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The solution

Focusing on outcomes

Our health and social services often focus on things that are easy to measure (and these are are often around processes rather than outcomes). So we measure and report waiting times, for example – but report a lot less on what outcomes were achieved when we were seen (I may have been seen within X weeks, but did it actually make a difference?)

In the UK, there was once an improvement project that was thinking about judging its success on whether or not it could increase the number of people who had a signed copy of their care plan. This really matters to some people, and it’s probably a measure that is meant to be indicative of something harder to get at about the extent to which we feel in control of what happens to us. If I had a choice between having a signed copy and not having a signed copy, I’d probably choose to have one – but it ought to 100% in any case (and indeed should have been 100% since the policy was first introduced in 1991!!) – so I’m not sure increasing from 30% to 35%, say, would actually make much difference…

When I speak to people, they say they want more friends, they want to live somewhere they like and they want a job. What would happen if we measured what impact services have, not via how many people have a signed copy of their care plan, but on how many people say they have enough friends, live somewhere they choose/like and have a job they like and find meaningful? For me this is a question about gets to decide what success looks like – and which voices get heard/don’t get heard in these debates

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