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Strategic management and achieving outcomes
- 3. © OECD
AjointinitiativeoftheOECDandtheEuropeanUnion,
principallyfinancedbytheEU
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.
- 5. Outcomes Outputs Processes Inputs
Shifting to outcome-based management
Law, values,
policy and
research
evidence
Evaluating
Monitoring
- 6. © OECD
AjointinitiativeoftheOECDandtheEuropeanUnion,
principallyfinancedbytheEU
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?)
- 8. Step 1: Identification of key outcomes
This can be done in a creative way involving service providers and
service users!
- 9. © OECD
AjointinitiativeoftheOECDandtheEuropeanUnion,
principallyfinancedbytheEU
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
- 12. © OECD
AjointinitiativeoftheOECDandtheEuropeanUnion,
principallyfinancedbytheEU
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 â no
understanding of how they are linked.
4) What is needed is a âmodelâ of how we achieve our
outcomes and objectives â a cause-and-effect chain â a
âpathway to outcomesâ.