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Strategic management and achieving outcomes

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Strategic management and achieving outcomes

  1. 1. © OECD AjointinitiativeoftheOECDandtheEuropeanUnion, principallyfinancedbytheEU Zagreb (Croatia) 22-23 May 2014 Elke Löffler & Marcel Guenoun, SIGMA Experts Strategic management: Developing pathways to outcomes
  2. 2. © OECD AjointinitiativeoftheOECDandtheEuropeanUnion, principallyfinancedbytheEU What’s most important in public services: Outcomes “This inquiry saw too many examples of those in senior positions attempting to justify their work in terms of bureaucratic activity, rather than outcomes for people”. Source: Department of Health (2003) The Victoria Climbié Inquiry. Summary Report.p.6.
  3. 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.
  4. 4. © OECD AjointinitiativeoftheOECDandtheEuropeanUnion, principallyfinancedbytheEU WHAT IS AN OUTCOME? (with apologies to Superman)  It it a task?  Is it a process?  Is it a service?  No - it’s a benefit! Or at least what an organisation intends to achieve for individuals, communities and citizens.
  5. 5. Outcomes Outputs Processes Inputs Shifting to outcome-based management Law, values, policy and research evidence Evaluating Monitoring
  6. 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?)
  7. 7. © OECD AjointinitiativeoftheOECDandtheEuropeanUnion, principallyfinancedbytheEU The importance of equality outcomes: “A Tale of Two Cities” The Undergroup map “Lives on the Line” shows there is a 20-year difference in life expectancy between those born near Oxford Circus and others born close to some stations on the Docklands Light Railway (DLR). Source: http://life.mappinglondon.co.uk/
  8. 8. Step 1: Identification of key outcomes This can be done in a creative way involving service providers and service users!
  9. 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
  10. 10. © OECD AjointinitiativeoftheOECDandtheEuropeanUnion, principallyfinancedbytheEU Group Work: An assessment of the NHS Outcomes Framework 10 1. Get together in small groups 2. Assess the NHS Outcomes Framework: Are all these domains outcomes? If not, what are they? 3. From a Croatian perspective, which outcomes would you add?
  11. 11. © OECD AjointinitiativeoftheOECDandtheEuropeanUnion, principallyfinancedbytheEU 1) Relate your strategic objectives to outcomes 2) Be clear about objectives 3) Relate PIs to objectives 4) Use targets – but they should be smart! This requires a logical model! Some silver rules of performance management
  12. 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 – no understanding of how they are linked. 4) What is needed is a ‘model’ of how we achieve our outcomes and objectives – a cause-and-effect chain – a ‘pathway to outcomes’.
  13. 13. Example: A Logical Model for Road Safety
  14. 14. © OECD AjointinitiativeoftheOECDandtheEuropeanUnion, principallyfinancedbytheEU AND …? “To reduce the occurrence of coronary heart disease and to reduce associated deaths and ill health and to improve the treatment and rehabilitation of those suffering from it”. Source: Health of the Nation (HMSO, 1991).
  15. 15. © OECD AjointinitiativeoftheOECDandtheEuropeanUnion, principallyfinancedbytheEU Step 3: Relate your performance indicators and targets to the logical model Case study: A logical framework developed by Young People’s Services in Surrey County Council (See separate hand-out)
  16. 16. © OECD AjointinitiativeoftheOECDandtheEuropeanUnion, principallyfinancedbytheEU Exercise: Designing an outcome-based logical model 1) In groups, devise a hierarchy of objectives for a service or a specific stakeholder. 2) Discuss how you would assess achievement of outcomes for all of the outcomes in the first three levels of the hierarchy. 3) Check how your current PIs relate to the objectives in your logical model.
  17. 17. © OECD AjointinitiativeoftheOECDandtheEuropeanUnion, principallyfinancedbytheEU Do’s and don’ts for developing a logical model 1) Do have more than ONE top objective/outcome, if appropriate 2) Do test the HOW and WHY logics 3) Do start objectives with a verb (“to ….”) 4) Don’t worry about aims/goals/objective split … or final/intermediate outcome split 5) Don’t prioritise ‘objectives’ – it’s pathways!

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