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Working with personal outcomes
I have written before about the importance of personal outcomes in providing personal support and care.
I think it is useful to look at detailed findings of what works best in working to people's best outcomes. Practice is increasingly recognising the importance of personal outcomes. This is reflected in the incoming new National Health and Social Care standards in Scotland. These are being rolled out from 1 April 2017, and under each of the five overarching principles, the wishes, aspirations and choices of people receiving the service are pointed out as central. So to achieve quality of service under modern standards, care services must identify and work towards the personal outcomes to which people using the service aspire.
Important issues in Personal Outcomes work
Healthcare Improvement Scotland, the health service Scrutiny body in Scotland last year carried out a program focusing on exploring and improving work towards personal outcomes. A range of services from different sectors were involved, and the report (available on their ihub.scot web page) showed that useful lessons were learned.
The program was called 'Meaningful and Measurable', and five main areas of good practice and for development were identified.
- Clear conversations must take place regarding outcomes, between professionals as well as with service users.
- Recording practice needed to improve, to clearly indicate outcomes and working towards these.
- Recorded data should not just document progress, but be used to boost overall practice in the service and organisation.
- There was a need for balance between qualitative and quantitative data, incorporating the personal point of view as well as objective facts.
- Performance management and measurement needed to be made consistent with, and not dominate the drive to improve through an outcome focus.
These were all important, but i believe recording was a main point to bear in mind. The program found there was a need for personalisation involving the family/service user, and being action focussed in recording progress. There is also a need to incorporate qualitative recording in the main documentation. What does the person and/or their representative think about the progress made? How has their life changed in relevant respects? How is this recorded and used to measure the progress and success of the work?
The importance of recording
I recently saw a useful implementation of these lessons. A community support service had incorporated the use of star charts: these started with usually six agreed personal outcomes, and at regular intervals the person using the service themselves reviewed and recorded, for each outcome a score out of 10 for the progress made since the last review. This was supplemented by staff comments and overview. A series of these star charts then gave a continuous visible record of progress being made towards the desired outcomes. This documentation also solved other issues: it included both quantitative and qualitative measures (the person themselves scoring and recording a number for the progress being made); it promoted good focused discussion about outcomes, and it could clearly provide data to be linked to overall performance indicators for the service. Not least, the charts were incorporated as a central part of the support planning documentation, so putting outcomes and the person's viewpoint at the top of the agenda at reviews.
I think focusing on outcomes is the way to change the culture of care, putting the importance of the client first, and underlying any sustainable and genuine measure of improving quality.
The new standards for evaluating care in Scotland mean that quality will importantly be determined by how well staff and managers understand that outcomes must figure in all that they do: care planning , practice, recording, review, assessment and evaluation.
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