Everyone’s talking about outcomes

19 February 2015

Blog by Jo Harvey

Everybody is talking about outcomes these days and its something I have been wrestling with a lot over the last few years. This year we developed something we called the 8-step process for developing person centred outcomes shown here below:

 

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I wanted to share a story about my experience of using the 8-step process directly with a person I was recently planning with. Jennifer is somebody I have met through a project I am working on in relation to promoting self-management and personalised care planning. Jennifer is a lovely woman who loves the theatre and is a very talented dressmaker. She also has rheumatoid arthritis. I worked with Jennifer to look at what was working and not working in her life. She talked about a number of things that weren’t working for her but in particular she identified she was struggling with getting out of a chair, particularly when out. This was beginning to have an effect on her life as she was stopping herself from going out, particularly to the theatre. She prioritised this as the main issue she wanted to address. I checked how it important it was to her to address this issue by asking her to rate it on a scale of 0-10, she said it was a 10, therefore being of the utmost importance to her. When I asked her about how confident she felt to address the issue she rated it as only a 2. This was quite revealing as I could then see a lot of it was about how she was feeling and thinking.

I then asked her what it would look like for her if she successfully addressed the issue. She said…

“I would not worry about going out and how I will get out of my chair when I am out”. This was not really an outcome yet but gave me a good idea of what Jennifer was aiming for.

I then talked to her about what was important to her specifically about this issue. She said…

Going to the theatre

Feeling safe and not falling over

Not worrying about getting up out of a chair when out

Not worrying about people looking at me

I then asked what was it important for us to pay good attention to regarding keeping her healthy and safe with this issue. She said…..

Having the right help to get up out of a chair.

Not hurting herself through a fall.

From that we developed a first draft outcome:

To go to the theatre with my friend Gill once a month and to be able to be get out of my chair safely and not worry about people looking at me.

 

We then checked that we had really got to the crux of the issue. I asked Jennifer if she achieved that outcome…

What would that give her? She said confidence

What would that do for her? She said give me a sense of freedom

What would it make possible for her? She said going out with friends and family and not worrying.

We then refined the outcome slightly by adding in the word confidence

To go to the theatre with my friend Gill once a month and to be able to be get out of my chair safely and confidently and not worry about people looking at me.

I then talked to Jennifer about what was getting in the way of achieving the outcome, what the barriers were. She said the following:

I really worry about people looking at me as I am struggling to get up.

Often the chairs are too low and it makes it more difficult to get up.

I have a fear of falling over in front of people.

We then did some blue sky thinking to come up with some ideas about how she could address these barriers and achieve her outcome. We thought about all sorts of ideas including a taking a cushion with her and a Zebedee spring! We agreed the following:

Jennifer was going to make a cushion that she will take out with her so the chairs are not too low

Jennifer will go and talk to the disability equipment shop to see if they have any equipment that can help her get out of the chair that will be portable. (Zebedee spring)

Jennifer to look into cognitive behaviour therapy to address her worries about people watching her.

Jennifer then recorded this in her personalised care plan.

It was quite a hard session and Jennifer felt quite emotional at the time. However I received the following e-mail from her 2 weeks later.

“ I just want to say thank you for what you’ve done for me. We had a lovely hols and I don’t remember one time Simon had to help me up, I made a small cushion myself out of some Cath Kidson-like material which I put a handle on and kept thinking of what you said when I got it out. We went to the pics and I even managed to get myself up from that which was for me a big step. It just feels like I can go out with friends again. All it took was for someone to say it’s OK to do it.”

What a fantastic result from such a simple conversation. With outcomes being on the tip of everybody’s tongue right now we have to work hard to make sure that the outcomes we are developing with people are truly person centred, that have the kind of relevance that they change people’s lives.

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