Star Struck – outcomes measurement, distance travelled, and proving the value of support

I was reading a back issue (May 2008 ) of the SITRA bulletin, where I found an article on the latest metamorphosis of the Outcomes Star developed by Triangle Consulting.  This was the mental health version, the Recovery Star.

The Outcomes Star has been used in the Homelessness field for some time, and has gone through various versions.  All of them measure, usually on a scale of 1-10, a ten dimensions that represent areas of a client’s life.  The Recovery Star includes Work, Relationships, Addictions, Trust and Hope and similar.  The original measured different areas, such as offending, managing money and meaningful use of time.

This is a fine shot at measuring what is often thought of as unmeasurable, and it has become popular with several large homeless charities, some local authorities and been adapted as an idea by others, including to measure needs according to the Supporting People Outcomes areas. One point of doing this is to evidence the work done in supported housing by capturing “softer” outcomes, to justify grants and government expenditure.  Another is to provide a basis to work with clients to help them set targets and record the achievements they make.

However, I’d like to express some reservations about the basis of the underlying idea.

First, the model is based on identifying deficiencies, or needs.  What about a person’s strengths, assets and aspirations?  These can be worked in, but the need comes first.  To my mind this continues an old voluntary sector theme of seeing clients as a bundle of needs to be helped, creating dependency. It also provides labels that can be self fulfilling – if a client thinks they rate poorly in an area then it is likely they will act in that way.  Also, from any kind of performance measurement perspective it can be a nightmare, as ratings will go up and down depending not on progress, but on how much is disclosed or known at the time of a particular assessment.

Second, what you measure is what you get.  Although dressed up as a star, essentially it is a series of disconnected linear measurements.  While a skilled worker will help a service user see the links between the different areas, and be aware that going forwards can contain many dead ends and needs to go back, the model does not promote this.  As this is what we are measuring the areas identified will be what we get.  The danger is that the complexity of individual behaviour is reduced to fixing particular areas specified not by the service users themselves, but by the monitoring system.

I would argue for alternatives.  Brief Therapy ideas provide an alternative as do most coaching models.  Starting with aspirations and what a client can do, rather than on the past and needs, can form a more positive way of moving forwards.  Otherwise clients may stay stuck in the past, may pay more attention to what is stopping them than what they can do, and not achieve the outcomes that we so desperately want to measure.

Tendering vs Partnerships – the credit crunch extends government power over charities?

I’ve always preferred partnerships to competitive tendering as a model for supply to not for profit organisations, or for their relationship with their funders.  The relationship horizon with competitive tendering is a few years, not long enough to develop real, deep and trusting relationships between supplier and supplied.  You certainly cannot develop a system such as Toyota’s famous JIT (just in time) that relies on integrating suppliers, or M&S’s relationship with their suppliers (or that of Zara, or a host of others) when every 3 years you know it all might change due to an imperfect and cost driven tendering system.

This is not anti-competition and value for money: the appropriateness of competitive tendering versus partnerships depends on the type of service you are buying.  If you buy a commodity you search for the cheapest price.  If you are buying something complex that takes situated knowledge and commitment to deliver, such as a mental health support service, you might want to use other criteria.  While you might argue that such knowledge and commitment can be bought, I’d argue that the situated knowledge required to run such services is better developed over time.

To give some examples from the supported housing sector.  The search for staff to cover shifts in hostels is endless, and normally organisations go to employment agencies for this.  Some are specialised, and many of those working for them are skilled, but often the reverse is the case.  The agency staff employed lack knowledge specific to the sites they are asked to work at or the organisations they are asked to work for.  However, a longer term partnership between agency and organisation can develop, with specific training and better knowledge of the sites by all concerned, including those at the agency responsible for placements.  The result is improved quality of service to clients.  It can even keep costs down.

Perhaps my biggest beef with the current state of Supporting People services, is that we have a competitive market where all the power lies with the one purchaser (the local authority) while many potential suppliers compete.  This makes the charities involved mistrust each other, spend a lot of time on complex tendering, then spend time on taking over services, remodelling them, TUPE, re-budgeting and negotiating, and then going through it all again.  Until the 3 year settlement, the funding horizon was year by year, hardly a safe environment to encourage investment in services by charities.  It means constant reorganisation, taking on services or staff with different cultures and practices.  This works against any organisation learning how to run a particular type of service, and sees some larger charities tendering for everything in sight.

The up side to this is that quality has improved and poor performers have been driven out of the market.  It promotes flexibility and the ability to adapt quickly to change.  The down side is the slow consolidation of organisations, as smaller more specialist ones are driven under, with the local authorities able to call the shots and specify what they want, sometimes to a crazy level of detail (considering they often lack specialist knowledge of the services they are commissioning).

The credit crunch can only make this worse – donations to charities can enable them to undertake ground breaking and specialist work that local authorities won’t initially buy.  As voluntary donations dry up, those charities that contract with Supporting People will increasingly rely on those contracts, which are continually squeezed.  Slowly some sectors will turn into extensions of local authorities, with all the ills that led to the government outsourcing to charities in the first place.

The private sector has proved that both competitive tendering and long term partnerships have their place in business.  My fear is that the supporting people regime, and what is to follow through Local Area Agreements, will focus only on tendering.  However, I am grateful that in some places relationships still count and there is learning and development that circumvents the “lets tender everything” approach of some local authorities.

The rhetoric of “lets work together” can be lost somewhere between a tender and a hard place.  Where complex services are concerned, more partnership development and less tendering might work better.

Client risk management – the paradox of control

When you are working with vulnerable people in a service paid for by the Local Authority Supporting People team, you have a directive paymaster who wants to see certain things for their money. Other stakeholders include the organisation you work for and the client themselves.  What the 3 want or need can be quite different.

The paradox I see is this:  when we provide support to vulnerable people, we are expected to control risk, yet by trying to control that risk we often create it or enlarge it.

Clients take risks – its a normal part of being an adult, and you may want to encourage the client to be an independent adult.  A lot of risk taking relates to wanting to feel in control – and may mean breaking rules.  The more they are under control, or feel they have lost control, the more risky behaviour may become.  For example, someone who cuts themself may be doing this to feel in control of their body.  Tell them to stop, and the risk is they will cut more.  Nag them some more, try to control them more, and they’ll withdraw from you, show their control in other ways.  Maybe all you can do is support them to explore alternatives and understand why they are cutting.

Yet the duty of care kicks in – organisations, and Local Authorities, are scared of risk, with good cause.  They would like things to be safe, predictable and controlled.  They don’t want clients to cut themselves.  You don’t either, but how can you show this without exerting the control that may make things worse?  It takes bravery to hand control to the client.

Compound this with the common psychology of those working with vulnerable people, who want to “help” – to rescue people.  This can lead to inappropriate offers of help, which can become either somethering or controlling.

Yet even if you are brave and self aware enough to step back and support the empowered client, you run risks.  Have you judged it right?  At some points you do have to step in and take control, especially if there is a risk of suicide.  Dead is dead – and stopping someone from killing themselves or others if the first of your duties.  With that in the back of your mind, how do you know if the cutting is just the tip of an iceberg you have failed to uncover.  What about all those other risk factors…..

As with most paradox, I think we can only hope to manage as best we can, bearing the weight of expectation from our 3 main stakeholders, taking our own risks.

Web 1.0, 2.0 and onwards

Here’s another blog article to chew on, about the developing use of the web .. with obvious implications for how companies do things, even in the 3rd Sector.

Another something worth considering is how publishing is meeting social networking.

Combining ideas, theory and bias?

Combination is an idea used by Nonaka and Takeuchi to help understand knowledge creation – basically throw different ideas from as diverse domains or people as possible together and you get new knowledge.  This idea’s also useful in creative problem solving.

I think this is also useful when considering management theory, as it may help make sense of complex situations by combining management theories, taking appropriate elements different models and combining or letting them play off each other, even when there is contradiction or paradox.

However, I’m also mindful of  bias in how we select ideas (vivid and available ideas and memories get more attention, we favour information that shows us favourably, the confirmation bias where we take a first position then seek information that agrees and screen out that which does not).  How is the combination approach is affected by this?

It may create knowledge and ideas, but those are untested until you put them into practice and see what works.  The confirmation bias would make this difficult, but practically speaking we can construct a working theory without exhaustive academic trials and testing. The key may be awareness of own bias and thinking, and to constantly hold up new ideas for criticism.

Harder than it might sound! The approach will definately fail if suitable evidence is not sought and analysed.  However, I also suspect that, while this might be a way to produce fads, the implementation of any idea or model is going to be as crucial as its “objective” soundness. This assumes there can be any objectively right model or theory anyway (which I don’t think there can be) – so the usefulness of a theory might relate to how easy it is to implement, how easy it is to understand and use, and if it leads to successful outcomes or at least learning. Hmmmm…..

How can small not for profits communicate creatively?

There seem to be a lot of  “answers” out there, but not much application in the not for profit world.  I find myself confronted with dull web pages, turgid and controlled intranets, and a lot of hierarchy.

And if you know the sector, you’ll know that not for profits can be slow to act, react, or take decisions.  Would enabling better communication through the organisation make them worse or better?

I became interested recently in the idea of using participative video techniques for leadership or staff development.  Combine the content that would create with use of free web resources to host them, throw in a dash of yammer or use of a facebook-like platform, and you might get a change from control to community.

What else is out there?