Outcome Based Practice
yOutcome based practice, is defined by the Scottish Government as “an outcomes-based approach encourages us all to focus on the differences that we make and not just the input or processes over which we have control” (Scottish Government 2011). In 2011, the English Government launched is first framework of outcomes for adult health and social care. Within this framework, they stated “set of outcomes measures which have been agreed to be of value, both nationally and locally for demonstrating the achievements of adult social care”.
The Social Care Institute for Excellence define ‘outcomes’ as follows: “Outcomes are defined as the impact, or end-results, of services on a person’s life; therefore outcomes-focused services are those that aim to achieve the priorities that service users themselves identify as important. ” A study carried out at York University by Harris et al (2005) broke outcomes down into 4 sections, these being Autonomy, personal comfort, economic participation and social participation.
Autonomy outcomes were broken down into the following sections by the above study: Access to all areas of the home; Access to locality and wider environment; Communicative access and Financial security Personal Comfort outcomes were broken down into the following sections by the above study: Personal hygiene; Safety/security; Desired level of cleanliness of the home; Emotional wellbeing and Physical health.
Economic Participation outcomes were broken down into the following sections by the above study: Access to paid employment as desired; Access to training; Access to further/higher education/employment and Access to appropriate training for new skills (e. g. lip reading). Social Participation outcomes were broken down into the following sections by the above study: Access to mainstream leisure activities; Access to support in parenting roles; Access to support for personal secure relationships; Access to advocacy/peer support and Citizenship. When an outcome focussed approach is used, this should support the whole approach.
This approach was researched and developed with people who were disabled, rather than those who were elderly. Although the information gathered can be used with disabled elderly people, it can be argued whether this information can be used with those who have mental illnesses or physical illness. Mark Friedman (2005) developed the Results Based Accountability approach. This approach works backwards by taking the steps needed to obtain the desired outcome, the necessary resources involved and how to recognise when the objective have been achieved.
Friedman makes a clear difference between responsibility and accountability for a population group as a whole which he calls Population Accountability and responsibility for outcomes for a defined customer group which he calls Performance Accountability. Population accountability is both overarching and collaborative in nature and responsibility cannot therefore be allocated to any one organisation alone. To ensure successful outcomes for this population, this can only be achieved by partnership between services e. g. GP practices and local authorities.
Performance accountability tells of the achievement of outcomes for service users at a more local level or to the work of a specific service or agency. Results based accountability differentiates between measuring the outcomes for the individual receiving the service as opposed to the processes for achieving them This is approach can be reviewed as being difficult to use as population accountability can only be used if outside agencies (GP services, local authorities) are willing to provide the information needed.
If one agency is willing and another isn’t, a successfully partnership can’t be achieved and therefore, the approach becomes inconclusive. However, should the agencies work together; it can create an approach that becomes very efficient in the data it concludes. Outcomes Management comes from a large insurance based healthcare field in the US. Steinwachs et al (1994) carried out the research within thirteen care organisations looking at two conditions: asthma and cardiac angioplasty.
Carrying on from this study, it has now been applied across a broader spectrum of health and social care. Brown et al (2001) described how the approach had been applied across mental health services within the US. Outcomes have now been reflected within the Essential Standards of Quality and Safety adopted by the Care Quality Commission. Since outcome based practice has come into force, the care industry has now become more personalised. Outcomes can have very positive effects on individual’s lives.
The SCIE website have defined all their evidence into key points of what they believe can create positive effects. However, elderly people within ethnic minority communities have fewer studies focused on them, but what research has been carried out, indicates the same values and beliefs. SCIE have identified three outcomes they believe to have the biggest positive effect. These are: outcomes involving change, outcomes involving maintenance or prevention and service process outcomes.