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Outcome Based Care – Outcomes, Not Inputs
When I began working in the care of the elderly some years ago, I found it enjoyable and rewarding from the outset. However, I was surprised to see that daily recording of the work done was often of mundane details, such as meals taken, visitors, minor ailments, baths and so on.
Apart from being largely a waste of time, I thought this style of recording did not reflect the emotional support or innovative approaches which carers often provided.
In management, we set about to change this. We asked key workers to have supportive conversations with people about what their ambitions and aspirations might be. We then built these into the care planning , ensuring that support staff used these targets, setting time aside to do outcome work, and to record carefully as progress was made to reach the set objectives.
This worked well, in most situations. I recall a person later in life taking up piano lessons: another person helped us to set up a putting green in the grounds, golf having been one of their loves. In a moving case we helped a person to re-establish relations with their family which had been disrupted for some time.
It is good to see that personal outcomes are now becoming centre stage in health and social care . I have been impressed with outcome based approaches in community recovery programs to resolve addiction or mental health issues. Where people set their own targets, and are assisted, often by peers, to attain these then success often results.
In October 2014, NHS Scotland published an important document: "Optimising Older People’s Quality of Life: An Outcomes Framework". This has now been taken forward by Healthcare Improvement Scotland. This is a scrutiny body for health and social care set up by the Public Services Reform (Scotland) Act 2010. Their aim is to promote and support excellence in all care services across Scotland. The organisation states their purpose as:
To support healthcare providers in Scotland to deliver high quality, evidence-based, safe, effective and person-centred care; and to scrutinise those services to provide public assurance about the quality and safety of that care.
The agency has released information through their iHub website on work which has been done with a spectrum of care services recently. This focussed on recognising and promoting the importance of personal outcomes in care.
It makes good reading, and the project looked at many examples of excellence in supporting people to achieve their outcomes and aspirations. Three important issues discussed, for me, were Measurement, Meaningful and Qualitative aspects of outcome work.
I believe that in today's context of reduced funding and increasing demand, that increasing outcome based work has promise to bring about more satisfying and effective ways of working. Not least, it centres itself on the people cared for.
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