Our approach to outcomes

Our thinking about outcomes as a broad discipline for care, health and social services

Triangle believes that outcomes-driven, client centred practice should be a goal for all service providers and commissioners. That’s why all of our pioneering work around outcomes tools and approaches is based on some key pillars:

1) The real goal is organisational learning and service development

The primary reason to measure outcomes is to be able to understand and evidence what is working and what isn’t, to inform and drive service improvement. It is there to enable you to serve the service user better. Accountability to commissioners and funders is also an important and valid motivation but when this becomes too dominant, it can be counterproductive and result in a focus on figures rather than people.

Triangle believe that it is organisations who are continually learning about themselves and the work they do, that make the biggest difference in people’s lives. We encourage organisations and commissioners to assess the extent to which services are measuring, learning and improving as a result of outcomes measurement, rather than focusing narrowly on particular outcome figures.

2) What you measure shapes what you do – outcomes focused means user focused

Outcomes is about much more than measurement. It can provide a focus for embedding a results-driven, service user focused culture deep within services and organisations. Being outcomes focused means shifting the whole focus of keywork and management to the service user and the changes they experience rather than the service and how it is being delivered. Below is a table reproduced from an early article Triangle published about the link between outcomes and user focused services:

Service focused	User focused
Focus on service deliverer	Focus on service user
Focus on how you deliver services	Focuses on how service user changes
Focus on quality of services	Focus on effectiveness of services
Emphasis on improving quality	Emphasis on improving effectiveness
Measure amount of what you do	Measure benefit of what you do
Evidence of activity (weak case with funders)	Evidence of results (strong case with funders)
The task is never finished (and so staff get de-motivated)	Clients achieve goals (which is motivating for staff and service users)
Service specified in terms of what is offered and intended outcome	Service specified in terms of service user need

Because what you measure shapes what you do, measuring change holistically can encourage people to work holistically. And by measuring distance travelled towards larger goals, you can embed a focus on realistic and sustainable change. And, by making service users active participants in the measurement and outcomes process, “measuring” itself can be a powerful demonstration of empowerment – done with people, rather than done to.

3) Co-reported outcomes bring the best of both worlds

Traditional approaches to measuring change in attitudes, skills and behaviour tend to use either a ‘professional’ or clinical assessment by a worker, or ‘self-reported’ information from a service user. Whilst these approaches have value, both bring only one perspective to bear on the situation.

By bringing together the views and insight of all parties involved, the knowledge of both sides can inform measurement and be reflected in a more rounded assessment of the situation. In addition, the process of discussion and shared reflection has its own benefits in terms of supporting the change process. In keywork settings, the building of a shared view of the issues and action needed has been found to be an essential foundation for successful keywork. The concept of co-reporting is unpacked further in Triangle’s article for the Journal of Housing and Social Care.

4) Counting what really counts – there is nothing soft about ‘soft’ outcomes

We believe that measuring changes in attitude, skills and behaviour is vital when assessing the effectiveness of an intervention. Hard outcomes like changes in employment, offending or housing status are very important too. But an exclusive focus on these external changes in circumstance may be less effective in predicting long-term outcomes, because they do not look at the ability of the person to sustain those improved circumstances.

It is now widely accepted and evidenced that skills and attitudes are important predictors of sustained change. And there is also the advantage that changes in these capabilities and qualities can be measured and monitored regularly whilst the service is being delivered to give a more immediate indicator of progress.

5) Advocating sector-wide approaches

We strongly advocate sector-wide tools because we believe they enable organisations to measure, learn and develop most effectively by:

• Saving organisations the time and effort of re-inventing the wheel by creating their own tool when there is often strong commonalities across the outcomes services are seeking to achieve
• Providing a shared language and understanding between providers and commissioners
• Providing consistency and continuity for service users as they move along the service pathway.

Triangle has pioneered this approach with the Outcomes Star family of tools for many different health, care and social sectors and it is gaining traction as a useful ambition, for example with NPC’s Inspiring Impact programme and work around shared measurement.

6) Validation should be balanced and holistic

Traditional outcomes tool validation processes often focus primarily on the needs of academics and policy makers and do not give sufficient attention to the perspective of service users, workers and managers. We believe that when tools are validated it is important that the needs of all stakeholders are taken into account.

Ultimately all stakeholders are interested in service user change, but their specific needs are different:

• Service users need tools that empower them to understand their lives and to make changes
• Workers need tools that help them build effective relationships with service users and to have meaningful conversations with and about service users
• Managers need tools that help them identify service strengths and challenges and that help them embed consistent, outcomes-focused and effective ways of working
• Commissioners need tools that allow them to identify effective providers and to support them to be more effective or share learning with others
• Academics and policy makers need tools that help establish what interventions are most effective

Focusing exclusively on the perspective of academics and policy makers can result in tools that are difficult to use, take the focus away from service delivery, don’t relate to the work they are doing and, at worst, get in the way of service user progress. We advocate the use of tools that have been assessed and validated against the needs of all stakeholders.