1. “It‟s what matters to me that counts” – keeping
the person at the heart of the services we
deliver

2. Real Change
“When people not used to speaking out are heard by people
not used to listening, then real change is made”
(John O‟Brien, undated)

3. Improved confidence and skills
Improved symptoms
Improved mobility

4. Smale et al (1993)

5. Thistle’s journey towards
a person centred approach
15 years ago Thistle Foundation became serious about
commitment to person centred services. Social care world
changing rapidly:
• large institutions closing
• people previously considered too disabled or too
challenging returning to the community
• existing services not able to respond to needs and
many new provider organisations emerged

6. So…
Thistle acted decisively and radically to survive in new
world:
• Implemented complete service restructure and redesign:
residential homes closed, people supported in own
homes, including people with much more complex
medical and social needs
• Expected staff to work in new ways, grappling with
concepts such as empowerment and inclusion
• Invested heavily in the development of new accredited
training programme for support staff

7. HEC in Person Centred Approaches
• From 2002, over 600 support workers (in Thistle and
other agencies) undertook this course, accredited by
Queen Margaret University
• Course synthesised ideas from person centred
therapeutic approaches (Carl Rogers) with person
centred planning tools and concepts originating in
North America and Canada (Michael Smull; John O‟Brien
and others)

8. Fast forward: What worked well?
• Course very successful, winning several awards
• Led to many positive changes in work practice resulting
in better outcomes for people using services
• Workers very focussed on building best possible
relationship with person being supported
• Experiential nature of learning worked: workers learned
much from sharing in consistent cohorts
• Length of course (two years part time) helped to process
learning and embed practice change

9. What else?
• Workers embraced modules relating to self awareness
• Workers became more reflective - aware of values,
prejudices, strengths and development needs – and able
to work on these
• Workers understood what is meant by active listening

10. What didn’t work so well?
In a number of cases, while huge beneficial impact on
course participants, this not translated into equally
positive changes in quality of life of someone using service

11. Which meant that...
• Workers did not always recognise development and
maintenance of „right relationship‟ was for clear purpose -
to be able to recognise and work towards personal
outcomes
• Sometimes when workers attempted this, focus was on
outputs rather than outcomes
• Some workers stuck in „helper mode‟, thinking they knew
what was in person‟s best interests based on own values
and judgements

12. Putting our learning into practice
All staff development activities delivered by Thistle
emphasise the concept of:
A person centred relationship with intent

13. Person centred approach – a trinity
Identifying and
realising personal
outcomes
(aka personalisation)
A relationship based A focus on assets and
on the core conditions positive reputations

14. What does a person centred approach
mean in practice at Thistle?
Workers must be able to...
• Keep person at centre – and in control - of process
• Build strong, real and respectful relationships with
person using the service
• Focus on person‟s assets and strengths
• Involve family and friends as partners

15. Cont‟d
Workers must be able to...
• Focus on what‟s important TO person...........while also
paying attention to what‟s important FOR person [ health
and safety and safeguard positive reputations]
• Intentionally sustain and build connections in community
• Go beyond conventional service responses
• Continue to listen and learn with person

16. Simultaneously…
Organisational systems and processes:
• Strategic direction must reflect outcomes
• Language must be used consistently
• Person centred relationships must be modelled
• Policies and procedures need to be responsive to
individual needs, as well as fulfilling statutory
requirements
• Participative leadership needs to move from rhetoric to
reality
• Cross organisational working groups can help e.g.
Personal Outcomes Group

17. One of the things that is
making a significant difference…
Using Talking Points framework helps to embed link
between person centred relationships and working towards
personal outcomes

18. Talking Points –
A Personal Outcomes Approach
• Outcomes are the end results of support and/or
service(s) in the person‟s life
• 15 years of research identified a framework of inter-
related outcomes relating to:
• Quality of Life (getting or maintaining it)
• Process (interaction between staff and person)
• Change (for a better life)

19. Outcomes for people we support
Quality of life Process Change
•Feeling safe •Listened to •Improved
•Having things to •Having a say confidence /
do •Treated with
morale
•Seeing people respect •Improved skills
•Staying as well •Responded to •Improved
as you can •Reliability
mobility
•Living where •Reduced
and as you want symptoms
•Dealing with
stigma/discrimin
ation

20. Supporting person to
identify and realise outcomes
•Holding good conversations (include people who don‟t
communicate verbally), actively listening to find out what
really matters to the person in life – the outcomes
•Working with person's outcomes to identify what activities,
supports and/or services are required to realise them over
agreed timescale
•Maximising person‟s own assets, strengths, skills, and
involvement in realising their outcomes along with family,
community etc.

21. What kind of outcomes?
Input Process Outputs Outcomes
Joe, Joe‟s Meet Joe, listen Training Joe wants to
SW, to him, find out certificates; do something
Employment what he can do, supported with his time to
Advisor, what he‟s paid or unpaid feel good and
Supported interested in job to increase his
Employment doing ; book skills.
service training
courses.
Ann, Ann‟s Meet Ann, listen Plan for Ann‟s Ann wants to
family, Ann‟s to her hopes, supported self stop worrying
SW, Heart discuss how management about
Failure Nurse everyone can diagnosis and
support Ann to get back to
live her life doings things
she enjoys

22. What are we learning?
• The personal outcomes journey takes time
• Don‟t start with paperwork
• Improve practice before proving practice
• To measure the difference made, get a baseline
• Common language in recording is essential for
consistency
• Workers need ongoing support and feedback
• Record all contributions (not attributions) to outcomes –
not just Thistle service

23. A cautionary reminder…
“The overwhelming evidence is that what people do for
themselves and with others – not services – delivers the
bulk of social outcomes”
Routledge and Witton, 2010

24. Contact us
Thistle Foundation:
Nikki Bruce Nikki.Bruce@thistle.org.uk
Learning and Development Manager
Gail Cunningham Gail.Cunningham@thistle.org.uk
Research and Development Coordinator
Joint Improvement Team:
Chris Bruce Chris.bruce@scotland.gsi.gov.uk
Lead on Outcomes