How do we know if what we are doing is working? Or judge how effective it is?
One of the differences I noticed in the different cultures of the Health and Social Service worlds I have worked in (if you can consider them separately), is that in Health they seem to be much more rigorous about knowing and establishing the evidence base for what they do. (I know measuring has changed a lot since I worked in a purely Social Services setting so I’m ready to be shot down here.)
I wonder if that’s because, in Health, the range of treatments and interventions is so wide that the need to establish the most effective ones is vital. Or could it be that because the risk of doing harm is great, in addition to the possibility of patient claims against the system, makes its practitioners more rigorous?
Whatever the cause might be, there seems to be a more established research culture supporting clinicians, commissioners and patients themselves to make choices about what they use and where money gets spent.
Massive Open Online Courses
I am involved with a voluntary organisation which aims to improve the life and health of vulnerable families and we run something called a ‘Families Fit for Life’ course. (The ‘Fit for Life’ course is about improving skills, knowledge and behaviours around many areas of a family’s life – health, diet, activity, parenting, finance, social engagement.) I am learning now about the techniques behind developing measuring tools, literature research, and patient and clinician engagement, focus groups, hoping to do some technology transfer and apply some of these tools to track our group’s impact.
To get back to measuring, I was part way through week one of the course, learning about how to develop a Patient Reported Outcome Measure (PROM), when the old debate about what we call people sprang to mind - Patients, Service Users, People? We couldn’t use a PROM; the people on our courses are not patients. But it struck me we could rename it a BROM – a Beneficiary Reported Outcome Measure. Well produced BROMs could be more widely used across of spectrum of social service interventions, family support, home care, even for comparing the effectiveness of assessment teams.
So I think we can agree there is a lot of ‘science’ going into the Health side of measurement. But like I said, I think we are very far behind in Social Care. For example, for many years I was involved in delivery of the grants to voluntary organisations programme of a large council. Almost every year I did this, the budget was cut, and decisions had to be made about which services we could not support any longer.
I struggled to bring some objectivity to this work, as I disliked comparing apples with pears, and I tried to develop a way of outcome reporting. I don’t think I really achieved that much, despite all my efforts; I think the struggle on that still has to be won and for services delivering more ‘social functioning improvement’ than health improvement, I think it is vital we strive to get the same rigour and academic support into this as health has.
I rather hope someone is going to tell me it’s all happening already! Which is fine – but if you’ve found out nothing else from this blog, I’ve promoted Futurelearn which I can’t speak highly enough about. Go and check it out! https://www.futurelearn.com/