The OBA Journey and Accountability

The Outcome Based Accountability™ journey from Talk to Action is shown here as a flow chart, starting with the desired whole population outcome at the top left hand side of the chart travelling through seven steps to the Action Plan. Because of the complexity of the issues faced in communities, this is an iterative process, constantly reviewing the data and changing story behind the baseline to adjust our thinking accordingly. 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 lower half of the graphic as the delivery or procurement of actions arising out of the Action Plan. Projects or services are defined by performance measures which measure the quantity (How Much?), quality (How Well?) and impact (Better Off?) of individual actions or interventions. The graphic demonstrates how the “Better Off” measures (or Customer Outcomes) contribute towards the desired outcome (the ends) at the whole population level.

It is critical that the distinction between ends and means is understood otherwise the lines of accountability become blurred, confusion sets in and progress towards outcomes is frustrated.

Accountability

Attaining clarity around appropriate accountability is critical for designing and monitoring strategies to improve community quality of life. Confusing accountability fosters a blame culture; blaming the social worker if a child is abused; blaming the police if crime levels are high; blaming doctors for poor health. It is irrational to hold a single organisation wholly accountable for change at the whole population level when this work is invariably mired in complexity with multiple factors impacting on successful outcomes.

For example: To move towards a whole population outcome of ‘all people enjoy good health and wellbeing’, we need a broad range of partners working together to formulate a plan consisting of a range of actions that have a reasoned chance of making a difference (i.e. a strategy). Improving health and wellbeing in a community requires (amongst other things) decent housing; community safety; good education; economic prosperity; healthy lifestyles; a clean and quality environment. To attempt to pin accountability onto a single organisation working in isolation therefore makes no sense. Instead we need a cross-sector partnership of organisations and stakeholders to take collective accountability for designing and monitoring a credible strategy.

Despite the logic of this approach, it is still common practice to see blame placed on single agencies for failings at the Whole Population level. If health indicators are failing to improve, then the health providers are typically blamed: the finger of blame is usually pointed at the Police Service for spiralling crime rates. Both agencies clearly have a major role to play but neither can make a significant impact on outcomes for a whole population by working in isolation.

On the other hand, it is reasonable to hold a single organisation accountable for the quality and impact of the services it provides directly to its clients or service users. So, for example, it is reasonable to hold a doctor’s surgery accountable for the quality of service it gives to its patients in terms of treating them well, giving an accurate diagnosis and appropriate treatment or referral. But that is not the same as holding the GP solely accountable for the patient’s overall health and well-being.

Recognising this, Outcome Based Accountability™ (OBA) identifies two distinct types of accountability:

Population Accountability: Being about the wellbeing of whole populations, i.e. all people within a defined community whether they are in receipt of services or not.

Performance Accountability:  Being about the effectiveness of service providing agencies, programmes or projects and the wellbeing of their client populations or service users. Ensuring clarity of thinking on recognising appropriate accountability is critical.

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