Outcome Based Accountability ‘From Talk to Action’ David Burnby

Outcome Based Accountability

‘From Talk to Action’David Burnby

www.davidburnby.co.uk

Fiscal Policy Studies InstituteSanté Fe, New Mexico

www.resultsbasedaccountabilty.comwww.raguide.orgwww.resultsleadership.org (publications)


• 1 Language• 2 Levels of Accountability• 7 Steps from Talk to Action

Two Levels of Accountability

Population Accountabilityabout the well-being of WHOLE POPULATIONS

for neighbourhoods – districts – regions - countries

Performance AccountabilityAbout the well-being ofCLIENT POPULATIONS

for projects – agencies – service providers

1 Language• Outcome

– A condition of well-being for children, adults, families or communities

• 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

Pop

ula

tion

A

ccou

nta

bili

ty

Perf

orm

an

ceA

ccou

nta

bili

ty

EN

DS

MEA

NS

Population and Performance Accountability

All Young People in (a place)WHOLE POPULATION

OUTCOME: All Young People in

(a place) are Healthy

INDICATORObesity Rate

Young people attending

active lifestyle

programme

PERFORMANCE MEASURE

% Young people attending losing weight

Contribution

Means

End

Seven Steps from Talk to Action:The Leaking Roof

Inch

es

of

Wate

r

Time

Experience

Measure

Story behind the baseline (causes)PartnersWhat Works?Action Plan (Strategy)

ForecastFixed?

Not OK

OUTCOME “Healthy and Successful Adults”

INDICATORSMeasures of the outcome

1. All age, all cause mortality rate2. 16+ current smoking rate3. Healthy life expectancy at Age 65

BASELINES • Where we’ve been• Where we’re going• Where we want to be

STORYBehind the baselines

• The causes, the forces at work• What’s driving the baselines?

PARTNERSWith a role to play

• Public, Private and Voluntary Sector• Community groups• Residents

WHAT WORKS• What would it take to turn the curve?• Best practice• Best hunches

ACTION PLAN • What we propose to do, how and by when

Data DevelopmentAgenda (Pt 1)

Data DevelopmentAgenda (Pt 2)

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?

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

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)

Whole Population Turning The Curve Report

NB: ONE SIDE OF FLIPCHART PAPER ONLY!

Key pointers to action


Managing and Improving Performance

Programme Performance Measures

How much service did

we deliver?

How well did we

deliver it?

How much change/effect

did we produce?

What quality of

change/effect did we

produce?

QUANTITY QUALITYEFF

OR

TEFF

EC

T

INPU

TO

UTPU

T

Cause

Effect

Drug Treatment Programme

QUANTITY QUALITYEFF

OR

TEFF

EC

THow much did we do? How well did we do it?

Is anyone better off?

• Number of clients enrolled

• Number of courses

• Number of counselling sessions

• % clients completing programme

• % counsellors trained to professional standard

• % clients saying they were treated well• Number clients

drug free• At exit of

programme• After 12 months

• Number clients saying they were helped with their problems

• Percentage clients drug free

• At exit of programme

• After 12 months• Percentage clients

saying they were helped with their problems

Not All Performance Measures Are Created Equal...

QUANTITY QUALITY

EFF

OR

TE

FFE

CT

How much did we do? How well did we do it?


LEASTimportant

Also Very Important

MOSTimportant

The Matter of Control

QUALITY

EFF

OR

TE

FFE

CT



MOSTcontrol

LESScontrol

We have the least control over the most important matters

PARTNERSHIPS

QUANTITY

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)

Performance Turning The Curve Report


Next Generation Commissioning

Outcome Based CommissioningHome Care Service


Number of persons served

• No. visits per week• Average length of visit• % service users who say

service is reliable, flexible, respectful, friendly

• Number service users reporting that service has enabled them to remain at home


• 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)

Service Specification (Home Care Service)

• 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.

Next Generation CommissioningQuantity

Eff

ect

Eff

ort

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.

WHICH MEANS

BUT2. They break down in

the Is anyone better off?quadrants (because of case mix differences and perverse

incentives).

1. Traditional purchasing methods work fine in the upper quadrants.

Quality

The Three Essential Provisionsof Next Generation Commissioning

1. The most important performance measures

How much? How Well?

Anyone Better Off?

The three to five measures that say most about the effectiveness of the service provider’s performance*

*As determined from the Five Step Method

The Three Essential Provisionsof 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 Provisionsof 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 QUALITYEFF

OR

TEFF

EC



• Number of persons served

• Number of home visits

• Number of shopping trips

• Number of visits per week

• Average length of visit

• % clients saying they were treated with dignity and respect

• 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 QUALITYEFF

OR

TEFF

EC



• Number of units produced

• Tons of steel deployed

• Residual value of cars

• Warranty claims• Unit cost• Customer

satisfaction

• £ Profit Margin• £ Share price• £ Return on Capital

• % Profit margin• % Share price growth• % Return of Capital

Private Sector Home Care ServiceQUANTITY QUALITY

EFF

OR

TEFF

EC



• Number of persons served

• Number of home visits

• Number of shopping trips

• Number of visits per week

• Average length of visit

• % clients saying they were treated with dignity and respect





Private Sector Home Care Service

QUANTITY QUALITYEFF

OR

TEFF

EC

T



• Number of persons served• Number of home visits• Number of shopping trips

• Number of visits per week• Average length of visit• % clients saying they were

treated with dignity and respect






QUANTITY QUALITYEFF

OR

TEFF

EC

T





treated with dignity and respect• % clients saying that service has enabled them to stay in their own home







QUANTITY QUALITYEFF

OR

TEFF

EC

T





treated with dignity and respect







The OBA Journey – From Talk to Action

DESIREDOUTCOM

E

Choosing the

INDICATORS

Drawing the BASELINE (and the

CURVE TO TURN)

The STORY BEHIND

THE BASELINE

Choosing the

PARTNERS

Deciding WHAT

WORKS

The ACTION PLAN

REVIEW

PROCUREMENT

PERFORMANCE MEASURESHow Much?How Well?Better Off?

(CLIENT OUTCOMES)

Contributory Relationship

ENDS (POPULATION ACCOUNTABILITY)

MEANS (PERFORMANCE ACCOUNTABILITY)

Documents

Outcome Based Accountability ‘From Talk to Action’ David Burnby