The importance of listening

Headshot of Tom Currie against a white wall
Ahead of Samaritans Awareness Day this Saturday, 24th July, Trainer and Implementation Lead Tom Currie reflects on the power of listening and why it is so important in relationships that are committed to supporting change.

Hopefully we all know how important listening is. Really listening. Listening fully to what is being said and what is not. In relationships that are committed to supporting change listening is essential, literally, the essence of the purpose of the relationship is to listen. Yes, the listener may need to speak at some point but, when they do, what they say will be a lot more valuable if it is informed by good listening first. What they say is also much more likely to be heard when spoken to someone who has first experienced being fully heard.

In the almost 200 courses that I have led in using the Outcomes Star, listening is always talked about. Usually brought up by practitioners when talking about effective work with clients. They know how important it is to their work.

The Outcomes Star is a relational tool that supports change in keywork relationships. It helps practitioners and their clients to have better conversations. It does this by helping create a better quality of listening. There are three ways that it does this: by creating permission, by providing frameworks and by opening a space for sharing.

Creating Permission

Each Outcomes Star has between 6 and 10 points. Each point describes an Outcome Area, an aspect of life that contributes to the client fulfilling their potential. This holistic model provides a framework for the conversation between keyworker and client that helps create permission to discuss a range of aspects of life that the client may otherwise not have brought into the conversation. It also helps the keyworker build a fuller, more rounded picture of the client and their life, to go beyond the presenting issue and work to support the whole person.

A practitioner working with a Probation Trust to support prisoners through the gates and help them find accommodation told me that the wide-ranging conversations she had with her clients when discussing Outcome Areas like ‘positive use of time’ and ‘mental health and well-being’ helped her build a fuller understanding of them and their interests. This not only meant that she gained an understanding of what would be right for them but helped her, when finding them a new place to live, to present a better account of them to prospective landlords.

Providing Frameworks

All Outcomes Stars are underpinned by the Journey of Change. The Journey of Change is a model that outlines the stages people go through when making sustainable change in their lives. The attitudes and behaviour at each of the points on each scale are clearly defined. There are five different types of Journey of Change. Being able to create a shared language for where someone is and where they have not yet got to on their journey through life is a useful step in helping them get there.

I was delivering training to two women who set up a charity supporting parents of children who developed a neuro-degenerative disease that is sadly commonly fatal before the child reaches adult hood. They use the Support Stars – for use with parents, children and young people facing serious illness – which we developed in partnership with CLIC Sargent.

When supporting parents through these difficult times, they said the Journey of Change was key to helping parents make sense of what they were going through. It helped them to acknowledge the overwhelming nature of the shock of the diagnosis, to take in their new reality and begin to engage with how they might navigate the challenges they faced. As human beings we need to make sense of the experiences we face and be able to own and author the narratives of our lives – listening plays a key role in enabling us to do that.

A space for Sharing

The Journey of Change is a universal model that resonates with all the people I have shared it with and provides new insights about our own part in the challenges we face. This creates the opportunity for keyworker and client to meet on a more human level and share more honestly about their own experience, moving beyond the usual paradigms of service provider and service user to a space that is more human, more healing and more hopeful.

In my own life, taking time to reflect on where I am in my own journey through the lens of the five stage Journey of Change often provides me with new insights on ways that I am stopping my own progress, whether by not asking for support or hanging on to outdated behaviours that no longer fit with who and where I am. It helps me to listen more deeply to my own truth.

So, for all these reasons, I celebrate the Samaritans Awareness Day as a chance to champion all those who support people to change by offering the generous, supportive, curious and subtle art of listening. Let’s all listen to each other (and ourselves).

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Tom is a member of Triangle’s Training Team and provides support to our clients across London and the South East, including 18 London Boroughs, a number of County Council services and a couple of national charities. He lives near Oxford and is a trustee for Spark Inside, an organisation delivering coaching programmes in prisons, where he leads on impact and evaluation.

The Support Stars were developed for use with children and young people who are facing serious illness. The Support Star (Parents) is designed to support their families.

How the ideas driving social provision are steering service delivery off course

Triangle, the social enterprise behind the widely used Outcomes Star tools, is calling for a paradigm shift in social provision.  In a new report to be published in September 2021, co-founder and Star co-author Joy MacKeith argues that at its heart service delivery is about meeting human needs and changing behaviour.  Everything we know about how change happens points to the importance of relationships, trust and connection.  Research also shows that services must be holistic and tailored to each person. But the ideas currently driving social provision steer the focus away from relationships and flexibility and onto procedures, markets, targets and standardisation.  They break service delivery down into parts rather than focusing on the whole system.

The report presents an alternative vision – an enabling approach to service delivery.  Called Enabling Help, this alternative puts the focus of the service delivery system on the service user, rather than the helper, the service or the intervention.  Enabling Help builds relationships, trust and hope, develops skills and capabilities, is holistic, responsive and tailored to each individual person.

It also paints a picture of what it means to make Enabling Help a reality in practice. At the front-line it means moving to a collaborative approach rather than telling and directing. For managers it means changing the emphasis from managing procedures to enabling front-line workers to deliver relationship oriented, collaborative, flexible, problem-solving services.  For commissioners it means shifting the focus from numbers to narratives – co-learning with service providers about what works. 

‘Enabling Help’ builds on Triangle’s twenty years’ experience of helping organisations to support and measure change for people receiving services.  Working with over one hundred collaborating organisations including local and national charities, housing associations, grant-making trusts, local authorities and NHS trusts, has provided a unique insight into what works when supporting change and building well-being and potential.  And training and supporting over one thousand organisations to use the Outcomes Star in practice has highlighted what can get in the way of delivering what works.  This report pulls all this learning together and identifies the real reasons why people being helped get stuck in services and the people delivering the help feel frustrated and de-motivated.

The report calls on all those involved in service delivery from front-line workers, to managers, commissioners, researchers and policy-makers to embrace this new set of ideas and put relationships, responsiveness and learning at the heart of everything they do. 

The Outcomes Star: helping make trauma informed philosophy practice

Over the past decade, there has been increasing recognition of both:

  • the high prevalence of complex trauma, adverse childhood events and the different ways in which trauma presents and
  • how important it is to ensure that services are delivered in ways that do not risk people becoming re-traumatised, in relation to how workers engage with them and the topics discussed.

Given the potential of the COVID-19 context and measures to cause, exacerbate and reactivate trauma, it has been argued that –

  “never before has trauma-informed care been so important to promote the health and well-being of all and to protect our marginalised populations at greatest risk”
(Collin-Vézina, Brend & Beeman, 2020)

Trustworthiness, transparency; collaboration and empowerment are key principles of trauma-informed care, which can guide service delivery policies and practices (SAMSHA, 2014). However, there can be barriers to putting these into practice.  Tools that offer a clear framework for translation of the principles of trauma informed care into practice can benefit many organisations and help them overcome these barriers.

The Outcomes Star tools have many features that directly support trauma informed working, including:

Relationship-based – The collaborative process of practitioners and clients completing the Outcomes Star helps to build a trusting and positive relationship, giving service users greater control and voice and within which important connections in the person’s life are discussed.

Empowering – The Journey of Change is sensitive to small but important steps and progress. Visually showing change can be empowering and motivating for both practitioners and clients.

Focuses on the present not someone’s history – completing the Star is a conversation about someone’s life, how things are for them and what they are doing now, rather than bringing up past histories or traumatic experiences.

Strengths based not deficit-based; they use positive language focusing on the process of change and the support and actions needed, not on the severity of problems.

Holistic – the whole person and all relevant life circumstances are recognised. Plotting where someone is on the Star chart provides a clear representation of where support is needed and where things are going well, highlighting the interaction between different areas of someone’s life.

As well as the tools themselves, training and guidance around the Outcomes Star emphasises flexibility in responding to a client’s window of tolerance and preferences – for example, about when and how to introduce and discuss the different outcome areas. There is also guidance about identifying appropriate action plans in a trauma-informed way that is sensitive to the client’s capacity to drive things forward themselves.

Triangle is committed to continuous learning and improvement of the Outcomes Stars and how they are used. Staff have received training and advice from experts on trauma informed care and we are currently reviewing some of our older, widely used Stars using a trauma-informed lens.

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For more information, please see our guide on ;How to use the Outcomes Stars with trauma informed approaches’ or get in touch on info@triangleconsulting.co.uk or +44(0) 207 272 8765.

5 things licensed trainers and keyworkers need to know about trauma-informed approaches

As part of Triangle’s Licensed Trainer option, trainers are expected to complete a certain number of continuing development programs over the course of each year. Nick Karr will be running a session, this May, for Licensed Trainers on how the Star is becoming more trauma informed and how this can be embedded into Outcomes Star training. He shares 5 key things that people should know about trauma-informed approaches.

5 things licensed trainers and workers should know about trauma-informed approaches:

  • A trauma-informed approach, like the Star, uses the client centred and strengths based approaches you already know about and use with clients
  • It shifts the perspective from ‘what is wrong with you’ to ‘what has happened to you’
  • You can’t take away the client’s past – but a supportive relationship with a worker, can make a big difference
  • The conversations you have with clients when using the Star contribute to a trauma sensitive approach, as we are focusing on the present, not the past
  • It isn’t all up to you as a worker – a trauma-informed approach, like the Outcomes Star, needs buy in from your organisation and you need their support.

On May 24, 2021, Nick Karr will host a short session on the Star and trauma informed approaches and training. These CPD sessions are free but available for Licensed Trainers only. Nick Karr has worked with Triangle for seven years. He delivered the first Outcomes Star training in the USA in 2010 and then helped launch and run the Outcomes Star in Australia for two years. Nick is a London based psychotherapist where he has worked in a range of specialist clinical roles, and is now the Lead in an NHS service for people with mental health and substance misuse problems. He completed a Masters’ in Social Work at the Tavistock Clinic, taught on university social work and mental health programs, and is also a Professional Advisor for Young Minds.

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For more information on how the Stars can support organisations and keyworkers to work in a more trauma-informed manner, please take a look at our guide, or contact Triangle for a more in depth conversation about the Stars, which Stars may be appropriate for your organisations and more information on our training offers.

Employability and the Outcomes Stars

According to the Employment Related Services Association (ERSA), the latest official labour market data shows that “in September to November of 2020 unemployment hit 5 per cent, with redundancies at a record high of 395,000”. While the government’s Job Retention Scheme has no doubt helped many businesses and other organisations that may otherwise have made even more jobs redundant, there is significant uncertainty over what the future may hold.

As creators of the Outcomes Star, Triangle works with many of the organisations that provide front-line employability services, particularly those whose services focus on more vulnerable individuals and groups. People who are unemployed and struggling with issues such as mental illness, addiction or homelessness face significant challenges with finding employment at the best of times; now their prospects of finding meaningful work may seem more remote. Others may have recently found themselves facing family difficulties, trauma or other complex issues as a result of the pandemic that create barriers to finding employment.

It is widely reported that already disadvantaged groups have generally fared worse than others over the last year, exacerbating already existing inequalities. For example, ERSA reports that “disabled jobseekers are now more than twice as likely to be unemployed as non-disabled people” and that “the UK jobless rate for young black people has also risen by more than a third, to 35 per cent” over the past year.

In 2021 there is a significant need for traditional forms of employment support to help those people who have recently become unemployed or who face the risk of redundancy. However, we must also ensure that the longer term unemployed are not overlooked in the process. There is a need for holistic, person-centred services that engage with the range of complex, and often related, issues that are the underlying reason why an individual may be unemployed. These innovative programmes offer bespoke one-to-one help for people with complex needs, focusing on helping individuals to overcome the specific challenges they face. This is where the popular Outcomes Star can be most useful.

Triangle has developed two versions of the Outcomes Star for providers of employability services: the Work Star and the Pathway Star.

Employment support services have been using the Work Star for many years to support people to return to work or to find a job for the first time. The original Work Star was developed with service providers and commissioners from Camden, Islington and Kensington and Chelsea Borough Council. Now in its 3rd edition, the Work Star covers the traditional areas of employment support – skills and experience, aspiration and motivation, job search skills and the like, but also has two areas for drilling down into the person’s context – their health and well-being and the level of stability they have in their life. The current version was published in 2017 with input from the Department of Work and Pensions, Prospects, Hounslow Council and The LightBulb.

Launched in late 2019, the Pathway Star was developed by Triangle with service providers and commissioners from Liverpool City Region Combined Authority as part of its Households Into Work (HIW) programme; a unique and innovative programme of support for people who, because of their circumstances, have difficulty finding and sustaining employment.

The Pathway Star is designed for use with people who need considerable support if they are to move towards work. It is an outcomes tool that helps guide keywork and conversations, with the focus on helping people move towards work rather than necessarily finding a job. It’s structured around the individual and the barriers they face to employment – things like stability at home, household finances, family and relationships and emotional well-being.

For service users, working with either the Work Star or the Pathway Star, seeing their situation and their progress in a simple visual form can be powerful. “I got a surprise regarding my progress over the last few months,” said one person on the HIW pilot. “I’m pleased I’ve got some change in my life where I wanted help.”

“The Work Star is ideal for mainstream services or for people who need help with navigating job search or brushing up on skills. But if you’re a service working with people who are far from being job-ready and you’re offering in-depth, holistic support, take a look at the Pathway Star. From what we’ve seen so far, it’s a really persuasive tool in helping people to change.”
Juliet Kemp
Implementation Lead

For managers and commissioners of employability services, there are additional benefits in the form of the management information that these tools provide. Using the Outcomes Star can provide organisations with a unique and valuable data set around meaningful outcomes for service users and the progress they have made. Analysing and evaluating the holistic dataset collected by the Outcomes Star can be useful in a number of ways:

  • Demonstrating and evidencing the impact of services to a range of stakeholders
  • Learning about what is working well and what can be improved for the future
  • Providing motivation for service users and for staff by highlighting the change that has been achieved

Ultimately, though, the most significant benefit of implementing the Outcomes Star may be the change that this encourages towards more of an enabling approach to service delivery. Employability services that focus on a strengths-based, holistic and person-centred way of working enable individual service users to focus on the outcomes that they to wish to achieve.

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If you have any questions or queries about the Work Star or Pathway Star, or you would just like find out more about how the Stars can support your service users, keyworkers and organisation, please contact us on info@triangleconsulting.co.uk or +44 (0) 207 272 8765.

International Women’s Day: I didn’t choose to challenge – but that’s the outcome

Sara Burns reflects on the 2021 International Women's Day theme “choose to challenge” in relation to founding a women-led organisation and creating the Outcomes Stars.

She highlights the recently published Change Star, which is designed to help reduce violence against women and being presented this week at the ANROWS conference in Australia.

I haven’t chosen to challenge. That’s not how it feels. Challenge was not what motivated us, as three women creating the effective and widely used Outcomes Star tools, and Triangle, our successful social enterprise. Rather, my response – our response – was always to recognise when something wasn’t working and get on with finding a better way. We never overtly challenged, confronted criticism or found out what the competition might be, we just didn’t accept the status quo and did something different. We didn’t have the time or energy to directly challenge because there was so much call for what we were doing, because it worked for people in a huge range of services. We invested our energy in creating tools that were helpful, engaging, demystifying and accessible. It felt pragmatic and positive and it did challenge. It still does.

Doing things differently does challenge

I was working in monitoring and evaluation of health and social care, particularly addiction services, in the late 1990s when the concept of outcomes measurement first crossed from the States to the UK. I was commissioned to look at what that would mean, on the assumption that it was wholly inappropriate. I concluded that while funding on the basis of blunt, end outcomes was unhelpful, focusing monitoring more fully on the people you support and understanding how change happens for them, could be transformative. Rather than focus on ‘bums on seats’, this opened the potential to listen to people and witness their progress directly and holistically. Further, I could find practical ways to identify and measure even amorphous, internal changes so they could be part of the conversation. That was 20 years ago, and my work won a charity award. I was invited to speak at conferences and widely challenged. I hadn’t chosen to challenge, but I had found a different approach.

We just didn't accept the status quo and did something different.

Creating the Star and Triangle as a women-led social enterprise

A couple of years later, around my kitchen table, the ‘triangle’ of Joy MacKeith, Kate Graham and I were grappling with the considerable challenge of measuring how people change across the wide range of St Mungo’s services. We were faced with far more variables and questions than anyone could possibly be asked in a questionnaire. Out of our grappling arose the prototype for the Outcomes Star, a genuine collaboration and co-creation. Working together was so effective, the three of us formed Triangle. That was nearly 20 years and 40 Outcomes Stars ago. Kate moved on after a few years, choosing new challenges, and recently, we recruited a managing director, a man, but Triangle is still mostly women-led, with a workforce of mainly women. We are passionate about work life balance, having created the enterprise while raising children; we believe people, and especially women, can have meaningful and responsible roles, part time and without working silly hours.

The Star supports gentle, considered and appropriate challenge

Choosing to challenge is relevant when it comes to using the Outcomes Star and challenge is a word often used in Star training for workers. It is a gentle, considered and appropriate challenge. When a worker sits down with someone they support, the Star can help guide a conversation about the different aspects of their life, and the completed Star reflects information back to both of them in an accessible, visual way. Workers need all their keyworking skills to choose when to focus on building trusting relationships, reassurance and confidence and when to challenge someone’s perspective or point out dissonance. The aim is to arrive at a realistic, shared understanding of where somebody is in their journey of recovery or change, so that support can be tailored to what they need and can engage with.

Further, the Star can be used not only for workers to challenge, but to be challenged by those they support, who can use the Star to collect evidence of the difficulties they face and the achievements they make. That can demonstrate powerfully how the service user can take responsibility for and drive the change processes they are involved in. There aren’t many tools out there that provide this opportunity, but by being collaborative, accessible, visual and shared, the Star does.

Creating the Change Star for men – to challenge violence against women

Using the Star to help workers challenge is perhaps particularly pertinent to the new Change Star, being presented as a poster last week at the ANROWS conference in Australia. Developed in collaboration with UnitingCare Queensland, it is for use with men who have been violent or abusive in other ways towards women partners or ex-partners and are in support programmes to change. I lead on and am integral to the development of new versions of the Star, now supported by a small team. I find it completely fascinating to engage at that level in a new sector, listening to people and understanding how things change for those they support. Often, I get to hear from clients directly, and they are always part of the co-creation process. It is rare that I am not excited when we start a new Star. But the Change Star was one of those – our exploratory literature review was not optimistic about the outcomes of these support programmes and it was not a client group I was interested to get to know.

From the first workshop, my views were challenged, through listening to workers who run groups in the change programmes, who are themselves fascinated by what motivates the men and how to enable at least some of them to make real and lasting change. I wasn’t confident that the Star was the right tool, because most versions for adults rely on the potential for self-awareness and honesty, at least as people progress. But it does work. The Journey of Change maps progress from men not recognising or denying any wrongdoing or harm, including some men who are experts at image management, through different levels of acknowledgment and taking responsibility. Towards the top of the scales, men are able to put themselves in the shoes of the women they have harmed and get some understanding of the impact from the women’s perspective. This is key to enabling them to make lasting changes. Not all get there.

The Change Star also recognises that many men who are abusive have also been abused or traumatised. We needed to write the scales to hit the right tone between not colluding with the men and not shaming them, as shame is so unhelpful for change. I was inspired by the workers because they are expert at that, learning when and how they choose to challenge, without collusion or shaming, enabling the men to recognise and build on the positive strengths and values they do have to confront the harm they have caused and how they need to change to be safe for women and children to be around. The pilot response was extraordinarily positive; the Star helped make the change process more transparent and shared, giving men in the programs clear feedback about where they were and their possible next steps.

The vast majority of the Outcomes Stars are ungendered. The only other exceptions are the Empowerment Star for women who have experienced domestic abuse, and one of the suite of Family Stars – the New Mums Star. Others for parents are largely used with women as they tend to be the ones engaged with services to enable their children to thrive, but those and also the Parent & Baby Star in the field of perinatal health mental health equally work with fathers and those who are gender diverse.

Challenge helps us keep learning and responding to a changing world

The Outcomes Stars being out there so widely, naturally invites challenge. This we welcome. We choose to respond to challenge and engage with it as helpful information. The world has changed a lot in the 15 years that we have been developing versions of the Star, and we have learned a lot in developing successive versions, now spanning conception to grave. The challenge includes in relation to gender. For example, we are currently reviewing the first Star we created, in the homelessness sector; one of the reasons to review now is that women made up a very small proportion of the client group when we first developed it in 2006, but many services now support significant numbers of women who are homeless. We are sometimes challenged about the Stars that are gendered, including the Empowerment Star, which we are also reviewing this year. However, in that case it is clear that the vast majority of domestic violence and abuse is against women, even more so looking at serious abuse and death, so while we are open to collaborating on a variant that could be for men and gender diverse, we will keep the focus on women for that Star.

In conclusion, I have enjoyed reflecting on this year’s theme for International Women’s Day. Though my starting point is that I haven’t consciously chosen to challenge, and I’m grateful to the many people who do overtly confront and challenge injustice, challenge takes many forms and is relevant and integral to many aspects of the Star and Triangle. This includes the skilful challenge of workers helping men acknowledge and take responsibility for harm without falling into colluding or shaming. It includes how we respond to those that challenge us as an invitation to look and learn and change and different aspects of the Outcomes Stars and Triangle.

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The Change Star was published in 2020 and is designed to support organisations working to empower men in behavioural change. Australia’s National Research Organisation for Women’s Safety Limited  (ANROWS) is an independent, not-for-profit research organisation established to produce evidence to support the reduction of violence against women and their children. Their 2021 conference was held on 1-5 March 2021 and explored how policymakers, practice designers and practitioners are using evidence to understand, respond to and prevent violence against women and their children.

The Empowerment Star is the Outcomes Star for use with women who have experienced domestic violence. For more information on either Star or to find out more about, and feedback into, the upcoming reviews of the Stars please contact us. 

Equality in Evaluation

It is an exciting time to be part of the world of measurement and evaluation. Having attended three conferences this autumn, it is clear that those with a critique of the traditional ways of doing things are finding a voice, and being given a platform. In the wake of Black Lives Matter everyone seems more open to looking deeper into the implicit assumptions that we make about each other, and along with that, into the power dynamics of measurement and evaluation. 

NPC ignites was one of these events and it was the session “Rebalancing data for the 21st century” that really captured my attention. Jara Dean Coffey, Director of the Equitable Evaluation Initiative presented a five-year plan she is leading to change the way funders in the United States think about evaluation. Bonnie Chui of The Social Investment Consultancy is leading an initiative bringing together people of colour working in evaluation. Here were some of their key messages:

Co-create knowledge rather than extract data

Traditional approaches to the evaluation involve experts collecting data and taking it away to analyse and draw conclusions. The subjects of the evaluation are passive in the process. Bonnie described this as like using research as tool of ‘command and control’. Jara argued, like several others I have heard this year, that we learn more when knowledge is co-created – researcher and subject bringing together their very different expertise to build a more complete and informed picture. This is one way to challenge the power relationships in evaluation and promote greater equity. The Outcomes Star’s collaborative approach to measurement brings these ideas alive in day-to-day service delivery. 

What is the Outcomes Star

The Star is underpinned by three values – empowerment, collaboration and integration

Get comfortable with complexity

“We need to let go of causality and be OK with contribution”

Star Data

The Star collects an innovative and holistic dataset

Jara made the case that although funders who commission evaluations want certainty and yes/no answers, the complex reality of service provision can’t be reduced to a few numbers.  Funders and evaluators need to embrace the complexity that comes from working in open systems where it isn’t possible to control all the variables and come up with answers that are always true no matter what the context. Bonnie also made the point that top down funder-driven monitoring and evaluation frameworks can perpetuate power imbalances. It is difficult for funded organisations to raise these issues because of their dependence on the funders so it is important that evaluators use their influence. This very much echoes points we have been raising at Triangle for some time. Data is helpful but must be interpreted in context. The numbers help to focus our questions rather than providing definitive yes/no answers. 

De-colonise evidence

Bonnie Chui argued that we need to ‘decolonise’ evidence and ensure that people of colour are both reached by research and represented in the research and evaluation community.   Jara is promoting multi-cultural validity alongside statistical validity, a point which chimes with issues Triangle has raised about moving beyond traditional formulations of what is a ‘good’ tool (keep an eye on our homepage for a blog on this coming out soon).

Both presenters made the case that evaluation is a human process. Those doing the evaluation have to do their own personal work to understand their own implicit biases as well as those that are hardwired into the context in which they are working. The biases identified were racial ones as well as foundational ideas such as the preference for doing over being and our belief in scarcity rather than abundance.

I found it very inspiring to hear an analysis connecting up racism, core orientations towards life and the way services are valued and measured. I can’t do it all justice here, so I recommend that you take a look at the recording of the session.

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Triangle is the social enterprise behind the Outcomes Star™. Triangle exists to help service providers transform lives by creating engaging tools and promoting enabling approaches. To talk to Joy MacKeith or another member of the Triangle team, or for any other information, please email info@triangleconsulting.co.uk.

The Missing Middle Way: How Management by Results can help us not just measure, but also improve outcomes

Joy MacKeith argues that Payment by Results can cause as many problems as it addresses.  Management by Results, which supports ongoing learning and collaboration, is the missing middle way between ignoring outcomes on the one hand, and linking them to financial incentives on the other.

In early September I was privileged to participate in the fifth Social Outcomes Conference, organised by the Government Outcomes Lab at Oxford University. Contributions from both academics and practitioners from all over the world made for a very rich debate in which everyone had their eye on the prize of improving social outcomes.

The debate got me thinking about the limitations of Payment by Results and an alternative – an approach I am calling Management by Results.  This blogpost explains the difference between the two and how Management by Results has the potential to unlock performance improvement.

Why I am a fan of an outcomes approach

In the old days we didn’t measure outcomes.  We counted inputs and outputs.  We collected case studies.  Occasionally we commissioned evaluations or user surveys.  Then came the outcomes revolution.  I have been part of that revolution, spending much of the last 20 years helping organisations to measure their outcomes.

I am a fan because I have seen that defining, measuring, and managing outcomes enables service providers to create services with a clarity of purpose, identify issues and gaps, and ultimately improve what they deliver for service users. It undoubtedly is a good thing for organisations to focus on outcomes.

But what happens when financial imperatives are introduced into the equation?  What happens when a project or organisation’s survival becomes dependent on evidencing that they have achieved certain outcomes?

Why I’m wary of linking outcomes with financial incentives

In the employment sector where Payment by Results (PbR) has been in operation for some time the consequences are quite well documented (Hudson., Phillips, Ray, Vegeris & Davidson, 2010[1]).  Organisations can be incentivised to focus narrowly on the specific targets which are linked to payment and ignore everything else.

This can lead to a narrowing of their work with individuals (just making sure they get a job rather than working on longer-term issues such as addiction or mental health problems that are likely to impact on their ability to keep the job for example).  It can lead to short-termism with less focus on long-term impact and sustainability.  It can lead to ‘cherry picking’ of clients who are most likely to achieve the target (also called ‘creaming’) and not ‘wasting resources’ on those who are not likely to achieve the target within the timescale of the project (also known as ‘parking’).

The fact that there are widely used terms for these kinds of gaming practices reflects the fact that these perverse incentives are widely recognised and understood. In the financial sector Goodhart’s Law[1] that any financial indicator that is chosen by government as a means of regulation becomes unreliable is well accepted. In the words of the anthropologist Marilyn Strathern “When a measure becomes a target, it ceases to be a good measure”.[2]

In addition to this, there are other more subtle but nevertheless powerful impacts.  In Triangle’s work helping organisations to measure their outcomes we have seen time and again that when the impetus for this measurement is commissioner requirement, the organisation is likely to see outcomes as something that is done for the commissioner rather than something they own.

The result is that the quality of the data collected is poorer and the service provider just passes it on to the commissioner rather than mining this outcomes gold for learning and service development.  This is very unfortunate because sending outcomes information to commissioners doesn’t improve outcomes, whereas using it to better understand delivery does.

Another impact of PbR is that it focuses attention on the work of the service provider in isolation as opposed to looking at how the service delivery system as a whole is working. In practice often it is the network of service provision that achieves the outcome rather than a single provider.

Finally, in the market for social outcomes, providers find themselves in competitive rather than collaborative relationships, which can make system-wide cooperation and information sharing more difficult.

The missing middle way
There were several speakers at the recent GoLab conference who argued that financial incentives can work – if they are done well.  I am writing primarily from personal experience rather than extensive research and I trust that what they say is true.  I am also aware myself of PbR contracts and Social Impact Bonds that have been sensitively implemented with all parties understanding the risks and the funding mechanisms carefully designed to build the right incentives.

My concern is that too often the approach isn’t done well and also that the alternative of MbR is not recognised and considered.  In our enthusiasm to embrace outcomes we have gone from one extreme of not talking about or measuring outcomes at all, to the other extreme of linking payment to outcomes.  Between these two poles there is a middle ground – a third way which can unlock the potential of outcome measurement without so many of the downsides.

So what does Management by Results look like and how is it different from Payment by Results?

The Management by Results mindset
Both MbR and PbR involve identifying and measuring outcomes.  But in MbR the emphasis is on the service provider using this information in the management of the service to identify strengths, weaknesses and issues to be addressed.  Whereas in PbR the emphasis for the service provider is on using the information to secure the funding the organisation needs to survive.

For commissioners MbR means requiring the service provider to measure their outcomes and then drawing on that information to assess their performance.  But crucially in MbR the commissioner draws on other information as well and has room for judgement.  PbR is black and white.  Target achieved = good, payment made. Target not achieved = bad, no payment made.

MbR allows for greater subtlety and a more rounded assessment.  The commissioner looks at the data, but they also look at the organisation’s narrative about the data.  Is it a coherent narrative? Are they learning from their data and using the lessons to improve service delivery?  What do others say about the service?  What do you see if you visit and what do service users have to say?

The commissioner draws on all this information to make their assessment.  Of course, life would be a lot easier if you didn’t have to do this and could reduce a project’s effectiveness to a few numbers.

But you can’t.

There is always a wider picture, for example in the employment sector, what is happening in the service user’s personal life, what is happening in the local economy, what other services  the person is receiving and what impact are they are having. The numbers have a part to play but they are never the whole answer.

How Management by Results changes the questions and supports learning
An organisation that is managing by results will take a systematic approach to collecting and analysing outcomes data and will then use that data for learning and accountability.  The job of the manager is to ask: “Why did this work – what good practice can we share?”  and “Why didn’t this work, what do we need to change and where can we learn from others?”

The job of the commissioner or investor is to assess “Is this organisation taking a sensible and systematic approach to measuring its outcomes? And is it learning from its measurement and continually changing and improving what it does?” PbR encourages hiding of poor results and exaggeration of positive results as well as the creaming and parking described above.  This positively hinders learning and obscures what is really happening.

MbR encourages collaboration between service provider and commissioner in identifying and achieving their shared goals.  PbR obscures these shared interests by incentivising service delivery organisations to prioritise their own survival.

The table below summarises the differences:

Payment by ResultsManagement by Results
A black and white approach.  Achieving the target is assumed to equate to successRecognises the complexity of service delivery and that success must be interpreted in context
Payment is linked to achievement of targets.  There is no room for skilled judgement or for considering wider contextual informationOutcomes information is placed in a wider context.  There is room for skilled judgement
Obscures the shared goals of commissioner and service provider and encourages service providers to focus on organisational survivalEmphasises the shared goals of service provider and commissioner and encourages the provider to focus on achieving intended outcomes
Encourages a gaming culture because service providers are assessed on whether they have met the targetBecause service providers are assessed on whether they are using outcome measurement to address issues and improve services it encourages a learning culture
Service providers are incentivised to withhold information from commissioners and even falsify dataService providers are incentivised to share information and learning with commissioners and problem solve together for the benefit of clients

Management by results is not easy but it is worth the effort

Management by Results is not easy.  At Triangle we support organisations to implement the Outcomes Star and in practice this means that we are supporting them to build a MbR approach.  This involves forging new habits, behaviours and organisational processes, creating new interdepartmental links, new reports and new software.

It isn’t easy and it takes time, even for the most willing and able.  But we also see the benefits for those that stick with it – managers with a much better handle on what is happening in their services, who can pinpoint and address issues and share good practice as well as evidence achievements.

I believe that if the sector put more energy, funding and research into supporting organisations to manage by results, it would really start to unlock the potential to not only measure, but also improve outcomes.

What do you think?

[1]Hudson, M., Phillips, J., Ray, K., Vegeris, S., & Davidson, R. (2010). The influence of outcome-based contracting on Provider-led Pathways to Work (Vol. 638). Department for Work and Pensions.

[2] Goodhart, C.A.E. (1975). “Problems of Monetary Management: The U.K. Experience”. Papers in Monetary Economics (Reserve Bank of Australia

[3] http://www.atm.damtp.cam.ac.uk/mcintyre/papers/LHCE/goodhart.html

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Triangle is the social enterprise behind the Outcomes Star™. Triangle exists to help service providers transform lives by creating engaging tools and promoting enabling approaches. To talk to Joy MacKeith or another member of the Triangle team, or for any other information, please email info@triangleconsulting.co.uk.

A Society in which everyone is able to thrive

Triangle Director Joy MacKeith reflects on the Social Value Matters 2020 international conference which took place last week and how it helped locate Triangle’s work in a wider movement for a fairer world.

The Social Value Matters 2020 conference was a truly immersive event.  The organisers took the opportunity of moving the event online to create a 24-hour programme so there was something for everyone, in every time zone, at every possible hour of the day.  

The result was a somewhat overwhelming amount of content but also a tremendous sense of being part of an international community looking for ways to measure things that really matter from environmental impact to worker’s rights to social inclusion.  And importantly looking for ways to make sure these things are not only valued but drive decision-making as well.

What was most interesting and encouraging for me was hearing the way that diverse agendas seem to be converging. 

Philanthropic organisations are more interested in systems change – understanding the underlying dynamics which keep the problems they are trying to address in place.  Corporations are going beyond the traditional domain of corporate social responsibility to engage with wider issues such as inequality. 

Governments are providing incentives to business owners to transfer ownership to their employees. Third sector organisations are using the language and practices of the market to express their achievements in terms that are engaging to governments and investors.  It seems that it is becoming easier, at least for some, to talk across sectoral boundaries. 

The wider vision that underpinned many of the contributions was the idea that if companies can be required to report on their environmental and social impact and demonstrate ethical governance (the ‘ESG’ agenda) then capitalism can start to serve the many and not just the few.

It seems that a growing number of investors want this and that many of the challenges are now technical – finding common metrics and benchmarks to allow comparability.  Jeremy Nicolls, one of the founders of Social Value International, urged everyone to be pragmatic and make it happen rather than spend time in pursuit of an impossible perfection.  There was a real sense of the possibility of change, and of the urgency too.

It all seemed a far cry from our Triangle world of supporting better conversations, enabling personal change and giving managers tools for service learning and development.  However, it was good to put our mission of helping service providers transform lives into a wider global context.  Triangle’s vision is a society in which everyone is able to thrive.  Every contributor at the event was, in one way or another, addressing that cause.  I hope that we can all find our place in the bigger picture so that we can play as full a part as possible in achieving this vision.

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Triangle is the social enterprise behind the Outcomes Star™. Triangle exists to help service providers transform lives by creating engaging tools and promoting enabling approaches. Through the Outcomes Star, they work with services to promote and measure individual change and to enable learning at an individual, service, organisation and sector-wide levels. The Outcomes Star™ is an evidence-based management tool for both supporting and measuring change. For more information email info@triangleconsulting.co.uk.

Carers Star makes collaboration count

How do you get someone whose life is centred on another person to look after themselves? For more than 50 carer organisations, the answer is with the help of the Carers Star.

Published in 2014, the year of the Care Act, the Carers Star filled an immediate need for services and commissioners alike – to measure the impact of “care for the carers”. But the Star isn’t just about good outcomes data. Even more crucial is its ability to engage struggling carers in the first place. And the key to the Star’s success here is collaboration.

 “Carers don’t want someone to come in and take over,” says Victoria Mellor, lead care advisor on the CarerLinks project for Crossroads Together. “There’s nothing worse than an assessment where someone’s in front of you scribbling away and you don’t know what’s being written. It can make you feel a bit paranoid – how is someone going to use that information?”

Example image showing the cover of the Carers Star User Guide and a open spread with the detailed scales for one area

By contrast, she says, the Carers Star is a tool that both worker and carer can see. Its visual form – the star shape – makes it instantly clear what is working and not working in each of seven areas of a carer’s life. Worker and carer fill it in together, in any order, led by the carer’s immediate concerns.

“Carers usually have something they want to focus on straightaway,” says Victoria. “With the Star you can look at that first, so the carer gets their priorities straight in their head. Then you work with them and map things out together – this is going to be your job, and these things are going to be mine. It really empowers the carer.”

How you fill in the Star is equally
flexible. Crossroads Together use it for assessment at the first home meeting,
but sometimes carers are in crisis or just not ready and it doesn’t feel
appropriate to complete the Star. “Then I just use it as a guide and a prompt
to bring things back if the conversation goes off at a tangent, and I fill it
in when I’m back in the office,” says Victoria.

“Later on, when things are brighter
for them, we use it reflect on what’s changed. They like to look back at the
journey – they ask ‘what did I say the first time? I’m in a different place
now’”. That’s really helpful. One of our main aims is to empower them to take
responsibility for what they need and how they can achieve it.”

At the original Carer Star
training, some Crossroads Together workers worried that carers wouldn’t like
the Star. “But carers do want to
engage,” says Victoria. “There’s no typical carer – they definitely keep you on
your toes. But that’s the great thing about the Star – you’re able to use it in
different ways with different people. It’s very adaptable.”

Stephen Taylor, service delivery manager at Carers Leeds, agrees. “There are lots of different ways to get the carer to engage with it. Carers like the visual stuff, they like the scaling, and they like to see change. The Star is about their journey – it helps carers to stay focused on the bigger picture, not just a bad week they’re having.”

Traditional assessments, he
says, tend to focus on what is wrong. “The Star is much more collaborative.
Because it’s strengths-based, people are really engaging in their own care
plan. Through good conversations, they’re coming up with their own ideas about
what works with them. The collaborative approach is a very powerful thing.”

And the collaboration isn’t just
between worker and carer. Both Crossroads Together and Carers Leeds have found
that the Star can help with spreading good ideas and ways of working across
their organisations.

“If an adviser has a really
successful Star, we use it as an example in a team meeting,” says Victoria. “It
helps show what’s working, say in Liverpool, that we might want to duplicate in
Shropshire.”

“There’s real potential to
share good practice when you see the variations,” says Stephen. “When I look at
the data, I try and look across the individual teams and how they’re doing in
particular Star areas. For example, are our mental health specialists doing
better on the “How you feel” scale for carers? It’s about asking good questions
– what are you doing well?”

“I think the Star’s great – I like the questions it raises.”


Using the Carers Star

  • The Star works well for carers with complex or ongoing needs
  • It’s typically used over three to six months
  • Each scale is underpinned by a five-stage Journey of Change – cause for concern, getting help, making changes, finding what works, as good as it can be
  • It’s also possible to use the Carers Star on the phone – Triangle can advise on good practice
  • For young carers, consider My Star instead of the Carers Star.

The Carers Star is available to all organisations with a Star licence, and full training can be given for workers and managers. Triangle is exhibiting at the Carers Trust Network Partner conference from 11th to 12th March. If you are attending and would like to meet the team, or want more information on the Carers Star, please contact us on info@triangleconsulting.co.uk or +44 (0) 207 272 8765.