“The Power of Outcome Thinking in “The Power of Outcome Thinking in Transforming the State of Health” The Annual Institute for Governors’ Health Policy Advisors Septembe10, 2004 William J. Phillips Center for Outcomes Center for Outcomes

The Think Tank with Muddy Boots

Overview Outcome Thinking versus Other Kinds Outcome Thinking versus Other Kinds Terms, Models and the like Terms, Models and the like Applications to Transformation Applications to Transformation

Hypothetical Scenario: Health program staff are largely in an activity mode. They focus on the process, services provided and numbers served. Health program staff are largely in an activity mode. They focus on the process, services provided and numbers served. Two years ago THE Governor issued an executive order demanding that all Health programs become outcome focused. Two years ago THE Governor issued an executive order demanding that all Health programs become outcome focused. Progress has been slow, staff have not been able to make the shift. It’s been “Business as Usual”. Progress has been slow, staff have not been able to make the shift. It’s been “Business as Usual”. You have been asked to make this your top priority. You have been asked to make this your top priority. How do you start? How do you start? A. A

Three Options Problem Approach Problem Approach Activity Mindset Activity Mindset Outcome Thinking Outcome Thinking

The Problem Approach… 1. Why do we have this problem? 2. What or who caused it? 3. What obstacles exist to solving it?

The Activity Mindset… 1. What should we do? 2. When can we start? 3. Who can do it?

Close your eyes; take a deep breath Close your eyes; take a deep breath You are now in a future place at a future time You are now in a future place at a future time Imagine that the situation we described earlier is gone Imagine that the situation we described earlier is gone Now open your eyes and answer these questions Now open your eyes and answer these questions

1. What are you hearing, seeing, feeling, experiencing? 2. What is in place that wasn’t before? 3. What has been gained ? Outcome Thinking

What’s the Difference?

The Difference Creates possibilities; generates ideas Creates possibilities; generates ideas Increases hope and energy Increases hope and energy Mobilizes resources Mobilizes resources Increases control; reduces stress Increases control; reduces stress Attracts the best and brightest Attracts the best and brightest

“Beginning with success in mind and keeping it there.” What is Outcome Thinking?

4 Outcome Shifts PROCESS TO RESULTS PROCESS TO RESULTS EVALUATION TO LEARNING EVALUATION TO LEARNING FUNDER TO INVESTOR FUNDER TO INVESTOR SUPPLICANT TO RESULTS MANAGER SUPPLICANT TO RESULTS MANAGER

FUNDERS ASK: Has all the money been spent? Has all the money been spent? Have all the rules been followed? Have all the rules been followed? Can we justify an increase? Can we justify an increase?

INVESTORS ASK : What results are we buying? What results are we buying? What are the chances for success? What are the chances for success? Are we paying the lowest possible costs for the best possible results? Are we paying the lowest possible costs for the best possible results?

Supplicants Ask: Have I carried out the plan? Have I carried out the plan? Have I followed the rules? Have I followed the rules? Have I spent all the money? Have I spent all the money?

RESULTS MANAGERS ASK: What results did I commit to achieve? What results did I commit to achieve? Can I do it, both financially and programmatically? Can I do it, both financially and programmatically? What did we learn and how can we use it to improve ? What did we learn and how can we use it to improve ?

Outcomes, schmoutcomes… Terms, Models, Systems, Graphics, etc, etc,…..

Key Outcome Terms Inputs: what goes in Inputs: what goes in Program: the products and services created from inputs and which add value (hopefully) Program: the products and services created from inputs and which add value (hopefully) Outputs: what comes out; what programs produce Outputs: what comes out; what programs produce Outcomes: the direct intended beneficial effect on those being served Outcomes: the direct intended beneficial effect on those being served Impacts: long term or indirect effects of outcomes on communities or individuals Impacts: long term or indirect effects of outcomes on communities or individuals

A Health Example: Program: smoking cessation workshops Program: smoking cessation workshops Outputs: curricula; horror films, people who attend one or more sessions; stop smoking plans Outputs: curricula; horror films, people who attend one or more sessions; stop smoking plans Outcomes: the number/percent completing who stop smoking for at least one year Outcomes: the number/percent completing who stop smoking for at least one year Impacts: reduced health care costs; improved air quality, reduced effects of second hand smoke. Impacts: reduced health care costs; improved air quality, reduced effects of second hand smoke.

Major Outcome Models Logic Model/Theory of Change Balanced Scorecard Logic Model/Theory of Change Balanced Scorecard Outcome Funding Framework Outcome Funding Framework Toward Outcomes for Programs Managing for Results Getting to Outcomes Scales and Ladders Results Mapping Results Based Accountability

A Logic Model

Theory of Change

Getting to Outcomes

Community Equity Scale

RBA Crosswalk

Balanced Scorecard

T.O.P. Pyramid

RI Outcome Framework Funnel

Outcome Tool Applications  Communication  Program planning  Funding  Learning/Evaluation  Result tracking tools  Reporting/Accountability  Resource Management

Application to Transformation Be balanced in your “thoughtware” Be balanced in your “thoughtware” Start with Success: What would a transformed health care system look like AND accomplish Start with Success: What would a transformed health care system look like AND accomplish Choose an outcome model that fits Choose an outcome model that fits Start with early adopters Start with early adopters Engage Rapid Prototyping Engage Rapid Prototyping Emphasize Learning Emphasize Learning Think management before accountability Think management before accountability

For More Information Visit our web site: Visit our web site: Call or Call or  Bill Phillips,  Mention this Session and get 15% off Mention this Session and get 15% off Outcome Frameworks …an overview for practitioners