Strategic management and achieving outcomes

© OECD

A j

oin

t i

nit

iati

ve o

f th

e O

EC

D a

nd

th

e E

uro

pe

an

Un

ion

,

pri

nc

ipall

y f

ina

nced

by t

he

EU

Zagreb (Croatia) 22-23 May 2014

Elke Löffler & Marcel Guenoun, SIGMA Experts

Strategic management:

Developing pathways to outcomes

© OECD

A j

oin

t i

nit

iati

ve o

f th

e O

EC

D a

nd

th

e E

uro

pe

an

Un

ion

,

pri

nc

ipall

y f

ina

nced

by t

he

EU

What’s most important in public services:

Outcomes

“This inquiry saw too many examples

of those in senior positions attempting

to justify their work in terms of

bureaucratic activity, rather than

outcomes for people”.

Source: Department of Health (2003) The Victoria

Climbié Inquiry. Summary Report.p.6.

© OECD

A j

oin

t i

nit

iati

ve o

f th

e O

EC

D a

nd

th

e E

uro

pe

an

Un

ion

,

pri

nc

ipall

y f

ina

nced

by t

he

EU

Outcomes measurement: Early years

From 19th century, concern with outcomes of public

policy, e.g. mortality rates, longevity and the educational

outcomes of schools.

Health-related quality of life measures were developed

and implemented by clinicians from the 1940s, although

often crude and limited to physical functioning

(Donabedian, 1966; Bowling, 1995).

From the 1950s, political interest extended to more

aggregate measures of wellbeing, including the standard

of living (UN, 1954) and quality of life (OECD, 1970).

Frederickson (1971): a central task of the New Public

Administration was to focus on policies which improve

the quality of life for all.

© OECD

A j

oin

t i

nit

iati

ve o

f th

e O

EC

D a

nd

th

e E

uro

pe

an

Un

ion

,

pri

nc

ipall

y f

ina

nced

by t

he

EU

WHAT IS AN OUTCOME?

(with apologies to Superman)

It it a task?

Is it a process?

Is it a service?

No - it’s a benefit!

Or at least what an

organisation intends to

achieve for individuals,

communities and citizens.

Outcomes

Outputs Processes Inputs

Shifting to outcome-based management

Law, values,

policy and

research

evidence

Evaluating

Monitoring

© OECD

A j

oin

t i

nit

iati

ve o

f th

e O

EC

D a

nd

th

e E

uro

pe

an

Un

ion

,

pri

nc

ipall

y f

ina

nced

by t

he

EU

Outcomes, outputs, processes, inputs

Outcomes - the actual or intended benefit of a service for the lives of individuals, communities and citizens

Equality Outcomes - the level of inequality in outcomes of services on people in relation to race, gender, sexuality, religion, disability and age

Outputs - the services that are produced (What services?, When?, Where?)

Processes - the systems used to produce services (How will we deliver these services?)

Inputs - the resources used to produce services (What staff, finances and other resources, e.g. citizen inputs, do we need to deliver these services?)

© OECD

A j

oin

t i

nit

iati

ve o

f th

e O

EC

D a

nd

th

e E

uro

pe

an

Un

ion

,

pri

nc

ipall

y f

ina

nced

by t

he

EU

The importance of equality outcomes:

“A Tale of Two Cities”

The Undergroup map “Lives on the Line” shows there is a 20-year difference in life expectancy between those born near Oxford Circus and others born close to some stations on the Docklands Light Railway (DLR).

Source: http://life.mappinglondon.co.uk/

Step 1: Identification of key outcomes

This can be done in a creative way involving service providers and

service users!

© OECD

A j

oin

t i

nit

iati

ve o

f th

e O

EC

D a

nd

th

e E

uro

pe

an

Un

ion

,

pri

nc

ipall

y f

ina

nced

by t

he

EU

The NHS Outcomes Framework 2013/14:

The five domains

Source: https://www.gov.uk/government/publications/nhs-outcomes-framework-

2013-to-2014 (published November 2012)

Domain 1 Preventing people from dying prematurely

Domain 2 Enhancing the quality of life for people with long-

term conditions

Domain 3 Helping people to recover from episodes of ill

health or following injury

Domain 4 Ensuring that people have a positive experience of

care

Domain 5 Treating and caring for people in a safe

environment and protecting them from avoidable

harm

© OECD

A j

oin

t i

nit

iati

ve o

f th

e O

EC

D a

nd

th

e E

uro

pe

an

Un

ion

,

pri

nc

ipall

y f

ina

nced

by t

he

EU

Group Work:

An assessment of the NHS Outcomes Framework

10

1. Get together in small groups

2. Assess the NHS Outcomes Framework:

Are all these domains outcomes?

If not, what are they?

3. From a Croatian perspective, which

outcomes would you add?

© OECD

A j

oin

t i

nit

iati

ve o

f th

e O

EC

D a

nd

th

e E

uro

pe

an

Un

ion

,

pri

nc

ipall

y f

ina

nced

by t

he

EU

1) Relate your strategic objectives to outcomes

2) Be clear about objectives

3) Relate PIs to objectives

4) Use targets – but they

should be smart!

This requires a logical model!

Some silver rules of

performance management

© OECD

A j

oin

t i

nit

iati

ve o

f th

e O

EC

D a

nd

th

e E

uro

pe

an

Un

ion

,

pri

nc

ipall

y f

ina

nced

by t

he

EU

Step 2: Define a hierarchy of objectives

1) Top objectives need to relate to OUTCOMES where

possible.

2) OUTCOMES are BENEFITS, as experienced by users or

citizens (ideally as IMPROVEMENT IN QUALITY OF LIFE).

3) Lists of objectives & outcomes are unsatisfactory – no

understanding of how they are linked.

4) What is needed is a ‘model’ of how we achieve our

outcomes and objectives – a cause-and-effect chain – a

‘pathway to outcomes’.

Example: A Logical Model for Road Safety

© OECD

A j

oin

t i

nit

iati

ve o

f th

e O

EC

D a

nd

th

e E

uro

pe

an

Un

ion

,

pri

nc

ipall

y f

ina

nced

by t

he

EU

AND …?

“To reduce the occurrence

of coronary heart disease and

to reduce associated deaths and

ill health and to improve the treatment and

rehabilitation of those suffering from it”.

Source: Health of the Nation (HMSO, 1991).

© OECD

A j

oin

t i

nit

iati

ve o

f th

e O

EC

D a

nd

th

e E

uro

pe

an

Un

ion

,

pri

nc

ipall

y f

ina

nced

by t

he

EU

Step 3: Relate your performance indicators and

targets to the logical model

Case study: A logical framework developed by Young

People’s Services in Surrey County Council

(See separate hand-out)

© OECD

A j

oin

t i

nit

iati

ve o

f th

e O

EC

D a

nd

th

e E

uro

pe

an

Un

ion

,

pri

nc

ipall

y f

ina

nced

by t

he

EU

Exercise:

Designing an outcome-based logical model

1) In groups, devise a hierarchy of objectives for a

service or a specific stakeholder.

2) Discuss how you would assess achievement of

outcomes for all of the outcomes in the first three

levels of the hierarchy.

3) Check how your current PIs relate to the

objectives in your logical model.

© OECD

A j

oin

t i

nit

iati

ve o

f th

e O

EC

D a

nd

th

e E

uro

pe

an

Un

ion

,

pri

nc

ipall

y f

ina

nced

by t

he

EU

Do’s and don’ts for developing a logical model

1) Do have more than ONE top objective/outcome, if appropriate

2) Do test the HOW and WHY logics

3) Do start objectives with a verb (“to ….”)

4) Don’t worry about aims/goals/objective split …

or final/intermediate outcome split

5) Don’t prioritise ‘objectives’ – it’s pathways!