Outcome Based Accountability

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Outcome Based Accountability

• From Talk to Action
• David Burnby
• www.davidburnby.co.uk

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• Fiscal Policy Studies Institute
• Santé Fe, New Mexico
• www.resultsbasedaccountabilty.com
• www.raguide.org
• www.resultsleadership.org (publications)

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Outcome Based Accountability

• 1 Language
• 2 Levels of Accountability
• 7 Steps from Talk to Action

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Two Levels of Accountability

• 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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1 Language

• Outcome
• A condition of well-being for children, adults,
  families or communities
• Indicator
• A measure which helps quantify the achievement of
  an outcome
• Performance Measure
• A measure to evaluate how well a programme,
  agency or service system is working

Population Accountability
ENDS
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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Seven Steps from Talk to ActionThe 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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Healthy and Successful Adults
OUTCOME

1. All age, all cause mortality rate
2. 16 current smoking rate
3. Healthy life expectancy at Age 65

Measures of the outcome
INDICATORS

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

BASELINES
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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The 7 Population Accountability Questions

• What are the quality of life conditions we want
  for the children, adults and families who live in
  our community?
• What would these conditions look like if we could
  see them?
• How can we measure these conditions?
• How are we doing on the most important of these
  measures?
• Who are the partners that have a role to play in
  doing better?
• What works to do better, including no cost/low
  cost ideas?
• What do we propose to do?

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Whole Population Turning The Curve Report
The definition of the WHOLE POPULATION we want to
impact on (e.g. All young people in Hull or
All older people in Middlesbrough etc.)
The desired OUTCOME The condition of well-being
we want for our defined whole population
The priority INDICATOR we will use to determine
progress towards our OUTCOME
The INDICATOR BASELINE made up of the historical
data, the projected forecast (if nothing is done)
and showing the curve we want to turn
The STORY BEHIND THE BASELINE What we know about
the factors driving the baseline. What are the
causes/factors at work? Whats our best community
intelligence on this issue?
Key pointers to action
What are the gaps in our knowledge (our DATA
DEVELOPMENT AGENDA)? What do we need to know to
inform our action plan?
Who are the KEY PARTNERS with a role to play in
Turning the Curve? These could be public sector
service providers, residents, voluntary and
community organisations and businesses amongst
others
WHAT WOULD IT TAKE TO TURN THE CURVE? Whats our
best thinking on this, our best hunches? What
would work in our community? Always include at
least one No Cost/Low Cost idea and an Off The
Wall idea (to generate creative thinking)
NB ONE SIDE OF FLIPCHART PAPER ONLY!
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Outcome Based Accountability

• Managing and Improving Performance

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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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Drug Treatment Programme
QUANTITY
QUALITY
How much did we do?
How well did we do it?

• clients completing programme
• counsellors trained to professional standard
• clients saying they were treated well

• Number of clients enrolled
• Number of courses
• Number of counselling sessions

EFFORT
Is anyone better off?

• Number clients drug free
• At exit of programme
• After 12 months
• Number clients saying they were helped with their
  problems

• Percentage clients drug free
• At exit of programme
• After 12 months
• Percentage clients saying they were helped with
  their problems

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
QUALITY
QUANTITY
How much did we do?
How well did we do it?
MOST control
EFFORT
Is anyone better off?
LESS control
EFFECT
PARTNERSHIPS
We have the least control over the most important
matters
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Performance Turning The Curve Report
The programme, service system or project being
performance managed
The customers i.e. the people whose lives are
affected (for better or worse) by the actions of
the programme
The priority PERFORMANCE MEASURE derived in
particular from the How well and Better Off
(right hand quadrant) questions
The PERFORMANCE MEASURE BASELINE made up of the
historical data, the projected forecast (if
nothing is done) and showing the curve we want to
turn
The STORY BEHIND THE BASELINE What we know about
the factors driving the baseline. What are the
causes/factors at work? What is our understanding
of whats driving our performance?
What are the gaps in our knowledge (our DATA
DEVELOPMENT AGENDA)? What do we need to know to
inform our action plan?
Who are the KEY PARTNERS with a role to play in
Turning the Curve? These could be internal
departments, service users, suppliers etc.
WHAT WOULD IT TAKE TO TURN THE CURVE? Whats our
best thinking on this, our best hunches? What
would work in our organisation? Always include at
least one No Cost/Low Cost idea and an Off The
Wall idea (to generate creative thinking)
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Outcome Based Accountability

• Next Generation Commissioning

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Outcome Based CommissioningHome Care Service
How much did we do?
How well did we do it?
Service Specification (Home Care Service)

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

• The WHOLE POPULATION OUTCOME were looking to
  contribute to Increased Choice and Control
• The INDICATOR were trying to influence (the
  CURVE we want to turn) Support to live
  independently (NI 139)
• (Story behind the baseline)
• Description of the service including the QUANTITY
  of service we want to buy
• We will measure the QUALITY of the service by
  these performance measures
• We will work together to maximise the EFFECT of
  the service demonstrated by these performance
  measures (Customer Outcomes)

Number of persons served
Is anyone better off?

• Percentage service users reporting that service
  has enabled them to remain at home

• Number service users reporting that service has
  enabled them to remain at home

1. You can purchase services. 2. You can
purchase service quality 3. You cannot purchase
customer outcomes. Instead, you can purchase a
contract relationship that maximizes good
customer outcomes.
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Next Generation Commissioning
Quantity
Quality
Effort
BUT
Effect
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The Three Essential Provisionsof Next Generation
Commissioning

1. The most important performance measures

How much? How Well?
Anyone Better Off? Anyone Better Off?
The three to five measures that say most about
the effectiveness of the service providers
performance
As determined from the Five Step Method
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The Three Essential Provisionsof Next Generation
Commissioning

1. Continuous Improvement Process

• Using Turning the Curve report cards based on the
  7 performance accountability questions
• Using the same basis for management supervision
  across the organisation

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The Three Essential Provisionsof Next Generation
Commissioning

• Performance Partnership between commissioner and
  service provider
• Periodic meetings to review progress on the three
  to five most importance performance measures
  (based on Turning the Curve reports)
• Reviewing changing stories behind the baseline
• Agreeing measures the commissioner can take to
  help improve performance as partners in
  facilitating improvement
• e.g. Technical assistance and support
• Brokering relationships with third parties
• Helping to break down barriers to progress
• This does not compromise respective
  accountability
• For commissioners responsibility for service
  providers performance and effective use of funds
• For service providers commitment to continuous
  improvement process

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Other 4 Quadrant Concepts
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Home Care Service
QUANTITY
QUALITY
How much did we do?
How well did we do it?

• Number of visits per week
• Average length of visit
• clients saying they were treated with dignity
  and respect

• Number of persons served
• Number of home visits
• Number of shopping trips

EFFORT
Is anyone better off?

• Number clients saying that service has enabled
  them to stay in their own home
• Number of clients saying they feel happy and
  comfortable in their own home

• clients saying that service has enabled them to
  stay in their own home
• of clients saying they feel happy and
  comfortable in their own home

EFFECT
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Car Manufacture
QUANTITY
QUALITY
How much did we do?
How well did we do it?

• Residual value of cars
• Warranty claims
• Unit cost
• Customer satisfaction

• Number of units produced
• Tons of steel deployed

EFFORT
Is anyone better off?

• Profit Margin
• Share price
• Return on Capital

• Profit margin
• Share price growth
• Return of Capital

EFFECT
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Private Sector Home Care Service
QUANTITY
QUALITY
How much did we do?
How well did we do it?

• Number of visits per week
• Average length of visit
• clients saying they were treated with dignity
  and respect

• Number of persons served
• Number of home visits
• Number of shopping trips

EFFORT
Is anyone better off?

• Number clients saying that service has enabled
  them to stay in their own home
• Number of clients saying they feel happy and
  comfortable in their own home

• clients saying that service has enabled them to
  stay in their own home
• of clients saying they feel happy and
  comfortable in their own home

EFFECT
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Private Sector Home Care Service
QUANTITY
QUALITY
How much did we do?
How well did we do it?

• Number of visits per week
• Average length of visit
• clients saying they were treated with dignity
  and respect

• Number of persons served
• Number of home visits
• Number of shopping trips

EFFORT
Is anyone better off?

• clients saying that service has enabled them to
  stay in their own home
• of clients saying they feel happy and
  comfortable in their own home

• Number clients saying that service has enabled
  them to stay in their own home
• Number of clients saying they feel happy and
  comfortable in their own home

EFFECT
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Private Sector Home Care Service
QUANTITY
QUALITY
How much did we do?
How well did we do it?

• Number of visits per week
• Average length of visit
• clients saying they were treated with dignity
  and respect

• Number of persons served
• Number of home visits
• Number of shopping trips

EFFORT

• Number clients saying that service has enabled
  them to stay in their own home
• Number of clients saying they feel happy and
  comfortable in their own home

• clients saying that service has enabled them to
  stay in their own home
• of clients saying they feel happy and
  comfortable in their own home

Is anyone better off?

• Profit Margin
• Share price
• Return on Capital

• Profit margin
• Share price growth
• Return of Capital

EFFECT
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Private Sector Home Care Service
QUANTITY
QUALITY
How much did we do?
How well did we do it?

• Number of visits per week
• Average length of visit
• clients saying they were treated with dignity
  and respect
• clients saying that service has enabled them to
  stay in their own home
• of clients saying they feel happy and
  comfortable in their own home

• Number of persons served
• Number of home visits
• Number of shopping trips

EFFORT

• Number clients saying that service has enabled
  them to stay in their own home
• Number of clients saying they feel happy and
  comfortable in their own home

Is anyone better off?

• Profit Margin
• Share price
• Return on Capital

• Profit margin
• Share price growth
• Return of Capital

EFFECT
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The OBA Journey From Talk to Action
ENDS (POPULATION ACCOUNTABILITY)
Drawing the BASELINE (and the CURVE TO TURN)
DESIRED OUTCOME
The STORY BEHIND THE BASELINE
Choosing the INDICATORS
Choosing the PARTNERS
REVIEW
Deciding WHAT WORKS
The ACTION PLAN
Contributory Relationship
PROCUREMENT
MEANS (PERFORMANCE ACCOUNTABILITY)
PERFORMANCE MEASURES How Much? How Well? Better
Off? (CLIENT OUTCOMES)