All about outcomes

19 February 2015 | By Helen Sanderson

It has reminded me how much debate and sometimes confusion about what we mean by an outcome. In this longer blog are the 8 steps that we are using to enable people to develop person-centred outcomes.

Here are some dictionary definitions of the word outcome:

• A final product or end result; a consequence
• A conclusion reached through a process of logical thinking

Sometimes there is confusion between aspirations and outcomes. Aspirations describe what someone wants their life to be in the long term, like living in their own flat, having a job and going out with friends. Outcomes describe the specific things that the person will do over a 2-3 year period to help them achieve their long term aspirations

A good outcome is:

• Building on something that is working well
• Changing something that doesn’t work well
• Addressing needs
• Moving the person towards their future aspirations

If the outcome being considered doesn’t address any of these issues, then it probably isn’t an outcome. A person-centred outcome can be described as:

• Being expressed from a personal perspective, not a service perspective
• Within the control and influence of the person and/or those involved
• Specific to the person and measurable

What mistakes do we make with developing outcomes?

Apart from confusing outcomes with aspirations, there are two further common mistakes often made when developing outcomes. They are:

•  Embedding the solution or provision into the outcome
• Not being specific enough to be able to measure whether it has been successfully achieved

Embedding the solution – often you will see outcomes that describe the solution for achieving the outcome as part of the outcome or they are describing the provision that will help the outcome be achieved. For example, to have 3 sessions of home care each week 

A solution is the resource (provision) that you need to achieve the outcome. It can be an item or an activity and it may have a cost attached to it or may be free.

In the process below you can see some tools to help you explore whether the outcomes you are developing have the solution embedded in them.

Not being specific enough – if an outcome is not specific enough it becomes really hard to measure whether it has been achieved and has made a difference in person’s life, for example, to improve my fitness and stamina. This outcome statement is not specific to the individual and we have no way of measuring if it has been achieved. We don’t know what to be fit looks or feels like to this person or what is important to them about improving their fitness and stamina.

In the process below you can see some tools to help you explore how to make outcomes more specific and measureable.

How can we ensure that we develop person-centred outcomes?

The 8-step process described in detail below can help you develop outcomes that are person centred.

Step 1: Check

Developing outcomes has to start with the person themselves. This should always be our very first port of call. We cannot support people to develop person-centred outcomes if we don’t first understand two key things at least. We must know what matters to them and what their future aspirations might be. This ensures our starting point is rooted in the things that are important to them, not to others and sets the direction of travel.

Not having this understanding puts us in danger of imposing our own ideas and often developing service driven outcomes.

To gain this understanding you need to have a person-centred conversation. The outcome of this conversation can be recorded in lots of different ways; it is the quality of the conversation that matters.

You can use person centred thinking and approaches as a framework for the conversations and record the information in a one-page profile.

Step 2: Now

Once we have checked that we have a good understanding of what matters to the-person, we need to establish a clear idea of current reality. This helps to establish the issues that are the priority for them and those that know them, to focus on.

If we use the working/not working tool to identify these issues, the outcomes that are ultimately developed will be relevant to the person and gives others that know and care about them, the opportunity to create a clearer picture of current reality and priorities.

 Step 3: Prioritise

You know what matters to the person, you have a clear idea of what is currently working and not working, it is now important make sure that the outcomes that are developed are important to the child and their family.

Again, taking the person centred approach; priorities should be agreed in partnership with the person and their family where appropriate. An agenda created collaboratively is far more likely to lead to outcomes successfully achieved and often people who are supporting the person to develop the information are the same people who will be involved in making sure actions are achieved.

Step 4: Success

It is important to reach agreement on what success looks like if the thing that is not working is resolved. This step is about being clear of your broad long-term aim for each priority area that has been identified.

By asking the person what success looks like for them then we are likely to make sure the outcome is specific to them and not assuming that a previous well trodden path for others in a similar situation, would automatically apply here.

It doesn’t have to be detailed or specific at this point

Step 5: Test it

We now need to get clear and specific by asking some questions. There are two main things to check are if your ideas to so far are actually outcomes or actually solutions disguised as outcomes and also that we haven’t drifted off the initial starting point too far and we are keeping close to what is important to the person.

The problem with confusing solutions with outcomes is that it shuts out alternative possibilities and other solutions too early. For example,

To have 3 hours of home care every week, may be a solution but we don’t really know what the person wants to achieve or whether the home care service is the best way or only way to help them achieve that.

To test if you really have articulated an outcome, the following questions, can be asked in no particular order or number of times.

What would it give you?

What would it do for you?

What would it make possible for you?

The second thing to test the outcome for is to check that we have really understood what is important to the person about this specific issue. We can do this by using the important to/important for tool. So exploring the fitness and stamina outcome:

Priority issueImproving my fitness and stamina
Important to me about this issueTo be strong enough to use amanual wheel chair all the time. To be able to do more than one thing per day without getting too tired Not being too tired to go out in the evenings with my friends.	Important for me about this issueTo improve my general health through exercise Not to get socially isolated because I am too tired to see family and friends
My OutcomeI am using my manual wheelchair 12-14hrs per day and I am not too tired and having to go to bed in the afternoon. I am going out 2-3 evenings each week with my friends.

Congratulations- you now have a robust, clear and truly person centred outcome. So what next?

Step 6: What’s stopping you? 

You have your outcome but at this point it is useful to ask what some of the barriers might be and the obstacles to achieving this outcome, so that we can take this into account when we identify our next steps.

Step 7: Action

Having identified the overall outcome and what’s getting in the way, the next step is to identify the steps that you need to take to achieve the outcome and overcome those obstacles. Try to think creatively, and not to jump to the obvious service options.

This is where you can identify small targets or goals to help achieve the broader outcome. Different places will do this in different ways and have different language to describe this and that is fine as long as there is clarity about what the outcome is.

Having identified the goals/targets then you can identify the first step actions to get started, SMART of course with timescales, people responsible and resources required.

Step 8: Record

Strangely the first starting point for organisations when thinking about outcomes, is sometimes to initially focus on what recording methods are being used at the time and equipping employees to be able to fill this in appropriately. The energy and focus can be on whether the paper is capturing the right information and we become absorbed in data collection rather than knowing what we do is making a real difference to people’s lives. If we always take our starting point as the person themselves, the recording that we do, should and could be led from that.

So in summary…..

Start with the person; know what matters to them, what is working and not working and their aspirations for the future. Make sure you find out what the priorities are and what it looks like when they are achieved. Check you have robust and clear outcomes from this, know what barriers you need to overcome and set clear actions from this, which you record in a transparent and clear and sensible way.

Lets see what the participants at the conference next week think.