New Types of Worker - Action Learning Sets to Facilitate the Delivery of Outcomes-Based Services
Action Learning Sets to Facilitate the Delivery of Outcomes-Based Services
Background
Health and social care is increasingly moving towards outcome-based services. An outcome is the word used to describe the measurable impact of the service on a person's life. Each individual will have different needs and goals, and an outcome-based service places these at the heart of its delivery, rather than using a 'one size fits all' approach.
Whilst this move is supported by the government in a range of papers and policies, it represents a radical shift in the way services are designed, commissioned, delivered and evaluated. Action learning sets are a useful tool which can encourage and support such a change. During the process key personnel gather together to discuss, plan and problem-solve pertinent issues.
Objectives
We wanted to support the action learning set process in order to the enable long term conditions staff at Bracknell Forrest Social Services to move towards outcome-based services. Above and beyond this, we wanted to evaluate this process in order to design a flexible model which could be used throughout the country across a range of different service areas.
The Plan
Working in partnership with Bracknell Forrest Borough Council (BFBC), we planned to convene a learning set of key personnel within the long term conditions staff team. Over six facilitated sessions, this learning set would support members in developing and implementing an outcomes-based approach in their service. An independent researcher would contact participants in between sessions to gain formative feedback which would help to shape future sessions. Finally, we would work with the researcher to evaluate the process, drawing out innovative success factors and designing the model itself.
What Happened
Our starting point was spending time with the BFBC project manager to establish their needs, expectations and the practicalities involved in launching an action learning set. Together we identified key participants (including the Head of Commissioning, the Head of Community Re-ablement, the Head of Older People and Long Term Conditions, Community Matrons and Home Support Managers). These participants met together over a six month period, as planned.
The group was larger than we had anticipated, its membership changed and it coincided with a period of significant organisational flux within the service. As such, it soon became clear that a series of facilitated workshops would be of most use to the participants at that time. These workshops featured outside expertise, from those already working in outcomes-based services, and provided a forum to look at areas of concern and plan a way forward.
During the workshops it became increasingly clear that organisations really need a practical toolkit of ideas and resources to help them deliver outcomes-based services. This led us to revise our initial plan and our experiences at Bracknell Forrest to design and build this toolkit.
What Was Achieved
Whilst the timing wasn't right in the organisation for a pure Action Learning Set, the facilitated workshop format helped participants to learn, and think about, the practicalities of outcome based services. Our experiences enabled us to identify the 'Key Success Factors and Innovation' from the process. We have also created a toolkit of ideas and resources to help managers across the care sector facilitate the organisational, and personal, change necessary to deliver outcome-based services.
What Helped and What Hindered
Participants valued the contact they had with both the facilitators and the independent researcher. The researcher's impartiality, credibility and sensitivity helped participants to share their feelings in between sessions in the knowledge that they would be fed back in a constructive, and non-attributable, way. This not only helped shape the direction of future sessions, but also provided valuable support during a period of uncertainty and change. The flexibility of the team helped participants to feel an active part of the process, encouraging them to bring it to life.
Different members of the group had different understandings of what 'outcome based services', 'personalisation' and 'person-centred services' really meant. As the membership of the group changed, time had to be spent ensuring that there was a common understanding between all members. This need to revisit the basics became frustrating for the group as a whole.
As mentioned previously, the large and shifting membership of the group coupled with the climate of organisational restructuring meant that an action learning set format was unfeasible, hence the change to workshop format. Inevitably, the uncertainty surrounding job roles and the workplace had an impact on the workshops themselves.
What We Found
Our findings resonated with the 'change of architecture' identified by Kanter (1983). Whilst a plan or timetable of activities can be initiated at a senior level, it is strengthened when everyone involved contributed to its design and building. They engage with the underbelly of change – the sense of lost control and helplessness – particularly when there is little preparation.
By introducing concepts of techniques like: a solution focused approach; change and innovation; reflective practice; the balanced scorecard; the performance prism, force field analysis and mindtools the workshops confirmed that change need not imply insecurity, but rather flexibility with a heart.
Evaluation
Alongside the participants, we developed a questionnaire covering key areas. The researcher made contact with participants between sessions, using this questionnaire as a foundation for discussion. The feedback resulting from this was discussed at the subsequent session. When developing the toolkit, we obtained feedback from a range of stakeholders including Skills For Care and potential users in other authorities.
The Future
The resources produced by this project will be widely available to support those in the social care sector to undertake the organisational, and personal, change necessary to introduce outcome-based, personalised, services.
Contact Details
Chris Bell, Education and Business Development Ltd
01752 405180, chris@cbebd.co.uk
March 2009
