Transcript Slide 1

Outcome Based Accountability
‘From Talk to Action’
David Burnby
www.davidburnby.co.uk
Fiscal Policy Studies
Institute
Santé Fe, New Mexico
www.resultsbasedaccountabilty.com
www.raguide.org
www.resultsleadership.org (publications)
Outcome Based Accountability
• 1 Language
• 2 Levels of Accountability
• 7 Steps from Talk to Action
Two Levels of Accountability
Population Accountability
about the well-being of
WHOLE POPULATIONS
for neighbourhoods – districts – regions - countries
Performance Accountability
About the well-being of
CLIENT POPULATIONS
for projects – agencies – service providers
1 Language
–
• 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
MEANS
Performance
Accountability
A condition of well-being for children,
adults, families or communities
ENDS
Population
Accountability
• Outcome
Population and Performance
Accountability
OUTCOME:
All Young People in
(a place)
are Healthy
INDICATOR
Obesity Rate
End
Young people
attending
active lifestyle
programme
All Young People in (a place)
WHOLE POPULATION
Contribution
PERFORMANCE MEASURE
% Young people attending
losing weight
Means
Seven Steps from Talk to Action:
The Leaking Roof
Experience
Measure
Inches of Water
Not OK
Forecast
Fixed?
Time
Story behind the baseline (causes)
Partners
What Works?
Action Plan (Strategy)
OUTCOME
INDICATORS
BASELINES
STORY
Behind the baselines
PARTNERS
With a role to play
WHAT WORKS
“Healthy and Successful Adults”
Measures of
the outcome
1. All age, all cause mortality rate
2. 16+ current smoking rate
3. Healthy life expectancy at Age 65
• Where we’ve been
• Where we’re going
• Where we want to be
• The causes, the forces at work
• What’s driving the baselines?
Data
Development
Agenda (Pt 1)
• Public, Private and Voluntary Sector
• Community groups
• Residents
• What would it take to turn the curve?
• Best practice
Data
• Best hunches
Development
Agenda (Pt 2)
ACTION PLAN
• What we propose to do, how and by when
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?
Whole Population Turning The Curve Report
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
Key pointers to
action
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)
NB: ONE SIDE OF FLIPCHART PAPER ONLY!
Outcome Based Accountability
Managing and Improving Performance
QUANTITY
QUALITY
EFFORT
How much
service did
we deliver?
How well
did we
deliver it?
Cause
EFFECT
OUTPUT
INPUT
Programme Performance Measures
How much
change/effect
did we produce?
What quality of
change/effect
did we
produce?
Effect
Drug Treatment Programme
QUANTITY
EFFORT
How much did we do?
• Number of clients
enrolled
• Number of courses
• Number of
counselling sessions
QUALITY
How well did we do it?
• % clients completing
programme
• % counsellors trained
to professional
standard
• % clients saying they
were treated well
EFFECT
Is anyone better off?
• Number clients drug
free
• Percentage clients
drug free
• Number clients saying
they were helped with
their problems
• Percentage clients
saying they were helped
with their problems
• At exit of programme
• After 12 months
• At exit of programme
• After 12 months
Not All Performance Measures Are
Created Equal...
QUANTITY
EFFORT
How much did we do?
LEAST
important
QUALITY
How well did we do it?
Also Very
Important
EFFECT
Is anyone better off?
MOST
important
The Matter of Control
QUANTITY
EFFORT
How much did we do?
QUALITY
How well did we do it?
MOST
control
EFFECT
Is anyone better off?
LESS
control
PARTNERSHIPS
We have the least
control over the most
important matters
Performance Turning The Curve Report
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)
Outcome Based Accountability
Next Generation Commissioning
Outcome Based Commissioning
Home Care Service
How much did we do?
How well did we do it?
Number of
persons served
• No. visits per week
• Average length of visit
• % service users who say
service is reliable,
flexible, respectful,
friendly
Is anyone better off?
• Number service users
reporting that service has
enabled them to remain
at home
• 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.
Service Specification (Home Care Service)
•
•
•
•
•
•
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)
Next Generation Commissioning
Effort
Quantity
Quality
1. Traditional purchasing
methods work fine in the
upper quadrants.
Effect
BUT
2. They break down in
the Is anyone better off?
quadrants (because of case mix
differences and perverse incentives).
WHICH MEANS
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.
The Three Essential Provisions
of Next Generation Commissioning
1. The most important performance measures
How much?
How Well?
Anyone Better Off?
*As determined from the Five Step Method
The three to five
measures that say most
about the effectiveness
of the service provider’s
performance*
The Three Essential Provisions
of 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 Provisions
of 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
EFFORT
How much did we do?
• Number of persons
served
• Number of home visits
• Number of shopping
trips
QUALITY
How well did we do it?
• Number of visits per
week
• Average length of visit
• % clients saying they
were treated with
dignity and respect
EFFECT
Is anyone better off?
• 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
EFFORT
How much did we do?
• Number of units
produced
• Tons of steel deployed
QUALITY
How well did we do it?
•
•
•
•
Residual value of cars
Warranty claims
Unit cost
Customer satisfaction
EFFECT
Is anyone better off?
• £ Profit Margin
• £ Share price
• £ Return on Capital
• % Profit margin
• % Share price growth
• % Return of Capital
Private Sector Home Care Service
QUANTITY
EFFORT
How much did we do?
• Number of persons
served
• Number of home visits
• Number of shopping
trips
QUALITY
How well did we do it?
• Number of visits per
week
• Average length of visit
• % clients saying they
were treated with
dignity and respect
EFFECT
Is anyone better off?
• 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
EFFORT
How much did we do?
• Number of persons served
• Number of home visits
• Number of shopping trips
QUALITY
How well did we do it?
• Number of visits per week
• Average length of visit
• % clients saying they were
treated with dignity and respect
EFFECT
Is anyone better off?
• 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
EFFORT
How much did we do?
Number of persons served
Number of home visits
Number of shopping trips
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
•
•
•
•
QUALITY
How well did we do it?
• 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
EFFECT
Is anyone better off?
• £ Profit Margin
• £ Share price
• £ Return on Capital
• % Profit margin
• % Share price growth
• % Return of Capital
Private Sector Home Care Service
QUANTITY
EFFORT
How much did we do?
Number of persons served
Number of home visits
Number of shopping trips
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
•
•
•
•
QUALITY
How well did we do it?
• 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
EFFECT
Is anyone better off?
• £ Profit Margin
• £ Share price
• £ Return on Capital
• % Profit margin
• % Share price growth
• % Return of Capital
The OBA Journey – From Talk to Action
ENDS (POPULATION ACCOUNTABILITY)
DESIRED
OUTCOME
Choosing the
INDICATORS
Drawing the
BASELINE (and
the CURVE TO
TURN)
Choosing the
PARTNERS
REVIEW
Contributory
Relationship
The STORY
BEHIND THE
BASELINE
The ACTION
PLAN
Deciding
WHAT WORKS
PROCUREMENT
MEANS (PERFORMANCE ACCOUNTABILITY)
PERFORMANCE
MEASURES
How Much?
How Well?
Better Off?
(CLIENT OUTCOMES)