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Setting goals and measuring outcomes

To effectively measure outcomes, you need to set goals in the first conversation with the consumer, by asking them:

  • ‘What would improvement look like for you?’
  • ‘What do you want to be different in your life?’
  • ‘If you had a magic wand, what would you want to improve in your life?’
  • ‘What does doing better look like in your life?’

Goals and outcomes need to be:

  • person-centred and meaningful to the consumer
  • proportionate to the complexity of the problem
  • SMART (specific, measurable, achievable, relevant, timely).

This should be a shared, ongoing process and conversation between you, the consumer and (where appropriate and consented) their carer, rather than a single conversation that happens at a pre-determined interval.

Stepped care is only one factor that can affect a consumer’s wellbeing, so it may not solely be the interventions you have provided or arranged that have led to progress, or the need to step up their care.

Therefore, how you measure the outcomes of the stepped care will vary from consumer to consumer, and include consideration of other factors, such as changes in their circumstances.

Improvement might be reflected in lived experience, not just symptom scores. For example, the consumer might be experiencing:
  • reduced distress
  • improved functioning, relationships, housing or work stability
  • increased sense of agency or confidence
  • increased self-care
  • participation in more social activities.

Similarly, if a consumer’s condition worsens, this could be the result of external factors (eg breakdown of a relationship, loss of housing) rather than receiving the ‘wrong’ level of care.

Before measuring an outcome, clarify the purpose of your review. Are you:

  • measuring the consumer’s progress (see Measuring a consumer’s progress below)
  • assessing whether a process of care (eg follow-up, engagement, access) is working (see Measuring process-based outcomes below)?

To measure the consumer’s progress, ask them questions, such as:

  • What does doing better look like for you?
  • What does good look like?
  • What have you learned from this experience?
  • What has changed in your life recently?
  • When did things start to feel different for you?
  • What has been helpful for you?

Post-crisis question

  • What did you do, even in a small way, that helped keep you safe or helped you get through the recent difficult time? 

Obtaining consent to ask for a carer’s perspective

Where appropriate, and with consent, carer perspectives can provide valuable insight. Ask for consent with a question such as:
  • ‘Is it okay if I ask your carer/support person if they have noticed any changes recently?’ 

Use of scales and tools

When choosing scales or tools to help measure outcomes, consider:

  • the importance of clinical judgement
  • the consumer’s preference
  • cultural suitability
  • the feasibility of the tool for this consumer (eg can they use an app if they’re not comfortable using a smart phone?)

Standardised tools can support your measurement of outcomes but should not be used in isolation or as the sole indicator of progress. One reason for this is because a person’s score may stay the same (particularly over a short period of time) even when meaningful improvement has occurred.

Some commonly used scales and tools

Consumer-centred scales and tools

In addition to the scales and tools listed above, you can also use:

  • comments by the consumer about how their life has improved in other ways
  • psychosocial progress (social, relationship, work, etc.)
  • information about the consumer’s self-care (eg participating in more social activities).

Some outcomes relate to how the care has been delivered by the practice and/or the health system, rather than changes in symptoms. For example, you may want to identify:

  • whether follow-up occurred
  • whether a planned review was offered or completed
  • how the practice responds when a consumer does not return
  • whether the service experienced was acceptable from the consumer’s perspective.

Useful measures might include:

  • the existence of a clear follow-up or ‘check-in’ step
  • the existence of processes in the practice to identify and address missed appointments or disengagement.
Measuring process should be a simple and feasible task, and not an unnecessary administrative process.

 

Downloads

GPMHSC-Guide-Stepped-care-model.pdf