The term outcomes always generates debate and often confusion. As a team, we wanted to get clear ourselves, and then find ways to help others understand how to develop person-centred outcomes. In this longer blog I’ve described the eight steps that we developed to enable people to develop person-centred outcomes.
What are ‘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 two-to-three 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 people often make 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 people call something an outcome when in fact they are describing the solution or provision they plan to use to achieve an outcome. For example, they may say, ‘to have three sessions of home care each week.’ This describes how they will achieve an outcome, not the outcome.
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 I’ve suggested 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.
Again, in the process below I’ve suggested 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 eight-step process I’ve described in detail below can help us develop outcomes that are person-centred.
Step 1: Check
When we develop person-centred outcomes we must clearly start with the person themselves. They should always be our very first port of call because 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.
If we don’t have this understanding we are in danger of imposing our own ideas and developing service-driven outcomes.
To gain this understanding we need to have a person-centred conversation. We can record the outcome of this conversation in lots of different ways; it is the quality of the conversation that matters.
We 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 what issues are a priority for them and the people who know them.
If we use the working/not working tool to identify these issues, the outcomes that we ultimately develop will be relevant to the person.
Step 3: Prioritise
Now we know what matters to the person and we have a clear idea of what is currently working and not working, we need to make sure that the outcomes we develop are important to the person.
Agree priorities in partnership with the person, and their family where appropriate. When we create an agenda collaboratively we are far more likely successfully to achieve the outcomes on it because often the people who support the person to develop this 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. What will we see if the thing that is not working for the person is resolved? In this step we clarify our broad long-term aim for each priority area.
Asking the person what success looks like for them means we are likely to make sure the outcome is specific to them and not one we have used for others in a similar situation.
We don’t have to go into detail at this point.
Step 5: Test it
We now need to ask some questions to check if our ideas so far are outcomes or solutions disguised as outcomes, and that we haven’t drifted off the initial starting point too far and 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 three 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 we really have articulated an outcome, we ask the following questions, 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?
To check that we have really understood what is important to the person about this specific issue, we use the important to/important for tool. If we were exploring the fitness and stamina outcome it might look like this:
|Priority issue Improving my fitness and stamina|
|Important to me about this issue
To be strong enough to use a manual wheelchair 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 issue
To improve my general health through exercise.
Not to get socially isolated because I am too tired to see family and friends.
I am using my manual wheelchair 12-14 hrs 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.
Hurrah – we now have a robust, clear and truly person-centred outcome. So what next?
Step 6: What’s stopping us?
We have our outcome but at this point it is useful to ask what some of the barriers might be to achieving it, so that we can take them 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 we 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 we 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 we can identify the first step actions to get started, being 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 focus on what recording methods are being used and equipping employees to be able to fill them in appropriately.
Our energy and focus can be on whether we are 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, know what barriers you need to overcome and set clear actions from this that you record in a transparent and clear and sensible way.