What has ‘clean’ go to do with quality?

Working out how to measure the right things can be difficult. It’s easy to fall into the trap of counting what’s easy and missing what matters. That seems to be especially true when it comes to measuring outcomes, where whatever we measure usually feels like it only gives a glimpse of what’s important but not enough to know that we’ve actually met our  purpose.

In the work I’ve been doing recently to create new Wellbeing Teams, I’ve been  focussed on finding a way past this problem. I want the information we use in these teams and in support of them, to help us pay attention to the right things in ways that are open and collaborative. Ideally, I want to find ways to do this that are simple and engaging too. Working with Andy from Easier Inc, one of the ways I’ve been exploring how to do this has led to a very unusual use of the word ‘clean’.

As Andy explains:

“One of the things about outcomes is that they happen after the fact. In a sense, worrying about them is to worry about what we want but not how to get it – the score but not the game. In the moment of caring for people, we can’t really know what outcomes we are going to achieve, only what we are doing or about to do. So we can draw a distinction between outcomes and inputs, inputs being the things we do. If we want to create really quick feedback loops that help us to think about and reflect on whether we are doing what matters in the moment, we can do a lot worse than ask ourselves whether we are delivering these inputs ‘clean’.”

OK, so that’s still a bit confusing. What does ‘clean’ mean? Here’s Andy again:

“A ‘clean’ input just means that what was done was done right. The trick is to define what we mean by ‘right’ with a clear understanding of what our purpose is and with reference to what matters to our customers, or in the case of Wellbeing Teams, what matters to the people being cared for and their families.”

A little clearer (maybe) but it was only when we started trying to define ‘clean’ inputs for a Wellbeing Team that the idea really clicked for me. We spent a little time thinking about the things that a Wellbeing Team does. For example, an initial conversation where we spend time getting to know the person we are going to support, their circumstances, what matters to them and what their existing support network is. For Wellbeing Teams, having these initial conversations visits will be a key ‘input’ that we have to do ‘clean.

So again, what does ‘clean’ mean? Well, how about the following:

At the end of an initial conversation the person we are supporting should be able to say…
“You understand what matters to me and what matters most”
“I trust you”
“I know what is going to happen next and who is going to do it”

The family of that person should be able to say…

“I trust you and am excited to try these new ways to keep in touch”

The colleague from the Wellbeing Team should be able to say…
“I have understood the greatest difference we can make and how to make this happen (within the person’s budget)”
“The week we have designed perfectly meets what matters to the person and makes best use of the their resources, technology, connections with friends, family and neighbours, and local community resources.”

We’re going to continue to work on these statements. In fact, we’ll never stop doing so. Our plan is to use them as prompts for reflective practice; to ask ourselves how confident we are that we are achieving ‘clean’ in these terms but also to keep asking whether we have defined ‘clean’ in the right way. We’ll also reflect on what patterns we find make achieving ‘clean’ easier or harder and what can we do about that.

Our hope is that focussing in this way will help us stay really grounded in our purpose and what matters to the people we support. We think that it will help us with a common language to unite thew work we do to deliver care and support with the work we do to constantly improve how we deliver care and support; a little engine for collaboration.

What do you think? Useful or not? How would you describe ‘clean’?

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