, unemployment rate 1. How much did we do? 2. How well did we do it? 3. Is anyone better off? = Customer Outcome OUTCOME or RESULT INDICATOR A condition of well-being for children, adults, families or communities An indicator which helps quantify the achievement of an outcome Population PERFORMANCE MEASURE A measure of how well a service, or organisation system is working Performance

From Ends to Means ENDS MEANS Population Performance OUTCOME or RESULT INDICATOR PERFORMANCE MEASURE Customer outcome = Ends Service delivery = Means

1. Safe Community 2. Crime Rate 3. Average Police response time 4. A community without graffiti 5. % of surveyed buildings without graffiti 6. People have living wage jobs and income 7. % of people with living wage jobs and income 8. % of participants in job training who get living wage jobs Is it a Result, Indicator or Performance Measure?

Community StrategyOutcome = A Healthy Place Indicator = % low birth weight babies in the County CYP PlanOutcome = Flying Start in life Indicator = % low birth weight in Flying Start population Ante-natal health project Customer result = % service users stopping smoking Flying Start Outcomes & contributions align – indicators/measures make sense – appropriate accountability – what matters is outcomes not plans and process How it all fits together Slide courtesy of Richard Morton WLGA

POPULATION ACCOUNTABILITY For Whole Populations in a Geographic Area Population Accountability

Every Child Matters – Children Act Outcomes for Children and Young People Being Healthy: enjoying good physical and mental health and living a healthy lifestyle. Staying Safe: being protected from harm and neglect and growing up able to look after themselves. Enjoying and Achieving: getting the most out of life and developing broad skills for adulthood. Making a Positive Contribution: to the community and to society and not engaging in anti-social or offending behaviour. Economic Well-being: overcoming socio-economic disadvantages to achieve their full potential in life.

1. Health & Emotional Well-being 2. Quality of life 3. Making a positive contribution 4. Exercising choice & control 5. Freedom from discrimination & harassment 6. Economic well being 7.Personal dignity & respect 8.Effective leadership 9. Effective commissioning Our Health, Our Care, Our Say White Paper Outcomes for Adults Source: A New Outcomes Framework for Performance Assessment of Adult Social Care

Population Accountability The 7 Population Accountability Questions 1.What are the quality of life conditions we want for the children, adults and families who live in our community? 2.What would these conditions look like if we could see them? 3.How can we measure these conditions? 4.How are we doing on the most important of these measures? 5.Who are the partners that have a role to play in doing better? 6.What works to do better, including no-cost and low-cost ideas? 7.What do we propose to do?

Population Accountability Outcome desired Indicators of success What does the data tell you? What is the story behind the data? What partners are needed? What works? Proposals – – Think 1%s – Find things you can do on Monday – Be more ambitious about less “turn the curve”

Turn the curve exercise Population Accountability

Performance Accountability For Services, Agencies and Organisations Performance Accountability

Developing performance measures How much service did we deliver? How well did we deliver it? How much change/effect did we have? What quality of change/effect did we have? Effort Effect Quantity Quality

Developing performance measures How much did we do? Least important How well did we do it? # % Most important Effort Effect Quantity Quality Is anyone better off?

Developing performance measures # customers served # activities % Common Measures Workload ratio, staff turnover, staff satisfaction, unit cost, customer satisfaction % Activity specific measures % on time, % correct, % complete # skills / knowledge # attitude / opinion # Behaviour # Circumstance % skills / knowledge %attitude / opinion % Behaviour % Circumstance

Example Drug/Alcohol Treatment programme performance measures How much did we do? Number of persons treated How well did we do it? Percent of clients who said they were dealt with appropriately (Did we treat you well?) Number of clients off alcohol& drugs: -At exit - After 12 months Percent of clients off alcohol & drugs: -At exit -- After 12 months Effort Effect Quantity Quality Is anyone better off?

Performance Accountability 1.Who are our customers? 2. How can we measure if our customers are better off? 3.How can we measure if we are delivering services well? 4.How are we doing on the most important of these measures? 5.Who are the partners that have a role to play in doing better? 6.What works to do better, including no-cost and low-cost ideas? 7.What do we propose to do? The 7 Performance Accountability Questions

Performance Accountability Matrix Exercise

PERFORMANCE ACCOUNTABILITY Population and Performance Accountability Fitting it all together Contribution relationship Alignment of measures Appropriate responsibility POPULATION ACCOUNTABILITY Being Healthy Rate of low birth-weight babies Staying Safe Rate of child abuse and neglect Enjoying and Achieving Percent with 5 A-C GCSE’s CUSTOMER OUTCOMES # of investigations completed % initiated within 24 hrs of report # repeat Abuse or Neglect % repeat Abuse or Neglect Child Protection Service POPULATION OUTCOMES

Summary & Benefits Using RBA enables public sector organisations to: pinpoint the activities that will make a difference to communities and individuals involve communities to play their parts in defining & achieving desired outcomes identify the contributions that are needed from each of the agencies operating in the community to realise the agreed outcomes align individual processes and service activities with delivery of the planned outcomes quantify the value of no and low cost activities towards achievement of the outcomes measure progress of delivery towards the outcomes by all those concerned ascertain the effect potential cost reductions will have on the attainment of the outcomes detect those activities that add least value to delivering the outcomes and so become prime candidates for reduction / removal ensure all decisions are fully informed by their potential impact on key citizen centred outcomes RBA enables public sector organisations to prioritise their effort and expenditure on the delivery of results that make a measurable difference to their citizens and communities.

Contact Carol Cornes Managing Consultant Coactiva Aspiren