Outcome consideration of difficulties, limitations and aspirations or

Outcome based care puts the person firmly at the centre of the care
service and delivers meaningful individual outcomes. This has created a results
based accountability culture, which relies on data driven decision making
processes to help to improve the lives of people using care services and the
community as a whole. Being accountable in this way means evidence is provided
for the outcomes achieved for service users and in this way services can be
judged as to whether service users are better of as a result of the services


Key benefits of such care are,

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Services users can choose care preferred and needed
to to improve their quality of life.

They can have more flexibility in choice and any
changes to need can be responded to more quickly.

Care workers can work closely with service users to
enable them to become more independent.

It strengthens partnership working

Evaluating the effectiveness of services is easier
where outcome measures are set





Outcome based practice versus Service led approach


Service Led

Outcome based

Tools encourage information gathering through
standardised question and answer approaches to assessment, support planning
and review

Semi-structured conversations with individuals in
assessment, support planning and review ”

“Tick box” approach to assessment

Analytical skills involved in assessment

The person is viewed as a client, service user or

The person is a citizen with rights and

If the person is deemed eligible, identified
needs are matched to a limited range of block provided services, resulting in
service-driven approaches

Identifying outcomes involves considering a range
of solutions/strategies including the role of the person, family supports and
community based resources

Where needs link to strict eligibility criteria,
the assessor is required to maximise individual difficulties to access

Involves consideration of difficulties,
limitations and aspirations or goals. 
The priority is to identify what to work towards

Focusing exclusively on deficits and
difficulties, and how needs are to be met, results in a focus on tasks and in
services which do things to people

By focusing on strengths, capacities and goals,
while mindful of limitations, the role of the person is maximised.  Services do things with people.

Matching needs/deficits to services tends to result
in static service delivery

Outcomes may change in the person’s life journey
and so should be revisited

Where outcomes are identified, these tend to be
professional or organisational outcomes e.g. improved nutrition, or avoid
delayed discharge

Outcomes are what matter to the person, though
often consistent with professional and organisational outcomes e.g. being
able to get out and about

Starting from what services are currently
available restricts communication and limits options 

Starting from the person’s priorities supports
enabling relationships, creates clarity and identifies goals at an early
stage. Being listened to, involved and respected supports better outcomes

Source: Miller, E., Cook, A., Samet, W. (2009) Philosophy and Principles
Underpinning a Personal Outcomes Approach. Joint Improvement Team.


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