Q. At a recent provider forum, one of those attending spoke about ‘outcomes’ and ‘outcome-focused care plans’. What are these and does our service need to deliver them?

Published: Tuesday, 06 September 2016

A. The term ‘outcomes’ causes some confusion in the care sector.

The essential standards (now replaced by the fundamental standards) referred to outcomes when specifying the required standards that care providers had to meet. This is not what is meant by the term today. An outcome is the end result for the service user of the service being provided. A way of defining an outcome is to think of the following phrase ‘By receiving this service, the service user will…’ 

Outcomes can be broken down into three broad categories. These are: maintenance, change and process. Maintenance out-comes are used when the desired end result is to keep to the status quo. An example could be: ‘James will continue to shower with prompting.’ A change outcome is used where an improvement is the desired outcome. An example of a change outcome would be: ‘James visits the local community centre on Wednesday and Fridays between 9am and 11am to chat to his peers.’ In this case James has the identified need to improve his social interaction. A process outcome is used when defining the desired end result of the care provider’s systems. An example of this would be: ‘James is supported to get ready for bed between 9.30pm and 10.00pm.’ It is not necessary to specify which type of outcome it is but it is important to know the difference between them.

Outcome-focused care plans start with an assessment of needs and preferences. The need is the circumstance that requires action and the preference is the way in which the service user wishes their needs to be met. An example is: ‘James requires full support to take his medication. He prefers to take tablets one at a time’. In this example, the need is the full support with medication and James’s preference is to take tablets one at a time. The next step is to define the outcome, i.e. the end result of the care provided in terms of our phrase ‘By receiving this service the service user will…’ In this case, the phrase would end ‘receive full support to take tablets one at a time in accordance with the prescriber’s instructions’. Of course, it is not necessary to include ‘By receiving this service the service user will…’ each time.

The next step is to define the clear instructions for staff on actions to take to meet the outcome. These will include specifics and should be in sufficient detail that an experienced care worker who does not know the service user can read them, carry them out and thus meet the service user’s needs and preferences. This section of a care plan could also contain information on health conditions, medication, risks and risk management. It should also contain information from staff on what to record. These recordings are then used to inform the care plan review process to determine whether the outcome was met. If the outcome was met then it can be maintained or changed (to further improve the outcome) or it may even be replaced with a new outcome altogether if the service provided has effected lasting change. If the outcome was not met, then the reason should be identified. This will either be due to the service user (failed to engage, wrong outcome etc.) or the service (staff did not follow the plan, lack of resources etc.). From this, new outcomes can be set as above.

Of course there is a lot more to outcome-focused care planning than that described above. There are a wide range of outcome planning and review tools available.

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