Communities For Health Round Table Meeting

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Communities For HealthRound Table Meeting

• Getting from Talk to Action
• An introduction to Outcome Based Accountability
• David Burnby
• November 18th 2008

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• Fiscal Policy Studies Institute
• Sante Fe, New Mexico
• www.resultsbasedaccountabilty.com
• www.raguide.com
• www.trafford.com

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Outcome Based Accountability

• Simple
• Common Sense
• Plain Language
• Minimum Paper
• Useful

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Outcome Accountabilityis made up of two parts

• Population Accountability
• about the well-being of
• WHOLE POPULATIONS
• for neighbourhoods districts regions -
  countries
• Performance Accountability
• About the well-being of
• CLIENT POPULATIONS
• for projects agencies service providers

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Outcome Accountability

• Common Language
• Common Sense
• Common Ground

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The Language TrapToo many terms, Too few
definitions, Too little discipline
Measurable Systemic Objectives!
Qualitative Performance Measures!
Benchmark
Result
Outcome
Modifiers Measurable Core
Urgent Qualitative Priority Programmatic
Targeted Performance Incremental Strategic
Systemic
Goal
Indicator
Targeted Incremental Results!
Priority Strategic Outcomes!
Objective
Measure
Target
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Definitions

• Outcomes
• Indicators
• Performance Measures

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Definitions
OUTCOMES

• A condition of well-being for children, adults,
  families or communities.

• Children born healthy
• Adults enjoying a good quality of life
• Safe communities
• Clean Environment
• Prosperous Economy

Stated in plain language that people can
understand Not about regen-speak or government
jargon A condition of well-being for people in a
place...... E.g. All in have
Adults
a place
personal dignity
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Outcomes for Communities

• Healthy Births
• Healthy Children and Adults
• Children Ready for School
• Children Succeeding in School
• Young People Staying Out of Trouble
• Stable Families
• Families with Adequate Income
• Safe and Supportive Communities

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Adult Social Care Outcomes

• Improved health and emotional well-being
• Improved quality of life
• Making a positive contribution
• Exercise of choice and control
• Freedom from discrimination and harassment
• Economic well-being
• Personal dignity

From our health, our care, our say a new
direction for community services, NHS, January
2006
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Definitions
INDICATORS

• A measure which helps quantify the achievement of
  an outcome.

• Rate of low birth weight babies
• Key stage test scores
• Burglary rate
• Air quality index
• Life expectancy rates

How would we recognise these outcomes in
measurable terms if we tripped over them? E.g.
Low burglary rate helps to quantify a safe
community
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Definitions
PERFORMANCE MEASURES

• A measure to evaluate how well a programme,
  agency or service system is working.

• Three questions
• How much did we do? (quantity)
• How well did we do it? (quality)
• Is anyone better off as a result? (quantity and
  quality of effect)

Performance measures tell us how well service
providers are working as opposed to the impact on
whole populations (i.e. outcomes)
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From ends to means...From talk to action...
OUTCOMES A condition of well-being for children,
adults, families or communities
Population Accountability
ENDS
INDICATORS A measure which helps quantify the
achievement of an outcome
PERFORMANCE MEASURES A measure to evaluate how
well a programme, agency or service system is
working
Performance Accountability
MEANS
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Population and Performance Accountability
OUTCOME All Young People in (a place) are
Healthy
INDICATOR Obesity Rate
End
Contribution
All Young People in (a place) WHOLE POPULATION
Young people attending active lifestyle programme
PERFORMANCE MEASURE Young people attending
losing weight
Means
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The National Indicator Set

• Outcome 4 HEALTHY SUCCESSFUL ADULTS

• Self-reported measure of peoples overall health
  and wellbeing
• All-age all cause mortality rate
• Mortality rate from all circulatory diseases at
  ages under 75
• Mortality rate from all cancers at ages under 75
• Stopping smoking
• People with a long-term condition supported to be
  independent and in control of their condition
• Achieving independence for older people through
  rehabilitation/intermediate care
• Early Access for Women to Maternity Services
• Self reported experience of social care users
• User reported measure of respect and dignity in
  their treatment
• End of life care access to appropriate care
  enabling people to be able to die at home
• Social Care clients receiving Self Directed
  Support per 100,000 population
• Delayed transfers of care
• Timeliness of social care assessment
• Timeliness of social care packages following
  assessment
• The number of emergency bed days per head of
  weighted population
• Carers receiving needs assessment or review and a
  specific carers service, or advice and info.
• People supported to live independently through
  social services (all adults)
• Healthy life expectancy at age

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MEANS not ENDS
(to improving outcomes) (in themselves)

• Sustainable Community Strategy
• Local Strategic Partnership
• Neighbourhood Management
• Local Area Agreement
• Adult Social Care Service Plan
• Re-organisation

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Outcome, Indicator or Performance Measure?

• Safe Community
• Crime Rate
• Average Police Response Time
• Healthy and Successful Adults
• 16 current smoking rate
• Exercise of choice and control
• No of older people helped to live at home
• User satisfaction of care workers

Outcome
Indicator
P. Measure
Outcome
Indicator
Outcome
Indicator
P. Measure
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The Leaking Roof
Not OK
Experience Measure
Forecast
Inches of Water
Fixed?
Time
Story behind the baseline (causes) Partners What
Works? Action Plan (Strategy)
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Increased Choice and Control
OUTCOME

• Households receiving intensive home care
• Number receiving direct payments
• People being helped at home

Measures of the outcome
INDICATORS
BASELINES

• Where weve been
• Where were going
• Where we want to be

Data Development Agenda (Pt 1)

• The causes, the forces at work
• Whats driving the baselines?

STORY Behind the baselines

• Public, Private and Voluntary Sector
• Community groups
• Residents

PARTNERS With a role to play

• What would it take to turn the curve?
• Best practice
• Best hunches

WHAT WORKS
Data Development Agenda (Pt 2)
ACTION PLAN

• What we propose to do, how and by when

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Turning the Curve
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Managing Performance using OBA (How do you know
performance management is effective?)
All Performance Measures that have ever existed
for any programme in the history of the universe
involve answering two sets of interlocking
questions.
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Programme Performance Measures
QUANTITY
QUALITY
How Much did we do? (number)
How Well did we do it? (percent)
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Programme Performance Measures
Effort How hard did we try?
Effect Is anyone any better off?
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Programme Performance Measures
QUANTITY
QUALITY
How much service did we deliver?
How well did we deliver it?
EFFORT
Cause
INPUT
How much change/effect did we produce?
What quality of change/effect did we produce?
EFFECT
OUTPUT
Effect
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Health Clinic
QUANTITY
QUALITY
How much did we do?
How well did we do it?
Percentage of patients treated in less than 1
hour
Number of Patients Treated
EFFORT
Is anyone better off?
Recovery Number (for patients of the clinic)
Recovery Rate (for patients of the clinic)
EFFECT
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Home Care Services
QUANTITY
QUALITY
How much did we do?
How well did we do it?

• No. Visits per week
• Average length of visit
• service users who say the service is reliable,
  flexible, respectful, friendly

• No. of persons served
• No. Visits

EFFORT
Is anyone better off?

• carers reporting the service helped the service
  user remain at home

• No. carers reporting the service helped the
  service user remain at home

EFFECT
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Not All Performance Measures Are Created Equal...
QUANTITY
QUALITY
How much did we do?
How well did we do it?
LEAST important
Also Very Important
EFFORT
Is anyone better off?
MOST important
EFFECT
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The Matter of Control
QUANTITY
QUALITY
How much did we do?
How well did we do it?
MOST control
EFFORT
Is anyone better off?
LESS control
PARTNERSHIPS
EFFECT
We have the least control over the most important
matters
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Performance Accountability Getting from Talk to
Action
Customers
Performance Measures

Baselines
How much did we do? How well did we do it? Is
anyone better off?
Turned Curve
Trend
(Data Development Agenda)
Story behind the baselines (Information and
Research Agenda about Causes)
Partners
What works (Information Research Agenda about
Solutions)
Strategy and Action Plan
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Hints and Tips

• The bottom line for this work is to turn curves
• Pick one thing and do it well dont try to do
  everything
• Anywhere leads to everywhere turn one curve
  and it will have a positive impact on another
• Develop report cards and make them visible put
  them on walls or in information bulletins

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Hints and Tips

• Be really clear about the difference between
  population and performance accountability
• Under population be clear about your role and
  what you are accountable for
• When is something a performance measure? when
  there is a defined population that you can name

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Hints and Tips

• You deliver services you cannot deliver
  outcomes dont talk about delivering outcomes
  talk about improving outcomes
• Create Outcomes Champions
• Start the parade others will want to join in

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An Outcomes Organisation....

• Understands the population and trends
• Knows the purpose, mission and vision and where
  the organisation is going all based on local
  population needs
• Is outward facing
• Uses data to assess how well the organisation is
  doing

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An Outcomes Organisation....

• Uses shared language
• Takes collective responsibility rather than
  blaming individuals
• Has incentives for creative thinking
• Focuses on actions, not just talk
• Encourages independent thinking and thinking
  outside of the box

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An Outcomes Organisation....

• Has population and performance charts on the wall
• Has people talking about population and
  performance and focusing on measures that make a
  difference (Bottom Right Hand Quadrant Measures)
• Successfully makes the move from Talk to Action

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And finally...

• There is nothing worse than doing something well
  that shouldn't be done at all. Be effective, and
  get the right things done
• Peter F Drucker
• American Businessman, Author, Speaker