Connected board-level outcomes to the activities clinical teams can meaningfully measure
Client and setting
A large urban NHS commissioner, building the measurement layers underneath its agreed outcomes framework
The challenge
Top-level outcomes are too far removed from day-to-day decisions to guide commissioning. Once the framework was agreed there was nothing linking it to what pathway teams, providers and analysts measure, and no shared language between them. The risk was a framework that looked good and went unused: too complicated to learn, never updated, and weighted towards whatever was already easy to measure.
What we did
Set out three layers: outcomes that rarely change, statements that turn them into something measurable, and indicators providers already report. Each item sits under one parent only, so nothing is counted twice.
Wrote the design rules down first, including outcomes rather than process, everything measurable at the lower levels, inequalities tracked at every level, and no overlap between statements.
Named the ways it could fail, complexity, standing still and uneven coverage, and set a test for each, including whether staff understand it after a 15-minute briefing and when the client can take it over.
Agreed with the client which uses came first, putting performance and value assurance and direction-setting ahead of the rest, with a named audience for each layer.
The outcome
The framework runs from around a dozen population-level outcomes, through roughly 35 statements, to about 100 indicators, with a named audience at each level from board to pathway team to provider. Commissioners can ask what a proposal does for outcomes rather than for activity, and gaps in what is measured show up as clearly as strengths.
Timescale and team
A separate second phase of the programme. Two partners and a public health analyst, working with the client’s business intelligence team.
