outcome based accountability ‘from talk to action’ david burnby
TRANSCRIPT
Outcome Based Accountability
‘From Talk to Action’David Burnby
www.davidburnby.co.uk
Fiscal Policy Studies InstituteSanté Fe, New Mexico
www.resultsbasedaccountabilty.comwww.raguide.orgwww.resultsleadership.org (publications)
Outcome Based Accountability
• 1 Language• 2 Levels of Accountability• 7 Steps from Talk to Action
Two Levels of Accountability
Population Accountabilityabout the well-being of WHOLE POPULATIONS
for neighbourhoods – districts – regions - countries
Performance AccountabilityAbout the well-being ofCLIENT POPULATIONS
for projects – agencies – service providers
1 Language• Outcome
– A condition of well-being for children, adults, families or communities
• Indicator – A measure which helps quantify the
achievement of an outcome
• Performance Measure– A measure to evaluate how well a
programme, agency or service system is working
Pop
ula
tion
A
ccou
nta
bili
ty
Perf
orm
an
ceA
ccou
nta
bili
ty
EN
DS
MEA
NS
Population and Performance Accountability
All Young People in (a place)WHOLE POPULATION
OUTCOME: All Young People in
(a place) are Healthy
INDICATORObesity Rate
Young people attending
active lifestyle
programme
PERFORMANCE MEASURE
% Young people attending losing weight
Contribution
Means
End
Seven Steps from Talk to Action:The Leaking Roof
Inch
es
of
Wate
r
Time
Experience
Measure
Story behind the baseline (causes)PartnersWhat Works?Action Plan (Strategy)
ForecastFixed?
Not OK
OUTCOME “Healthy and Successful Adults”
INDICATORSMeasures of the outcome
1. All age, all cause mortality rate2. 16+ current smoking rate3. Healthy life expectancy at Age 65
BASELINES • Where we’ve been• Where we’re going• Where we want to be
STORYBehind the baselines
• The causes, the forces at work• What’s driving the baselines?
PARTNERSWith a role to play
• Public, Private and Voluntary Sector• Community groups• Residents
WHAT WORKS• What would it take to turn the curve?• Best practice• Best hunches
ACTION PLAN • What we propose to do, how and by when
Data DevelopmentAgenda (Pt 1)
Data DevelopmentAgenda (Pt 2)
The 7 Population Accountability Questions
1. What are the quality of life conditions we want for the children, adults and families who live in our community?
2. What would these conditions look like if we could see them?
3. How can we measure these conditions?4. How are we doing on the most important of
these measures?5. Who are the partners that have a role to play in
doing better?6. What works to do better, including no cost/low
cost ideas?7. What do we propose to do?
The definition of the WHOLE POPULATION we want to impact on (e.g. “All young people in Hull” or “All older people in Middlesbrough” etc.)
The desired OUTCOME: The condition of well-being we want for our defined whole population
The priority INDICATOR we will use to determine progress towards our OUTCOME
The INDICATOR BASELINE made up of the historical data, the projected forecast (if nothing is done) and showing the curve we want to turn
The STORY BEHIND THE BASELINE: What we know about the factors driving the baseline. What are the causes/factors at work? What’s our best community intelligence on this issue?
What are the gaps in our knowledge (our DATA DEVELOPMENT AGENDA)? What do we need to know to inform our action plan?
Who are the KEY PARTNERS with a role to play in Turning the Curve? These could be public sector service providers, residents, voluntary and community organisations and businesses amongst others
WHAT WOULD IT TAKE TO TURN THE CURVE? What’s our best thinking on this, our best hunches? What would work in our community? Always include at least one “No Cost/Low Cost” idea and an “Off The Wall” idea (to generate creative thinking)
Whole Population Turning The Curve Report
NB: ONE SIDE OF FLIPCHART PAPER ONLY!
Key pointers to action
Outcome Based Accountability
Managing and Improving Performance
Programme Performance Measures
How much service did
we deliver?
How well did we
deliver it?
How much change/effect
did we produce?
What quality of
change/effect did we
produce?
QUANTITY QUALITYEFF
OR
TEFF
EC
T
INPU
TO
UTPU
T
Cause
Effect
Drug Treatment Programme
QUANTITY QUALITYEFF
OR
TEFF
EC
THow much did we do? How well did we do it?
Is anyone better off?
• Number of clients enrolled
• Number of courses
• Number of counselling sessions
• % clients completing programme
• % counsellors trained to professional standard
• % clients saying they were treated well• Number clients
drug free• At exit of
programme• After 12 months
• Number clients saying they were helped with their problems
• Percentage clients drug free
• At exit of programme
• After 12 months• Percentage clients
saying they were helped with their problems
Not All Performance Measures Are Created Equal...
QUANTITY QUALITY
EFF
OR
TE
FFE
CT
How much did we do? How well did we do it?
Is anyone better off?
LEASTimportant
Also Very Important
MOSTimportant
The Matter of Control
QUALITY
EFF
OR
TE
FFE
CT
How much did we do? How well did we do it?
Is anyone better off?
MOSTcontrol
LESScontrol
We have the least control over the most important matters
PARTNERSHIPS
QUANTITY
The programme, service system or project being performance managed
The customers: i.e. the people whose lives are affected (for better or worse) by the actions of the programme
The priority PERFORMANCE MEASURE derived in particular from the “How well” and “Better Off” (right hand quadrant) questions
The PERFORMANCE MEASURE BASELINE made up of the historical data, the projected forecast (if nothing is done) and showing the curve we want to turn
The STORY BEHIND THE BASELINE: What we know about the factors driving the baseline. What are the causes/factors at work? What is our understanding of what’s driving our performance?
What are the gaps in our knowledge (our DATA DEVELOPMENT AGENDA)? What do we need to know to inform our action plan?
Who are the KEY PARTNERS with a role to play in Turning the Curve? These could be internal departments, service users, suppliers etc.
WHAT WOULD IT TAKE TO TURN THE CURVE? What’s our best thinking on this, our best hunches? What would work in our organisation? Always include at least one “No Cost/Low Cost” idea and an “Off The Wall” idea (to generate creative thinking)
Performance Turning The Curve Report
Outcome Based Accountability
Next Generation Commissioning
Outcome Based CommissioningHome Care Service
Is anyone better off?
Number of persons served
• No. visits per week• Average length of visit• % service users who say
service is reliable, flexible, respectful, friendly
• Number service users reporting that service has enabled them to remain at home
How much did we do? How well did we do it?
• The WHOLE POPULATION OUTCOME we’re looking to contribute to: “Increased Choice and Control”
• The INDICATOR we’re trying to influence (the CURVE we want to turn): Support to live independently (NI 139)
• (Story behind the baseline)• Description of the service including the
QUANTITY of service we want to buy• We will measure the QUALITY of the
service by these performance measures
• We will work together to maximise the EFFECT of the service demonstrated by these performance measures (Customer Outcomes)
Service Specification (Home Care Service)
• Percentage service users reporting that service has enabled them to remain at home
1. You can purchase services.
2. You can purchase service quality
3. You cannot purchase customer outcomes. Instead, you can purchase a contract relationship that maximizes good customer outcomes.
Next Generation CommissioningQuantity
Eff
ect
Eff
ort
3. What we purchase in the lower quadrants are not deliverables, but rather a RELATIONSHIP where commissioner and service providers work together to maximize customer/client outcomes.
WHICH MEANS
BUT2. They break down in
the Is anyone better off?quadrants (because of case mix differences and perverse
incentives).
1. Traditional purchasing methods work fine in the upper quadrants.
Quality
The Three Essential Provisionsof Next Generation Commissioning
1. The most important performance measures
How much? How Well?
Anyone Better Off?
The three to five measures that say most about the effectiveness of the service provider’s performance*
*As determined from the Five Step Method
The Three Essential Provisionsof Next Generation Commissioning
2. Continuous Improvement Process
• Using Turning the Curve report cards based on the 7 performance accountability questions
• Using the same basis for management supervision across the organisation
The Three Essential Provisionsof Next Generation Commissioning 3. Performance Partnership between commissioner
and service provider– Periodic meetings to review progress on the three to five most
importance performance measures (based on Turning the Curve reports)
– Reviewing changing stories behind the baseline– Agreeing measures the commissioner can take to help improve
performance as partners in facilitating improvement• e.g. Technical assistance and support• Brokering relationships with third parties• Helping to break down barriers to progress
– This does not compromise respective accountability:• For commissioner’s responsibility for service provider’s performance
and effective use of funds• For service provider’s commitment to continuous improvement
process
Other 4 Quadrant Concepts
Home Care Service
QUANTITY QUALITYEFF
OR
TEFF
EC
THow much did we do? How well did we do it?
Is anyone better off?
• Number of persons served
• Number of home visits
• Number of shopping trips
• Number of visits per week
• Average length of visit
• % clients saying they were treated with dignity and respect
• Number clients saying that service has enabled them to stay in their own home
• Number of clients saying they feel happy and comfortable in their own home
• % clients saying that service has enabled them to stay in their own home
• % of clients saying they feel happy and comfortable in their own home
Car Manufacture
QUANTITY QUALITYEFF
OR
TEFF
EC
THow much did we do? How well did we do it?
Is anyone better off?
• Number of units produced
• Tons of steel deployed
• Residual value of cars
• Warranty claims• Unit cost• Customer
satisfaction
• £ Profit Margin• £ Share price• £ Return on Capital
• % Profit margin• % Share price growth• % Return of Capital
Private Sector Home Care ServiceQUANTITY QUALITY
EFF
OR
TEFF
EC
THow much did we do? How well did we do it?
Is anyone better off?
• Number of persons served
• Number of home visits
• Number of shopping trips
• Number of visits per week
• Average length of visit
• % clients saying they were treated with dignity and respect
• Number clients saying that service has enabled them to stay in their own home
• Number of clients saying they feel happy and comfortable in their own home
• % clients saying that service has enabled them to stay in their own home
• % of clients saying they feel happy and comfortable in their own home
Private Sector Home Care Service
QUANTITY QUALITYEFF
OR
TEFF
EC
T
How much did we do? How well did we do it?
Is anyone better off?
• Number of persons served• Number of home visits• Number of shopping trips
• Number of visits per week• Average length of visit• % clients saying they were
treated with dignity and respect
• % clients saying that service has enabled them to stay in their own home
• % of clients saying they feel happy and comfortable in their own home
• Number clients saying that service has enabled them to stay in their own home
• Number of clients saying they feel happy and comfortable in their own home
Private Sector Home Care Service
QUANTITY QUALITYEFF
OR
TEFF
EC
T
How much did we do? How well did we do it?
Is anyone better off?
• Number of persons served• Number of home visits• Number of shopping trips
• Number of visits per week• Average length of visit• % clients saying they were
treated with dignity and respect• % clients saying that service has enabled them to stay in their own home
• % of clients saying they feel happy and comfortable in their own home
• Number clients saying that service has enabled them to stay in their own home
• Number of clients saying they feel happy and comfortable in their own home
• £ Profit Margin• £ Share price• £ Return on Capital
• % Profit margin• % Share price growth• % Return of Capital
Private Sector Home Care Service
QUANTITY QUALITYEFF
OR
TEFF
EC
T
How much did we do? How well did we do it?
Is anyone better off?
• Number of persons served• Number of home visits• Number of shopping trips
• Number of visits per week• Average length of visit• % clients saying they were
treated with dignity and respect
• % clients saying that service has enabled them to stay in their own home
• % of clients saying they feel happy and comfortable in their own home
• Number clients saying that service has enabled them to stay in their own home
• Number of clients saying they feel happy and comfortable in their own home
• £ Profit Margin• £ Share price• £ Return on Capital
• % Profit margin• % Share price growth• % Return of Capital
The OBA Journey – From Talk to Action
DESIREDOUTCOM
E
Choosing the
INDICATORS
Drawing the BASELINE (and the
CURVE TO TURN)
The STORY BEHIND
THE BASELINE
Choosing the
PARTNERS
Deciding WHAT
WORKS
The ACTION PLAN
REVIEW
PROCUREMENT
PERFORMANCE MEASURESHow Much?How Well?Better Off?
(CLIENT OUTCOMES)
Contributory Relationship
ENDS (POPULATION ACCOUNTABILITY)
MEANS (PERFORMANCE ACCOUNTABILITY)