Achieving Outcomes – Choosing Targets and Making a Difference Lynne Dean DH/CSIP

Outcome Based Accountability Fiscal Policy Studies Institute Santa Fe, New Mexico WEBSITES BOOK ORDERS

Outcome Based Accountability is made up of two parts: Performance Accountability about the well-being of CUSTOMER POPULATIONS For Programs – Agencies – and Service Systems Population Accountability about the well-being of WHOLE POPULATIONS For Communities – Cities – Counties – States - Nations

THE LANGUAGE TRAP Benchmark Target IndicatorGoal Result Objective Outcome Measure Modifiers Measurable Core Urgent Qualitative Priority Programmatic Targeted Performance Incremental Strategic Systemic

Results and Performance Accountability COMMON LANGUAGE COMMON SENSE COMMON GROUND

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

POPULATION ACCOUNTABILITY For Whole Populations in a Geographic Area

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 Our Health, Our Care, Our Say – White Paper Outcomes for Adults Source: A New Outcomes Framework for Performance Assessment of Adult Social Care

Engaging the Public

Good Quality of Life for Older People 5Overall/general satisfaction with local area 9Perceptions that people in the area treat one another with respect and dignity 15Self-reported measure of people's overall health and wellbeing 16Self reported experience of social care users 17User reported measure of respect and dignity in their treatment 19Healthy life expectancy at age 65 20Satisfaction of people over 65 with both home and neighbourhood 21 People over 65 who say that they receive the information, assistance and support needed to exercise choice and control to live independently 22Fair treatment by local services

Leaking Roof (Results thinking in everyday life) Experience: Measure: Story behind the baseline (causes): Partners: What Works: Action Plan: Inches of Water ? Fixed Not OK Turning the Curve

The Matter of Baselines Baselines have two parts: history and forecast H M L History Forecast Turning the Curve Point to Point OK?

Outcomes

Alternative to Traditional Evaluation Methods: DEMONSTRATING a CONTRIBUTION to complex change efforts… requires 3 elements: Given a Curve to Turn 1 We tried a bunch of stuff that had a credible chance of making a difference … 2 …and it had a timely relationship to…. 3 …. a turn in the curve. c FPSI

Paulsgrove, Portsmouth, UK Youth Nuisance

Performance Accountability For Services, Agencies and Service Systems

How much did we do? Program Performance Measures How well did we do it? Is anyone better off? Quantity Quality Effect Effort # %

How much did we do? Drug/Alcohol Treatment Program How well did we do it? Is anyone better off? Number of persons treated Unit cost of treatment Number of clients off of alcohol & drugs - at exit - 12 months after exit Percent of clients off of alcohol & drugs - at exit - 12 months after exit

How much did we do? Home Care Services How well did we do it? Is anyone better off? # of persons served # visits # visits per week Ave length of visit % service users who say the service is reliable, flexible, respectful, friendly (SPRU)) Rate entry into hospital, residential or nursing care % carers report the service helped the service user remain at home # entry into hospital, residential or nursing care # carers report the service helped the service user remain at home

How much did we do? How well did we do it? Is anyone better off? # of persons served £ spent on communication speed of response Choice of support Coverage of support # making initial contact # not smoking after 4 weeks #not smoking after 1 year 16+ current smoking rate prevalence Population prevalence figure reduced

How much did we do? How well did we do it? Is anyone better off? Quantity Quality Effect Effort Number of people referred Number who are living independently at the end of 6 weeks % who are living independently after 6 months % who are happy with the service provided Rehabilitation Number of OT/ Physio /care staff employed Whether available in own homes/ day care/ residential care/ hospital

LR UR

How Population & Performance Accountability FIT TOGETHER

Contribution relationship Alignment of measures Appropriate responsibility THE LINKAGE Between POPULATION and PERFORMANCE POPULATION ACCOUNTABILITY Health & Emotional Well-being Quality of life Exercising choice & control # of people seen by rapid response services % provided with community support # repeat hospital admissions PERFORMANCE ACCOUNTABILITY Rate of emergency admissions CommissioningCommissioning

The Task What is seen as a major problem by all stakeholders in your area. What Outcome has wide stakeholder support What data do you have to establish the baseline and measure progress in turning the curve What is the story behind the problem Which of the NIS help to measure progress Will you use local indicators Who will be involved in making a difference- the partners What kinds of actions will make a difference Use the performance accountability grid to decide how you will monitor progress