Several approaches to outcome based practice have been identified. I
have listed some of these below,
Results based accountability is also known as outcome based
accountability. This approach uses data-driven decision making processes to help
problem solving and is a way of thinking and acting that improves the lives of
the community. It has been developed to improve the performance of an
organisations services .
Outcomes management is the means to help patients
and providers make care – related choices based on knowledge of the effects of
these choices may have on the patient’s life.
Outcomes into practice focuses on the outcomes
Logic model is a logical framework and theory of
change used by funders, managers, and evaluators of programmes to evaluate
Whichever model is implemented, the basic premise is that outcome based
practice is the way forward and replaces the needs led approach that tended to
focus more on the immediate situation and support requirements that would be
provided by a care professional.
The idea of outcomes in care was seen as an achievement and as a more
meaningful way to assist care. In using this approach, the worker takes on the
role of assisting the service user to identify immediate, medium term and long
term term goals. Rather than leading the service users care, the health
‘steers, guides and pronounces
the identification of “needs” and the proposed
towards practice driven by the service user , who is
facilitated to identify their “outcomes”, a set of immediate,
medium, and long
term goals, that they wish to achieve. The focus on outcomes
many of the
deficiencies of the “needs” led model described above .
Qureshi et al (2000), quoted in Barnes and Mercer (2004
Care work becomes target driven and specific , with a goal in mind and
its the service user in this type of care who sets the review dates and
monitors their achievements and the success or failure of the venture. In this
type of approach, the role of the care professional is to assist the service
user in the achievement of their only.
Whilst this approach would seem to provide the ultimate in person
centred care , it is not without its critics, and a critical evaluation of the
approach by Qureshi et al, in 2000 for York University highlighted some of the
issues with it.
Care professionals seemed to struggle with the concept of outcomes as
they lacked understanding of what the ‘outcomes’ focus actually was.
A further concern highlighted was with the notion of ‘expert power’ .
Putting the service user at the centre of the assessment process , identifying
their own aims and objectives in negotiation with care professionals meant that
the professional felt their role had been reduced to one of facilitator as the
control and responsibility for the achievement was very much with the service
user. This does not sit well with some professionals as with the belief that as
‘experts’ they should have a bigger part in the decision making process.
Outcome based practice is used in the services I manage and has been
difficult to implement for some of the reasons named above. However, in
forensic mental health there is more of a role for the ‘expert’ input from a
care professional. This is due to working with service users who have
restriction orders (section 41 MHA 1983). Service users do not always agree
with the ‘risk’ they may pose to others, and any aims and objectives they may
have, has to take their restrictions into account. Although this can have an
impact upon them, we work with the service user in a way as to optimise the
areas in which they can have the power and control to make choices and enable
them to achieve their goals, enabling them to build up confidence in their
decision making. Many of the people who use our service will have been in
secure setting for a number of years, in some cases over fifteen years. Having
the confidence and even the choice to think of your own aims and objectives can
be overwhelming. We have to ensure that the care and support provided to the
service user is very much at a pace that is right for them and tailored to
their individual situation.
I have been in the care industry for over twenty five years and have
seen the challenges of changing from a more needs led approach to one that is
more person centred and outcome focussed. Issues stemmed from a care professionals need to reach a service
solution rather than listening to the service users desired outcomes. This was reported as a need to take
responsibility on the part of the professional and also linked to pressure of
work. A number of professional practice issues have been noted in research
undertaken relating to this area along with the challenge of introducing an
outcomes approach which were,
the tendency of the care professional to fall back
into a provider service mode instead of thinking and acting creatively with the
The inability of care staff to grasp the outcomes
One interesting point that I noted from the research I read showed that
service users valued the outcomes approach and ‘appeared comfortable’ with
setting goals and working towards them.