To celebrate our birthday and the start of the ‘terrible twos’ (hopefully not…) we decided to take a look back at the past two years, and reflect on what we’ve achieved, what we’ve learned and what we might do differently were we starting again.
Of course, much like an X Factor contestant, these are entirely our own reflections of our journey so far – we’d love to hear yours! Tweet us @OBH_UK or use #OBHis2 to join in the conversation.

1 – There’s a risk that we don’t get ‘outcomes’ right

The biggest risk we see in our work to help healthcare organisations to define, measure and pay for the outcomes of care is a lack of precision in what actually constitutes an outcome. The way we see it, there is an element of the Emperor’s new clothes here: just calling activity and process measures ‘outcomes’ doesn’t actually make them outcomes! Similarly, if we call everything we currently do ‘value’ then we are not being honest with ourselves, and it makes it even harder for us to create true value.

Yes, designing services on the basis of outcomes is trickier than designing services to deliver specified activity or outputs, but it is also more likely to result in a better and more cost-effective service.
Here’s how we see it:

Outcomes are distinct from people’s experiences of healthcare and whether they feel satisfied with those experiences. They are also distinct from the ‘process’ of healthcare – an outcome does not tell us whether x or y happened, it simply focuses on the result. Experience, satisfaction and process measures are key to measuring quality, but they are not the same as the results that matter most to an individual.

2 – …But there is also a risk if we don’t change

So, getting outcomes ‘right’ does require a different way of working, it does require a fundamentally fresh way of thinking and perhaps even an element of risk. But we find that, too often, we can forget the risk of the status quo.

Often, certainly in healthcare, the status quo can be seen as zero risk. It’s now becoming obvious that this isn’t the case, and we need to be honest about it. What we currently do – the way we plan and deliver care and then understand its impact on patients – creates risk. We must accept that what we have right now is imperfect, before we are able to embrace the innovation which seeks to change it.