Unit 13 – Manage health and social care practice to ensure positive outcomes for individuals
In an attempt to ensure that all individuals requiring care are dealt with holistically and with their needs being met, the ‘personalisation’ agenda has been introduced into a lot of recent government documentation. A system of care and support tailored to meet the needs of the individual has replaced the ‘one size fits all’ approach previously in vogue.
Outcome based practice, also referred to as outcomes management, and outcomes-focused assessment, is one such approach to achieving desired patient care goals. It involves a combination of teamwork, quality improvement, which is continually evaluated, and process and outcome measurement.
Based upon the social model of disability and empowerment, this approach has been hailed as a better option to the needs-led assessment, and research supports this.
Three dimensions of the model have been put forward as being-
Outcomes involving change, such as those that focus on developing self-confidence, or skills which enable self-care.
Outcomes maintaining quality of life, occasionally referred to as maintenance outcomes.
Outcomes associated with the process of receiving services, or those which involve being valued and listened to in the care process.
AUTONOMY OUTCOMESPERSONAL COMFORT OUTCOMES
Access to all areas of the homePersonal hygiene
Access to locality and wider environmentSafety/security
Communicative accessDesired level of cleanliness of home
Financial securityEmotional well-being
ECONOMIC PARTICIPATION OUTCOMES
Access to paid employment as desired
Access to training
Access to further/higher education/employment
Access to appropriate training for new skills (e.g. lip reading)
SOCIAL PARTICIPATION OUTCOMES
Access to mainstream leisure activities
Access to support in parenting role
Access to support for personal secure relationships
Access to advocacy/peer support
Seen as a user-centred approach to care, it involves the care worker acting as a facilitator in care pathways.
Outcome based practice was a new way of working and replaced the needs-led approach. The reasons for this focus on the problems with ‘needs’, both conceptually and practically.
One of the problems is that the identification of ‘needs’ is highly subjective. Also, working with service users in a needs-led approach meant that processionals focussed on the immediate situation and support requirements that would be provided by the care professional.
Another problem with focussing on ‘needs’ is that they change over time, and there is no specified point at which the work can be said to have been achieved. The work frequently lacks direction and purpose and it is almost impossible to measure success or failure. Needs have a tendency to become moveable feasts in that once they are identified, others also become apparent and there appears to be no end to the work being done for a service user.
The idea of ‘outcomes’ in care was seen as a different approach to which the focus on achievement was a more meaningful way to assist with care. The focus of the work is on the goals or desired achievements of the service user and this has been seen as a very different approach oo that of the needs-led assessment of care.
In using this approach, the care worker takes on the role of assisting the services user to identify immediate, medium-term and long-term goals. Rather than leading the service user’s care, the health professional:
‘steers, guides, (and) pronounces the identification of ‘needs’ and the proposed ‘intervention’ towards practice driven by the service user, who is encouraged and facilitated to identify their ‘outcomes’, a set of immediate, medium-and long-term goals that they wish to achieve. The focus on outcomes overcomes many of the deficiencies of the ‘needs’ model.
With this renewed focus on outcomes, the work becomes target driven and specific, and this is a goal in mind. It is the service user in this type of care who sets review dates and monitors their achievement, thus moving the focus away from the care professionals’ ‘assessment of the service user’s needs.
The service user then remains in complete control of the entire process, from the identification of outcomes, to their achievement and evaluation of the success of failure of the venture. In this type of approach, the role of the care professional is to assist the service user in their achievement of their outcomes only.
One of the problem areas was the struggle with the concept of outcomes that care professionals seemed to have, together with the professional and organisational culture which did not accept the introduction of such innovations. Previous research and development work did find, however, that as staff gained a clearer understanding of the outcomes concept, the outcomes focus provided a clearer basis for care planning.
A further area of concern was with the whole notion of ‘expert power’. With the service user at the centre of the assessment process identifying their own aims and objectives in negotiation with care professionals, control and responsibility for the achievement sat very much with the service user. This meant that the professional felt their role had been reduced to one of facilitator and this did not sit well with some who believed that, as experts, they should have a bigger part in the decision-making mechanism.
This somewhat radical approach to care meant that professionals needed to change their perceptions of care and embrace a newer was of working. The change by care professionals to using the term ‘outcome’ rather than ‘need’ was one which helped to change perceptions.
The legislation with respect to outcome based practice is part of the personalisation agenda so favoured by health professionals and government over the last 40 years or so. Dissatisfaction with the care system saw the development of the civil rights movement of the 1960s and 1970s and the medical model came under scrutiny and the social model of disability became more accepted in practice.
In the 1980s and 1990s, there was a move towards a more individualistic, consumer-led approach to social care and the Conservative government talked of the ‘dependency culture’ that was in evidence and the need to address this.
The introduction of the personal health budget to allow people to have more choice, flexibility and control over the health services and care they receive came about as a result of the White Paper Personal Health Budgets: First steps (2009).
One of the newest papers is that provided by the White Paper A Vision For Adult Social Care: Capable communities and active citizens, which was published in November 2010, and set out the plans for a new direction for adult social care, putting personalized services and outcomes centre stage.
A subjective view of psychological well-being would be to say that we are happy or satisfied with our lives. But this is fraught with difficulty since what makes you happy is unlikely to be the same for your service users or other care workers, perhaps. So although our emotions and how we feel is a part of psychological well-being, it is not enough. In order to feel really good and to have fulfilling lives, we need to experience purpose and meaning, in addition to positive emotions. The psychologist Carol Ryff has developed a clear model of psychological well-being that breaks it down into six key parts and these are:-
Positive relations with others
Purpose in life
In ensuring the ‘well-being’ of our service users and even our staff, as managers we need to be aware of how we might measure the state of well-being to ensure that service users are getting their overall needs met to provide use with a sense of how happy and healthy someone is. When things are not going well and our joy with life and general sense of clam is lacking, we start to experience stress, worry and anxiety. Our psychological well-being becomes compromised and this will inevitably lead to our quality of life being reduced. For the people in our care, this can lead to depression and its subsequent effects on the physical well-being and health.
Psychological well-being is about enabling our service users to experience a well rounded and balanced life with all the attendant emotions that go with this.
PHYSICAL HEALTH – refers to the bodily functions and fitness etc. and describes the ability of the body to function in an efficient way.
INTELLECTUAL AND MENTAL HEALTH – concerns the sense of purpose we have in life and the ability to feel good and to cope. If we can think clearly and coherently, then we are more likely to be intellectually healthy. It also deals with the need to grow and learn and our capacity to become self-actualising. Has
Self-actualisation is worth mentioning since it is a term much used by psychologists. Kurt Goldstein (1878-1965) and Carl Rogers (1961) referred to this as a ‘basic drive’, and one which would enable us to reach our full potential Maslow’s hierarchy of needs (1970) has ‘self-actualisation’ as the apex of the pyramid and refers to creativity, motivation and development of problem-solving skills.
EMOTIONAL HEALTH – is about our capacity to love and feel loved, and to be able to voice our emotions in a responsible manner in order to maintain relationships with others.
Being involved in these sorts of relationships and having a sense of support in our lives is all about social health. Our ability to make friends and to be involved in activities with others is incorporated here as well.
SPIRITUAL HEALTH – is often a difficult one to recognise since not all of us have belief in god or a religion. Some individuals have a strong need to belong to a groups or organised religions and feel they are not complete without a belief of this kind. But spiritual health can also be about our moral principles and they way in which we live and have purpose in our lives. For these people, the concept of a god or a need to be part of a religion is unnecessary, they just want to live ‘good’ lives.