Title: Above and below the waterline Buoyancy tools for health improvement outcomes
1Above and below the waterline Buoyancy tools
for health improvement outcomes!
- Della Thomas and Neil Craig,
- NHS Health Scotland
2Session will cover
- What are the issues?
- What are the HIPM tools?
- How have they been used locally so far?
- Discussion
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4The Issues
- SOAs are strategic documents for local outcomes
above the waterline - Partnerships will need other supporting plans and
performance monitoring below the waterline of
the SOA - We have developed tools which are
evidence-informed to support partnership planning
for health improvement outcomes
56 Key Principles John Mayne
- Foster senior-level leadership
- Promote and support a culture of results
- Build results frameworks with ownership at all
levels - Measure sensibly and develop user-friendly
information systems - Use performance information for learning and
managing, as well as for reporting and
accountability - Build an adaptive regime through regular review
and update
Best Practices in Results-Based Management A
Review of Experience. Report for the United
Nations Secretariat, July 2007
6Buoyancy Aids Above and below the waterline
7Buoyancy Aids Below the waterline
8What are HIPM Tools?
Public ReportingNational Performance Framework
Including SOAs
HIGH LEVEL OUTCOMES
INTERMEDIATE OUTCOMES
Performance management
SERVICE DELIVERY OUTCOMES
Outcomes related to service delivery
Outputs
Processes
Inputs
9Outcomes Triangle Alcohol
Reduced Deaths/1000 population by alcohol-related
diseases (Menu) Reduced inequalities in HLE
(NI) Improved Mental WB (NI)
Less work absenteeism incapacity
Reduced alcohol-related hosp. admissions (NI and
Menu)
HIGH LEVEL OUTCOMES
Reduce alcohol-related ASB crime (Menu and NI)
Reduced alcohol consumption beyond recommended
limits
INTERMEDIATEOUTCOMES - BEHAVIOURAL
Sensible drinking culture
Safer drinking environment
Access to treatment services
Access to affordability of alcohol
INTERMEDIATEOUTCOMES - ENVIRONMENTAL
SERVICE DELIVERY OUTCOMES
Increased prices
Reduced size, no. /or density of licensed
premises
Wealthier Fairer
Smarter
Screening and brief interventions
Healthier
Safer Stronger
OUTPUTS
Greener
10Improved mental wellbeing Reduced inequalities in
HLE Reduced inequalities in CHD mortality Reduced
alcohol-related hospital admissions
National indicators
Reduced alcohol consumption
Previous HEAT target
Increased awareness of/reflection on drinking
behaviour increased referrals for treatment
Reduced screening FAST positive at follow-up
Those drinking at harmful levels (key sub-groups)
Screening Brief interventions (SIGN 74) no.
of screenings
Revised HEAT target
What the NHS has to do to reach the target group
and deliver effective brief interventions in key
settings
H4Alcohol
Funding, trained workforce, evidence-based
guidance, data to manage and monitor the
delivery of interventions
11Strategic Alcohol Outcomes Logic Model
(Simplified)
NATIONAL OUTCOMES
LONG-TERM OUTCOMES
INTERMEDIATE OUTCOMES
SHORT TERM OUTCOMES
Model a
Safer drinking and wider environments
Less absenteeism
Increased productivity
Changed consumption patterns
Improvements in knowledge and attitudes to
alcohol
Model b
Safer communities
Scotland is a healthier, safer and wealthier
country
Reduced costs
Reduced availability and affordability of alcohol
Reduced alcohol consumption
Model c
Improved health
Access to alcohol treatment services
Model d
12Model a Safer drinking and wider environments
(simplified)
Outputs Activities Reach
Short-term Outcomes
Intermediate Outcome
Lowered blood alcohol Concentrations in drivers
Drinking driving counter Measures Police
Drivers
Increased deterrent for detection
Reduction in the incidence of drinking and driving
Licensing policies (eg overprovision, size)
Local Authorities
Local licensed premises
Reduction in overprovision/super pubs in key areas
Fewer drinkers exiting premises simultaneously
Reduced number of ASB/crime flashpoints
Safer drinking and wider environments
Fewer intoxicated drinkers
Workplace alcohol policies
Employees customers
Reduced risk/mistakes in workplace
Reduction drinking pre/during work
13Alcohol multiple results chains
EXAMPLE
Improved mental wellbeingReduced inequalities in
healthy life expectancyReduced inequalities in
alcohol-related deaths and hospital admissions
BehaviourReduced alcohol consumption
levelsReduced drunkeness less drink-driving
EnvironmentsPhysical Reduced exposure to
alcohol-related hazardsEcon Reduced
availability/affordability of alcohol Social
Drunkeness less attractive sensible drinking the
norm
Service uptake engagement
Understanding risks, attitudes to drinking
Hazardous and harmful drinkers
General public - targeted
Preventive services
Sensible drinking messages
Media campaigns
Brief advice
Scottish Govt
NHS
14How are these tools being used?
- By Govt
- Alcohol strategy consultation
- Drug and alcohol outcomes toolkit
- Mental health improvement strategy
- By external partners, using (and amending) them
- to plan and develop strategy
- develop SOAs
- to guide performance management
15Local application example 1
- Phase 1 development of the model and approach
- Phase 2 - 5 geographical pilots using the life
stage model - Phase 3 roll out across West Lothian
- Tools
- Customer need - ven diagram
- Outcome logic models
- Implementation using REAIM
- Monitor using Covalent
16Effective interventions
17Local application example 2Physical Activity
Logic Models
- West Dunbartonshire Health Improvement Strategy
Group (HISG) - to promote discussion between national and local
stakeholders - shows how their prioritised activities/services
will contribute to the outcomes in SOAs - shows how the tools might be used in planning,
programme learning and performance management - not prescriptive
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20Key messages
- Logic models should be fit for purpose
- The value is in the process not the product
- Logic models should be embedded in part of a
wider performance management system and a
learning culture - Logic modelling is limited by, but may also
contribute to, the existing evidence base -
21Critical success factors
- Leadership (dispersed political and officer)
- Indicators and data at a sufficiently local level
- Evidence informed logic
- Clear priority groups and neighbourhoods
- An established or ready to change culture of
continuous improvement for monitoring progress - Community engagement and involvement
- Wider partnership involvement and collaboration
- A recognition that the process will take time and
resources