Post on 02-Jan-2016
““The Power of Outcome Thinking in The Power of Outcome Thinking in Transforming the State of Health”
The Annual Institute forGovernors’ Health Policy Advisors
Septembe10, 2004
William J. Phillips William J. Phillips
Center for Outcomes Center for Outcomes
The Think Tank with Muddy Boots
OverviewOverview
• Outcome Thinking versus Other KindsOutcome Thinking versus Other Kinds
• Terms, Models and the likeTerms, Models and the like
• Applications to Transformation Applications to Transformation
Hypothetical Scenario:Hypothetical Scenario:
• Health program staff are largely in an activity mode. They focus on the Health program staff are largely in an activity mode. They focus on the process, services provided and numbers served. process, services provided and numbers served.
• Two years ago THE Governor issued an executive order demanding that all Two years ago THE Governor issued an executive order demanding that all Health programs become outcome focused. Health programs become outcome focused.
• Progress has been slow, staff have not been able to make the shift. It’s been Progress has been slow, staff have not been able to make the shift. It’s been “Business as Usual”.“Business as Usual”.
• You have been asked to make this your top priority. You have been asked to make this your top priority.
• How do you start?How do you start?
A.A.
2.2.
Three OptionsThree Options
• Problem ApproachProblem Approach
• Activity MindsetActivity Mindset
• Outcome ThinkingOutcome Thinking
The Problem Approach…The Problem Approach…
1.1. Why do we have this problem?Why do we have this problem?
2.2. What or who caused it?What or who caused it?
3.3. What obstacles exist to solving it?What obstacles exist to solving it?
The Activity Mindset…The Activity Mindset…
1.1. What should we do?What should we do?
2.2. When can we start?When can we start?
3.3. Who can do it?Who can do it?
• Close your eyes; take a deep breathClose your eyes; take a deep breath
• You are now in a future place at a future timeYou are now in a future place at a future time
• Imagine that the situation we described earlier is goneImagine that the situation we described earlier is gone
• Now open your eyes and answer these questionsNow open your eyes and answer these questions
1.1. What are you hearing, seeing, feeling, What are you hearing, seeing, feeling, experiencing?experiencing?
2.2. What is in place that wasn’t before?What is in place that wasn’t before?
3.3. What has been gained ?What has been gained ?
Outcome Thinking
What’s the Difference?What’s the Difference?
The DifferenceThe Difference
• Creates possibilities; generates ideasCreates possibilities; generates ideas
• Increases hope and energyIncreases hope and energy
• Mobilizes resourcesMobilizes resources
• Increases control; reduces stressIncreases control; reduces stress
• Attracts the best and brightestAttracts the best and brightest
““Beginning with Beginning with success in success in mind and mind and keeping it there.”keeping it there.”
What is Outcome Thinking?
4 Outcome Shifts4 Outcome Shifts
• PROCESS TO RESULTSPROCESS TO RESULTS
• EVALUATION TO LEARNINGEVALUATION TO LEARNING
• FUNDER TO INVESTORFUNDER TO INVESTOR
• SUPPLICANT TO RESULTS MANAGERSUPPLICANT TO RESULTS MANAGER
FUNDERS ASK:FUNDERS ASK:
• Has all the money been spent?Has all the money been spent?
• Have all the rules been followed?Have all the rules been followed?
• Can we justify an increase?Can we justify an increase?
INVESTORS ASKINVESTORS ASK::
• What results are we buying?What results are we buying?
• What are the chances for success?What are the chances for success?
• Are we paying the lowest possible Are we paying the lowest possible costs for the best possible results?costs for the best possible results?
Supplicants Ask:Supplicants Ask:
• Have I carried out the plan?Have I carried out the plan?
• Have I followed the rules?Have I followed the rules?
• Have I spent all the money?Have I spent all the money?
RESULTS MANAGERS ASK:RESULTS MANAGERS ASK:
• What results did I commit to achieve?What results did I commit to achieve?
• Can I do it, both financially and Can I do it, both financially and programmatically?programmatically?
• What did we learn and how can we What did we learn and how can we use it to improveuse it to improve??
Outcomes, schmoutcomes…Outcomes, schmoutcomes…
Terms, Models, Systems, Terms, Models, Systems, Graphics, etc, etc,…..Graphics, etc, etc,…..
Key Outcome TermsKey Outcome Terms
• Inputs:Inputs: what goes in what goes in
• ProgramProgram: the products and services created from : the products and services created from inputs and which add value (hopefully)inputs and which add value (hopefully)
• OutputsOutputs: what comes out; what programs produce : what comes out; what programs produce
• Outcomes: Outcomes: the direct intended beneficial effect on the direct intended beneficial effect on those being served those being served
• Impacts: Impacts: long term or indirect effects of long term or indirect effects of outcomes outcomes on on communities or individualscommunities or individuals
A Health Example:A Health Example:
• Program: Program: smoking cessation workshopssmoking cessation workshops
• OutputsOutputs: curricula; horror films, people who attend : curricula; horror films, people who attend one or more sessions; stop smoking plans one or more sessions; stop smoking plans
• Outcomes: Outcomes: the number/percent completing who stop the number/percent completing who stop smoking for at least one year smoking for at least one year
• Impacts: Impacts: reduced health care costs; improved air reduced health care costs; improved air quality, reduced effects of second hand smoke.quality, reduced effects of second hand smoke.
Major Outcome ModelsMajor Outcome Models
Logic Model/Theory of ChangeLogic Model/Theory of Change Balanced ScorecardBalanced Scorecard
Outcome Funding Framework Outcome Funding Framework
Toward Outcomes for ProgramsToward Outcomes for Programs
Managing for ResultsManaging for Results
Getting to OutcomesGetting to Outcomes
Scales and LaddersScales and Ladders
Results MappingResults Mapping
Results Based AccountabilityResults Based Accountability
A Logic ModelA Logic Model
Providing Leadership for Program Evaluation
Logical Linkages: Series of If-Then Relationships
IF THEN IF THEN IF THEN IF THEN
INPUTS OUTPUTS OUTCOMES
Programinvests time
&money
Resourceinventorycan be
developed
Familieswill knowwhat is
available
Familieswill accessservices
Familieswill have
needs met
Theory of ChangeTheory of Change
Getting to Outcomes Getting to Outcomes
Community Equity ScaleCommunity Equity Scale
RBA CrosswalkRBA Crosswalk
Balanced ScorecardBalanced Scorecard
Clarifying and translating 1the vision and strategy, andgaining consensus.
Communicating and 2Linking:-communicating and education-setting goals-linking rew ards to performance measures
Strategic feedback and 4Learning:-articulate the shared vision-supply strategic feedback-facilitate strategic review and learning
Planning and target 3setting:-setting targets-aligning strategic initiatives-allocating resources-establishing milestones
BALANCEDSCORECARD
T.O.P. PyramidT.O.P. Pyramid
Targeting Outcomes of Programs (TOP) Model
KASA:K = KnowledgeA = AttitudeS = SkillA = Aspiration
Program Development(Goals/Objectives)
SEEC:S = SocialE = EconomicE = EnvironmentalC = Conditions
SEEC
PracticesKASA
Reactions
ParticipationActivities
Resources
Program Performance(Evaluation Measures)
ResourcesActivities
Participation
ReactionsKASA
PracticesSEEC
Source: Claude Bennett & Kay Rockwell, 1994
RI Outcome Framework Funnel
MILESTONES NUMBER NEEDED
CONVERSION FACTOR
1. Inquire about program
2. Decide to enroll
3. Attend first session
4. Retain information/skills
5. Attend all remaining
6. Retains information/ skills from all sessions
7. Start at job site
8. Performs
9. Stay at job for at least 6 months
2,000
400
300
200
100
100
80
60
50
5.0
1.3
1.5
2.0
1.0
1.2
1.3
1.2
MILESTONES NUMBER NEEDED
CONVERSION FACTOR
3.
4. Retain information/skills from first session
5. Attend all remaining sessions
6. Retains information/ skills from all sessions
7. Start at job site
8. Performs Satisfactorily on job
9. Stay at job for at least 6 months
2,000
400
300
200
5.0
1.3
1.5
2.0
1.0
1.2
1.3
1.2
The Corporate The Corporate sector; larger sector; larger nonprofit and nonprofit and philanthropic philanthropic
organizations.organizations.
Harvard Business Harvard Business School; The Balanced School; The Balanced Scorecard Scorecard Collaborative; Collaborative;
numerous numerous management management
consultancies in the consultancies in the U.S. , U .K ., Canada, U.S. , U .K ., Canada, and Australiaand Australia
To moni tor ei ther a To moni tor ei ther a single program with single program with several associated several associated initia tives, or mult iple initia tives, or mult iple
programs within a programs within a specific organization; specific organization;
to analyze the to analyze the alignment of alignment of resources and resources and initia tives to strategic initia tives to strategic targets. Mul tivariate targets. Mul tivariate situations needing a situations needing a
single encapsulating single encapsulating portrait o f several portrait o f several
s imultaneous simultaneous processesprocesses
Allows for a graphic Allows for a graphic assessment of the assessment of the degree to which an degree to which an organizations organizations
resources and resources and efforts ac tually efforts ac tually
support its goals .support its goals .
strategy, strategy, alignment , shortalignment , short --and longand long -- term term objectives; objectives;
financial and nonfinancial and non --financial financial
measures; lagging measures; lagging and leading and leading indicators; indicators; performance performance measures and measures and performance performance
drivers; internal drivers; internal and external and external
indices of indices of success.success.
A businessA business -- based based model, designed model, designed to provide to provide integrated integrated
management and management and accounting for accounting for
multiple variables multiple variables impacting impacting organization organization performance, by performance, by connecting them connecting them to a set o f to a set o f
performance performance indicatorsindicators
Balanced ScorecardBalanced Scorecard
Primarily Primarily used byused by
Most Commonly Most Commonly Associated WithAssociated With
Particularly well Particularly well suited forsuited for
Strong PointsStrong PointsKey Terms Key Terms and and ConceptsConcepts
DescriptionDescriptionName of ModelName of Model
The chart below is offered as a basic guide to a sample of outcome models. Models selected are among the mostly widely known, but not all models are currently used to an equal degree. Models are presented in alphabetical order.
A Table of Leading Outcome Models
Outcome Tool ApplicationsOutcome Tool Applications
Communication Communication
Program planning Program planning
Funding Funding
Learning/Evaluation Learning/Evaluation
Result tracking toolsResult tracking tools
Reporting/AccountabilityReporting/Accountability
Resource Management Resource Management
Application to Transformation Application to Transformation
• Be balanced in your “thoughtware”Be balanced in your “thoughtware”
• Start with Success: What would a transformed health Start with Success: What would a transformed health care system look like AND accomplishcare system look like AND accomplish
• Choose an outcome model that fits Choose an outcome model that fits
• Start with early adoptersStart with early adopters
• Engage Rapid PrototypingEngage Rapid Prototyping
• Emphasize LearningEmphasize Learning
• Think management before accountabilityThink management before accountability
For More InformationFor More Information
• Visit our web site: Visit our web site: www.Rinstitute.orgwww.Rinstitute.org
• Call or Email Call or Email
Bill Phillips, 518-797-3783Bill Phillips, 518-797-3783
Bphillips@Rinstitute.orgBphillips@Rinstitute.org
• Mention this Session and get 15% off Mention this Session and get 15% off
Outcome FrameworksOutcome Frameworks …an overview for …an overview for practitionerspractitioners