In the world of public policy, saying that outcomes are bad is like saying kittens are evil. It’s heresy.*
I’ll grant you, it’s not ‘hang on a minute, the earth goes round the sun’ levels of heresy. Nor have I nailed pieces of parchment to the doors of Downing Street (although, there’s an idea…). All I’ve done is to say that “outcomes” can’t be used as a way to effectively manage the performance of people who deliver social policy interventions. It doesn’t work. And, worse, it forces good people to lie about what they do.
There is emerging evidence in the media (including the Guardian, Daily Record, Radio 5 and File on 4) that outcome based approaches (OBAs) are subject to organisations ‘gaming’ the system. The reports suggest that service providers (from all sectors) are falsifying data in a number of ways (including the falsification of signatures on training registers and encouraging the unemployed to become self-employed thereby removing them from the unemployed statistics).
The organisations involved are clearly working under the impression that the benefits of meeting the specified ‘outcomes’ (and therefore getting paid) outweigh the risks of getting caught. This behaviour is so widespread as to suggest that it is systemic and therefore endemic in the ways in which public services are being contracted and delivered.
I’ve been talking about the findings of my research into Outcomes-Based Performance Management at ‘Kittens are Evil’ conferences, which we started in Newcastle upon Tyne. We started in Manchester, where we focussed on Payment by Results. Most recently, we went to Powys, in Wales, where we focussed on the Results-Based Accountability™ systems adopted by the Welsh administration.
We began by looking at the problems with the underlying theory of Outcomes-Based Performance Management. Firstly, that “outcomes” aren’t actually measuring impact in people’s lives – they’re not outcomes at all. And secondly, that outcomes aren’t created by organisations or programmes, they’re the emergent properties of complex systems, which means you can’t hold people, or organisations or programmes accountable for ‘delivering’ them – you’re asking people to be accountable for things they can’t control.
We then looked at all the evidence of what happens when people try to implement this flawed theory. Outcomes-Based Performance Management has been shown to distort organisational priorities, forcing managers to game the system in order to appear to be doing a good job. Further, it undermines frontline practice by making workers focus on achieving targets, rather than building relationships with people and helping them with the problems they actually have.
The Welsh context is very interesting, because there are lots of people inspired by the Vanguard approach who are doing things differently. Rick Wilson, Chief Executive of the Community Lives Consortium described how they’ve reworked their service to focus on the genuine needs of adults with disabilities, by abandoning the paperwork associated with personal planning and simply capturing people’s stories during their day to day activities. They’ve made a better, cheaper service by doing so.
North Wales Police vividly described how a target-culture had prevented them from doing a good job, and how they’ve re-organised to put expertise and the use of professional judgement back on the frontline.
The Supporting People Team at Powys County Council presented data to show how their relentless focus on helping people to get back on an even keel is reducing demand on their own service and on other public services.
Monmouthshire Social Care and Health Services showed what was possible when you abandon the nonsense of tick-box outcomes, and genuinely focus on the needs of the people who present to your service.
The clear picture that emerged from all the afternoon’s case studies was that in order to genuinely create outcomes, you need to abandon Outcome-Based Performance Management, inspire frontline professionals with an authentic purpose, then support and trust them to use their judgement.
Measure the impact you make, but use it to learn, not to make yourself accountable to others.
Accountability is a myth. It’s a comforting lie used by leaders to reassure themselves that they are making a difference. This is the paradox of Outcomes-Based Performance Management. The more you try and make people accountable for delivering a particular set of results, the worse results they will actually deliver for people on the ground. (Although, you’ll never know that as a leader, because all the data will be telling you the story you want to hear).
The truth about kittens and their evil ways spreads.
For more information about the problems with Outcomes-Based Performance Management, and Payment by Results in particular, visit www.saynottopbr.net
The next Kittens are Evil events are in Fareham on 30 September and London on 28 October. More information can be found on www.saynotopbr.net
My paper on Outcomes-Based Performance Management can be accessed here:
http://www.tandfonline.com/doi/abs/10.1080/09540962.2013.785707?journalCode=rpmm20
It has been downloaded over 1,000 times, and is the most downloaded in the journal’s history.
By Toby Lowe, Visiting Fellow of KITE.
Twitter: @tobyjlowe
*And the truth is, it’s not that outcomes are bad – how could helping someone achieve something positive in their lives be bad? It’s when “outcomes” are used as a performance management tool – like in Payment by Results, or Results Based Accountability ™ – that the problems arise.