London region outcome training

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  • We need to Point out the patient centred outcome, as it is their choice and understanding of where we have met their goal not ours. We can help them to understand it but we must not put words into their mouths
  • Advances in Govt policy regarding stroke care began several years ago: This slide lists our required objectives according to English DoH white paper, Our Health, Our Care, Our Say. OH, OC, OS – set out importance for crossing health and social care boundaries and identified objectives far beyond medical care and physical rehabilitation Referenced within the English Stroke Strategy and provided many of its underpinning principles
  • London region outcome training

    1. 1. Goals and Outcomes The Stroke Association’s Life After Stroke Services
    2. 2. What are Goals and Outcomes all about? <ul><li>Support Coordinators work in an ‘outcome oriented’ way </li></ul><ul><li>Establish processes for capturing outcomes </li></ul><ul><li>Provide the information that commissioners are asking for </li></ul>
    3. 3. 1: Support Coordinators to work in an ‘outcome oriented’ way <ul><li>Are we sure that what we do is what the service user wants us to do? </li></ul><ul><li>Does something useful result from what we do? </li></ul>
    4. 4. 2: Introduce processes to linking Goals with Outcomes <ul><li>Unmet Needs & Goals </li></ul><ul><li>Informal discussions with service users </li></ul><ul><li>Recorded in casenotes </li></ul><ul><li>Outcomes & Impact </li></ul><ul><li>Casenotes </li></ul><ul><li>Impact surveys </li></ul>Hard to extract information
    5. 5. 2: Introduce processes to linking Goals with Outcomes <ul><li>Unmet Needs & Goals </li></ul><ul><li>Unmet needs recorded </li></ul><ul><li>Goals formally identified </li></ul><ul><li>Illustrating a pathway for the service user </li></ul><ul><li>Outcomes & Impact </li></ul><ul><li>Outcomes captured in CRM </li></ul><ul><li>Linked to client cases </li></ul>
    6. 6. 3: Provide a better picture to commissioners about what we do <ul><li>Commissioners are demanding information about ‘outcomes’ rather than ‘outputs’ or ‘inputs’ </li></ul><ul><li>Hundreds of potential outcomes are mapped onto 7 ‘impact’ categories </li></ul><ul><li>Drawn from ‘our health our care our say’ </li></ul><ul><li>Widely accepted by commissioners </li></ul>
    7. 7. Linking Goals and Outcomes Unmet needs Getting to know service user. Finding out what is important to them Impact Reporting Matching ‘outcomes’ to ‘impact’ so that they can be reported on CRM & to Commissioners Outcome
    8. 8. What we’re going to be talking about: 2: Goals 3: Action 4: Outcomes 5: Impact Reporting 1: Needs Assessment 6: Case Studies
    9. 9. 1: Needs Assessment 2: Goals 3: Action 4: Outcomes 5: Impact Reporting 1: Needs Assessment 6: Case Studies
    10. 10. Needs assessment <ul><li>Opportunity to get a ‘global’ picture of what the service user’s unmet needs are </li></ul><ul><li>Could use the Initial Assessment form </li></ul><ul><li>Covers: </li></ul><ul><ul><li>Daily Living </li></ul></ul><ul><ul><li>Communication </li></ul></ul><ul><ul><li>Social, home and financial </li></ul></ul><ul><ul><li>Lifestyle and health education </li></ul></ul><ul><ul><li>Carer’s issue </li></ul></ul>1: Needs Assessment
    11. 11. 1: Needs Assessment
    12. 12. 2: Goals 2: Goals 3: Action 4: Outcomes 5: Impact Reporting 1: Needs Assessment 6: Case Studies
    13. 13. Are we doing what they want us to do? <ul><li>How do we know that what we’re doing is useful for the service user? </li></ul><ul><ul><li>Because our services are stroke services? </li></ul></ul><ul><ul><li>(when you’ve got a hammer. . . ) </li></ul></ul><ul><ul><li>Because we develop a plan with the service user </li></ul></ul><ul><ul><li>You to sit down with your service user and identify what is important for them </li></ul></ul><ul><ul><li>Does this get the focus it deserves? </li></ul></ul><ul><li>Central to a Person Centred Service </li></ul><ul><li>Art Group example </li></ul>2: Goals
    14. 14. Aside: Person Centred Planning <ul><li>A collection of tools and approaches built up around the field of Learning Disability that can be used to plan  with  a person - not  for  them . </li></ul><ul><li>Used to help the person think about what is important in their lives now and also to think about what would make a good future. </li></ul><ul><li>Planning should build the person's circle of support and involve all the people who are important in that person's life. </li></ul>2: Goals
    15. 15. Easy goals to identify <ul><li>I want to feel like someone cares </li></ul><ul><li>I want to talk with someone who understands and who’s got time to listen </li></ul><ul><li>I want to understand </li></ul><ul><li>I want to know what has happened to me and my family by talking with someone who knows what I’ve been through </li></ul><ul><li>I want to know what to expect </li></ul><ul><li>I want to talk with someone about what’s going to happen next </li></ul>2: Goals
    16. 16. Turning conversation into goals: what might be the barriers? <ul><li>The language of goals can be confronting and ‘alien’ </li></ul><ul><li>However, people do express wishes for the future once a relationship has been established </li></ul><ul><li>Goals have to be theirs, not ours </li></ul><ul><li>Employ the principles of ‘person centred planning’ </li></ul><ul><li>Keeping it achievable </li></ul>2: Goals
    17. 17. Dealing with un-achievable goals <ul><li>“ I want to go back to how I was” </li></ul><ul><li>“ I want to get back to work” </li></ul><ul><li>“ I want to speak again” </li></ul><ul><li>Building single high level goals into multiple achievable goals </li></ul><ul><li>Managing expectations </li></ul><ul><li>Developing an honest relationship </li></ul>
    18. 18. SMART Goals <ul><li>S Specific </li></ul><ul><li>M Measurable </li></ul><ul><li>A Achievable </li></ul><ul><li>R Realistic </li></ul><ul><li>T Time limited </li></ul>2: Goals
    19. 19. What sort of goals might Service Users have? Here Here And Here 2: Goals
    20. 20. 3: Action 2: Goals 3: Action 4: Outcomes 5: Impact Reporting 1: Needs Assessment 6: Case Studies
    21. 21. Action <ul><li>Who does what by when? </li></ul><ul><li>What is the key thing to bear in mind when ‘allocating tasks’? </li></ul><ul><li>Sets up an expectation for review at a definite point in the future </li></ul><ul><li>Produces a ‘dynamic’ to engagement </li></ul><ul><li>Results in an Outcome </li></ul><ul><li>Example: Amensiac patient </li></ul>3: Action
    22. 22. 4: Outcomes 2: Goals 3: Action 4: Outcomes 5: Impact Reporting 1: Needs Assessment 6: Case Studies
    23. 23. Where do outcomes come from? Action Output Input Outcome 4: Outcomes
    24. 24. Does something useful result? <ul><li>Achieving outcomes for a client is what we exist for </li></ul><ul><li>How do you capture this information? </li></ul><ul><ul><li>Case notes and case studies </li></ul></ul><ul><ul><li>Impact survey </li></ul></ul><ul><ul><li>Personal observations </li></ul></ul><ul><ul><li>Thankyou letters </li></ul></ul><ul><li>Does the achievement of an outcome get marked with the client? </li></ul><ul><li>This is the ‘Outcomes’ bit of ‘Goals & Outcomes’ </li></ul><ul><ul><li>Associates personal achievements with service user records on CRM </li></ul></ul>4: Outcomes
    25. 25. Hard Outcomes <ul><li>Clearly definable and quantifiable results that show the beneficiary has made progress towards achieving their personal goals. </li></ul><ul><li>Typically, </li></ul><ul><ul><li>completing a computer course, </li></ul></ul><ul><ul><li>returning to driving </li></ul></ul><ul><ul><li>or employment. </li></ul></ul><ul><li>Usually straight-forward both to identify and to measure </li></ul>4: Outcomes
    26. 26. Soft Outcomes <ul><li>Maybe intermediary steps towards achieving a hard outcome, such as: </li></ul><ul><li>Improved confidence </li></ul><ul><li>Practical work focussed skills such as taking up volunteering </li></ul><ul><li>Retraining in a different line of business </li></ul><ul><li>Equally soft outcomes can be </li></ul><ul><li>‘ distance travelled’, where people have moved from, having improved their mood or well being by engaging in peer support </li></ul><ul><li>other emotional support activities. </li></ul><ul><li>Increased, their confidence, in communications strategies </li></ul>4: Outcomes
    27. 27. 5: Impact 2: Goals 3: Action 4: Outcomes 5: Impact Reporting 1: Needs Assessment 6: Case Studies
    28. 28. Reporting on Outcomes <ul><li>In order to record what is achieved with service users, we convert Outcomes into Impacts </li></ul><ul><li>We use a well established and recognised group of indicators to identify the consequential outcomes for people we have supported </li></ul><ul><li>Ideally, this to be achieved with service users </li></ul><ul><li>Which are recognised and in many cases their measurement of choice for commissioners </li></ul><ul><li>Meets the requirement for us to be accountable to our commissioners by giving us the evidence of what we are achieving </li></ul>5: Impact Reporting
    29. 29. Our Health, Our Care, Our Say (January 2006) <ul><li>Improved health and emotional well-being </li></ul><ul><li>Improved quality of life </li></ul><ul><li>Making a positive contribution </li></ul><ul><li>Choice and Control </li></ul><ul><li>Freedom from discrimination </li></ul><ul><li>Economic well-being </li></ul><ul><li>Personal dignity </li></ul>5: Impact Reporting
    30. 30. Considerable overlap Choice and control Personal dignity Freedom from Discrimination Economic well being Making a positive contribution Health And well being Quality of life Client
    31. 31. Outcome: Giving up smoking 5: Impact Reporting Choice and control Personal dignity Freedom from Discrimination Economic well being Making a positive contribution Health And well being Quality of life Client
    32. 32. Outcome: Getting driving license 5: Impact Reporting Choice and control Personal dignity Freedom from Discrimination Economic well being Making a positive contribution Health And well being Quality of life Client
    33. 33. Outcome: Improved Confidence & Communication 5: Impact Reporting Choice and control Personal dignity Freedom from Discrimination Economic well being Making a positive contribution Health And well being Quality of life Client
    34. 34. Impact Bingo <ul><li>Giving up smoking </li></ul><ul><li>Getting a driving license </li></ul><ul><li>Improved confidence and communication </li></ul><ul><li>Getting someone re-housed so they can get in and out without calling on neighbours’ help </li></ul><ul><li>Getting a weight problem under control </li></ul><ul><li>Providing stroke information in hindi and arranging access to an interpreter </li></ul><ul><li>Getting someone back to work </li></ul><ul><li>Someone can visit their grandchildren </li></ul>5: Impact Reporting
    35. 35. Putting it all together Impact Outcome Action Goal Poor communication abilities Unmet Need
    36. 36. 1: Unmet need
    37. 37. 2,3,4: Goals, Actions and Outcomes
    38. 38. 5: Impact Reporting
    39. 39. 5: Impact Reporting
    40. 40. Whats going on at the moment? CRM Module/ Intermediate fix Coordinator Training Updated Commissioner Report
    41. 41. Practice
    42. 42. Scenario for Prevention <ul><li>Mary (49) had assessment via TIA clinic. </li></ul><ul><li>She is a smoker, hypertensive, overweight, and takes little exercise. She has a large family with adult children still at home. Husband is unemployed </li></ul><ul><li>The consultant referred requesting you see Mary and assess her for receiving service following his clinic. </li></ul><ul><li>What may you offer Mary? </li></ul><ul><li>What will she need to do? </li></ul>
    43. 43. From a clients perspective Improved Health and Well being I have undertaken the smoking cessation course and now do not smoke I have reduced my salt intake I have been provided with help to make changes I want to make i.e. smoking cessation, dietary advice, healthy cooking lessons I have accepted the risks but do not want to make the changes yet I have been provided with information to make lifestyle choices – around smoking, losing weight, taking exercise Assessing and discussing risks Agreeing individual goals- I want to give up smoking/lose weight/start to take exercise
    44. 44. Referral to Back to Life or CIS <ul><li>Referral via IAS (FACS) </li></ul><ul><li>John, had stroke nine months ago, still receiving support from the service but John feels ready for moving forward with his life. </li></ul><ul><li>He lost his job as an HGV driver due to stroke (licence withdrawn) </li></ul><ul><li>He misses driving, wants to take up some social activity which may lead to future employment options </li></ul><ul><li>Is anxious about his finances and not had benefits update </li></ul>
    45. 45. Example of an identified goal Economic well being Benefits secured, LAS grant awarded client feeling happier about financial circumstances Resulting in requiring an appeal. Coordinator, assisting/signposting LAS grants , other grants applied for Source form filling assistance/ completed sent off Coordinator to refer to /or provide information regarding benefit entitlement Assessment and goals relating to economic pressures
    46. 46. Key Points to Take Away <ul><li>Personal goals ascertained through observation, assessment, </li></ul><ul><li>Discussion and agreement </li></ul><ul><li>Consider options and priorities and agree with client/service users-they are their goals not ours </li></ul><ul><li>Plan approach, resources etc </li></ul><ul><li>Review progress, success and record outcomes </li></ul><ul><li>Ask client, family about impact, request Impact survey completion if appropriate </li></ul><ul><li>Record outcomes in CRM and identify absolute ‘doozy’s’ to your manager </li></ul>
    47. 47. Next <ul><li>Exploring the goals set we want you to identify the impact you believe this has had on the service user from the given scenarios and outcomes- from their perspective . </li></ul>
    48. 48. Thank-you and Safe Journey home

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