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The Outcome Pages

Outcome Based Accountability

Outcome Based Accountability™ was first developed in the early 1990s by Mark Friedman and is now used extensively across the United States and increasingly in eight other countries including the UK. The framework evolved out of Mark’s 19 years experience as a state government official. Before establishing the Fiscal Policy Studies Institute in 1996, as a member of a small Washington based think-tank Mark had the opportunity of developing his thinking to draw some fundamental conclusions:

Whilst Mark concluded that almost any planning system could be used for straightforward task and finish projects, tackling more complex and pervasive issues such as crime, anti-social behaviour, poverty, health inequalities or poor educational attainment needed a different approach.

Much of the emphasis on tackling these issues centres on investment in programmes or service systems of one kind or another. Yet despite billions of pounds of spending on a bewildering array of initiatives and concentration on systems, polices and strategies, in terms of quality of life for poorer communities, little seems to change. Mark recognised that the job of improving quality of life outcomes was bigger than individual programmes, indeed bigger than government itself. The answer lies in partnership working: bringing together all the stakeholders with a role to play including the main service providing agencies, service users, voluntary and community organisations and the business community.

Accountability

At the heart of this thinking is the understanding that if we hope to make a difference to quality of life outcomes, we must establish the right lines of accountability. The recognition that individual agencies or programmes or even government as a whole cannot by themselves address quality of life outcomes gives rise to two distinct types of accountability:

Whilst the need for partnership working to address outcomes has been recognised by the UK government for some time (demonstrated for example by the core roles given to Local Strategic Partnerships, Community Safety Partnerships or Children’s Trusts), the confusion between the two types of accountability still persists. It is not uncommon to see, for example, the police being held solely accountable for a high crime rate or the NHS being held solely accountable for poor health.

The reality is that the police (for example) cannot by themselves eradicate crime: only agencies and individuals working in partnership with the police can make inroads on indicators such as the burglary rate, violent assaults or anti social behaviour. Similarly, the NHS cannot in isolation address poor health indicators such as obesity, low life expectancy or heart disease. To hold individual agencies accountable for these indicators will result in a frustrating process of much talk, many strategies, much blame and little change.

This doesn’t mean letting agencies off the hook. An equally robust approach to managing service provision by measuring appropriate performance measures is central to OBATM thinking. Performance measures are determined by answering three simple questions:

To preserve clarity of thinking, it is important to recognise the difference between means (the agencies or programmes that deliver services) and ends (the outcomes we strive for). We should hold agencies accountable for their performance as the means (by using appropriate performance measures) and partnerships accountable for the ends (by measuring progress against appropriate indicators). The reality is that we often mix up the two as though the difference didn’t matter. The result is akin to a dog chasing its tail: considerable effort for no appreciable gain.

Getting from talk to Action – whole population level

The challenge then is to get from talk to action, from strategy to delivery. The process starts at the whole population level, which means starting by looking at the conditions of wellbeing we want for all people (or all children, all young people, all older people etc.) in a defined community. Because we are looking to contribute towards whole population outcomes then this process cannot be done by a single agency or service provider. We need to bring together all the relevant agencies and organisations together with service users, residents and community representatives with a role to play in addressing the desired outcome. We can then start the journey from talk to action by addressing seven questions:

  1. What are the quality of life conditions (outcomes) we want for our community and the children and families who live here?
  2. What would these conditions look like if we could see, feel and experience them?
  3. How can we measure if these conditions exist or not? (indicators) Are the measures getting better or worse? (baseline) Where are we headed if we just keep doing what we’re doing now (forecast)?
  4. Why are these conditions getting better or worse? (the story behind the baseline)
  5. Who are the partners that have a potential role to play in doing better?
  6. What works to do better? What would it take to turn the indicator curve? What can we do that is no-cost or low-cost in addition to things that cost money?
  7. What do we, individually and as a group, propose to do? (action plan)

This seven step ‘journey’ is structured around a process that enables participants to contribute their combined skills, knowledge and experiences to inform each step of the way. The process maximises the contribution of all partners and stakeholders and creates shared ownership for the conclusions. The core process (known as “Turning the Curve”) has been used extensively to inform strategic plans and actions for a broad range of partnership bodies including Local Strategic Partnerships, Neighbourhood Partnership Boards and Children’s Trusts.

The Turning the Curve exercise demonstrates the basic process and is structured around the seven questions above. Task groups of (typically) between six and eight partners are briefed to complete a single page report working step by step in a logical sequence from the defined population and outcome to the action plan. The Turning the Curve report which forms the basis for the exercise is illustrated here.

Performance Accountability

With the whole population level process completed as above, the next stage is to ensure that the means we are using to deliver against the desired outcomes are effective. The OBATM approach to performance management is characterised by the simple, common sense, minimum paper approach used at the whole population planning stage. Fundamentally, the process revolves around answering three questions about the programme or services being provided:

  1. How much did we do? (the quantity of service)
  2. How well did we do it? (the quality of the service)
  3. Is anyone better off? (the quantity and quality of the service outcome)

This can be illustrated graphically as four quadrants:

4quadrants

Populating these four quadrants gives us our performance measures. The top left hand quadrant is the easiest to fill (and interestingly, the least important). The performance measures in the top right hand quadrant are more difficult to determine and have a direct bearing on the measures in the bottom quadrants which are of course the most important. There is absolutely no point in delivering services if no one is any better off yet the bottom quadrant performance measures are usually the least defined and are frequently never measured at all. Obviously, if no one is any better off as a result of the service provided then we will make no impact whatsoever on the desired whole population outcomes we want for our communities. Relying on top left quadrant measures as the only means of determining service provision performance is a great recipe for encouraging a large quantity of relatively useless activity. Determining and measuring the bottom quadrant performance measures is seldom straight forwards, but we cannot abdicate responsibility for them if we are serious about wanting to make a positive difference to communities.

Improving Service Delivery

Using OBATM to improve service delivery is based on the same thinking as the whole population process, but with two important differences. Instead of starting by defining the whole population, because we are looking to performance manage a specific service to a defined group of service users, we start by answering the question “Who are our customers?” By customers, we mean those people whose lives are affected (for better or for worse) by the actions of the service. (Instead of customers, you might want to use the terms service users or clients.) The second important difference is that instead of using population indicators to measure improvement, we are looking to determine performance measures by populating the four quadrants illustrated above to demonstrate the impact of the service with a particular emphasis on the bottom right hand quadrant measures.

So the seven performance accountability questions to get from talk to action are:

  1. Who are our customers?
  2. How can we measure if our customers are better off? (bottom right hand quadrant measures)
  3. How can we measure if we’re delivering our services well (upper right quadrant measures)
  4. How are we doing on the most important of these measures? (creating a baseline and a curve to turn in exactly the same way as with population accountability. Understanding the story behind the baseline is crucial to understanding how to improve performance )
  5. Who are our partners who have a role to play in doing better? (this will inevitably include our customers and suppliers)
  6. What works to do better? (What would it take to turn the performance measure curve? What can we do that is no-cost or low-cost in addition to things that cost money?)
  7. What do we propose to do? (the action plan)

Using this thinking process to improve the performance of services follows an almost identical “Turning the Curve” approach, only defining customers instead of whole populations and performance measures (How Much, How Well, Better Off?) instead of population indicators. We baseline the data we have for our priority performance measures and forecast the future trend. We draw the curve we want to turn and then consult widely to inform the story behind our baseline and the partners we need to work with to improve our services. This in turn informs the answer to the key question “What would it take to improve our performance?” and the basis for our action plan. The Turning the Curve report which forms the basis for this exercise is illustrated here

The OBATM Journey

The journey from Talk to Action is shown graphically below, starting with the whole population design process from the Desired Outcome travelling through the seven steps to the Action Plan. Because of the complexity of the problems faced in communities, it is highly unlikely that significant impact on the outcomes will come from a single intervention. The flow chart therefore goes from the Action Plan through a review process referring back to progress against the indicator baseline. The process then repeats itself, reviewing the story behind the baseline, the choice of partners, what works and the action plan. Addressing challenges around social deprivation is rarely a ‘task and finish’ process. Progress against the indicators needs continuous review as the stories behind the baseline change, requiring adjustments to the Action Plan and the delivery mechanism to keep the curve turning in the right direction and at the right pace.

The means is illustrated in the graphic as the commissioning process arising out of the Action Plan and the performance measures which enable us to ensure that our chosen delivery method is effective. The graphic demonstrates how the delivery mechanism contributes towards the desired outcome (the ends) at the whole population level. It is vital that the distinction between ends and means is understood otherwise the lines of accountability become blurred, confusion sets in and little changes. We cannot hold individual service providers accountable for changing outcomes single handed: that requires the efforts of a range of stakeholders working in partnership. We can however hold service providers accountable for managing their services effectively and should rightly expect them to evidence how their customers are better off. The OBATM framework enables us to understand this contributory relationship between means and ends through a simple thinking process and in doing so, successfully make the journey from talk to action.

For a range of supporting materials, articles and publications on OBA™ see the Resources Page

The OBA<sup>TM</sup> Journey

Further Information

Trying Hard Is Not Good EnoughFor a more comprehensive understanding of Outcome Based Accountability™, I can strongly recommend Mark Friedman’s book “Trying Hard Is Not Good Enough” which can be ordered online from the UK from the Results Leadership Group in the US. Click on the book cover opposite for ordering information. The group has also published a DVD featuring Mark Friedman introducing the OBATM framework (available from the same source)

The book is described as: “… a “how to” book on accountability for public and private sector agencies, communities, school districts, cities, counties, states and nations. It is an antidote to all the overly complex and jargon-laden methods foisted on us in the past”

(For the avoidance of confusion, in the United States, OBA™ was developed as Results Based Accountability™. The framework is exactly the same – only the title is different).

LINKS

http://raguide.org/

This site is the Implementation Guide for Results/Outcome Based Accountability and features a mine of information, resources, case studies and tools.

http://resultsaccountability.com

This is the Fiscal Policy Studies Institute website edited by Mark Friedman and includes stories from the UK about OBATM as well as a host of other resources.

Acknowledgements and Copyright

The content in the Outcomes Pages is based on the work of Mark Freidman who retains the original copyright. The material is presented with his formal approval.

Limited permission is granted to government and non-profit organisations to use materials from this website. Such organisations may copy, distribute and use any of the material, providing it is done with full attribution to Mark Friedman and in the interest of improving the well-being of children, adults, families and communities. Materials may not be used for profit-making purposes without the express written consent of FPSI Inc. For purposes of this notice, profit making organisations include those non-profit organisations that provide consulting services and where revenue in excess of cost is added to organisational assets.

For-Profit Consulting Firms: It’s easy for small (generally less than 5 persons) for-profit consulting firms to get formal permission to use, without charge, the material from this website and www.raguide.org in their consulting practice. Send an email request to [email protected]. Larger for-profit firms making use of copyrighted FPSI methods or materials must contact FPSI to arrange for payment of licensing fees.