Establishing outcomes to understand and measure impact

Building local outcomes for better care

Over the last decade, there has been a wealth of national, regional and local initiatives to deliver integrated care. Though challenging to deliver, integrated care is critical to achieve high quality and sustainable service now and in the future – not just in England, but across the UK, and in every major health and care system in the world. This section provides tips and tools for how to articulate the outcomes providers seek to deliver.

What do we mean by outcomes?

Outcomes are the benefits that are delivered as a result of a service. Outcomes can range from broad lifestyle goals (e.g. supporting people with chronic conditions to live active and fulfilling lives in their homes and communities) to specific quality of care outcomes (e.g. patient care in the right setting at the right time). Outcomes are fundamentally different from outputs which measure the levels of activity of a service or intervention (e.g. number of personalised care plans or levels of delayed transfer of care).

Why do we need whole-system outcomes?

Failure to plan and coordinate services with and around people’s needs leads to fragmentations in care and sub-optimal outcomes. Redesigning care around the delivery of outcomes requires a multidisciplinary approach across prevention, diagnosis, treatment and follow-up. This needs to be supported by an environment of continuous learning, improvement and innovation with ongoing and robust quality assessments.

Outcomes should achieve the following:

Link to improved experiences of care, as defined by people

Person-centred health and care should be anchored in what people want and need. In other words, people’s own narratives should be at the centre. The outcomes defined should reflect the philosophy, overall aims and mission of that narrative. The narrative for person-centred coordinated care and accompanying ‘I-statements’ developed by National Voices help define goals from a user-based perspective. See also the How to ... lead and manage better care.

Capture expected changes to people’s health and wellbeing

These can be direct care outcomes for people (such as improved health and wellbeing, ability to manage own chronic illness, independence, quality of life, ability to die in a place of their choosing) or indirect care measures – or proxy outcomes – such as reduced hospitalisations/nursing home placements and other avoidable utilisation of services.

Consider use of resources

Value for money is critical to the sustainability of health and care. As such, financial measures should be included alongside quality and user experience measures in an outcome framework, with a clear outline of when, how and what benefits will be realised.

What are whole-system outcomes?

Outcomes should include individual and whole-system definitions of what ‘good’ looks like. They should combine locally articulated goals with those set out in national frameworks and include measures related to quality of care, patient wellbeing and experience as well as financial sustainability. This is expanded upon in the diagram below.


Integrated, person-centred care can never be achieved by one agency working in isolation. Because of this, outcomes should be co-produced or agreed to by the range of stakeholders involved. This is easier said than done: partners across health and care often have different goals, lines of accountability, cultures and ways of working. It is important to identify and acknowledge differences and complexities, and work together to negotiate a set of measures which are anchored in a common purpose – to improve health and wellbeing for individuals and communities.

What does good look like? Local authorities, community groups, people, patients and service users, providers, carers, regulators and other national bodies, CCGs.

There is no doubt that the pace of work across traditionally separate systems to improve care experiences and outcomes across the country is accelerating. The task now is to develop ways of measuring the difference integrated care and support is making to people’s quality of life. This is far harder than measuring more traditional straight input or output measures. System leaders need to understand that they have the freedom to experiment, and be allowed the flexibility to try new approaches. These systems need to be developed locally, alongside those who use services, an approach far more relevant and owned than top-down approaches can ever be. If we can get this right, the prize is more and more people living the lives they want, supported by services that fully and properly reflect their ambitions and strengths.

Tony Hunter, Chief Executive, SCIE

Using a logic model

Logic modelling, or programme logic, is a tool to help establish outcomes and consider impact – i.e. articulating how a project or programme is intended to achieve its outcomes and impact. As a tool, logic modelling has been used widely to help shape interventions and related monitoring and evaluation activities, including new models of care in many vanguard areas.

A logic model is a diagrammatic representation of the key components of a programme and the way that actions are intended to lead to outcomes. It helps set out plans and thoughts about what inputs (resources and target groups) will deliver the interventions (projects or programmes), which in turn will produce a set of outputs, outcomes and impacts. This logic chain, and the links between its different elements can help programme leads and stakeholders test assumptions and ‘reality check’ whether the programme’s interventions are adequate to achieve its intended outcomes.

A logic model is designed to:

  • clarify ‘what’ results a programme or project intends to achieve and ‘how’ these will be delivered
  • assess the strength of the assumptions being made about how a programme will achieve change and if the resources invested (inputs) are adequate
  • identify cause-effect relationships
  • raise awareness and build a common understanding among stakeholders about what needs to be delivered
  • provide a framework for clarifying outcomes and related measures.

The main problem I see in many local areas is that the logic models are often under-developed and/or flawed, usually because system leaders have not done enough in the first instance of really thinking through the actual changes in service delivery and how these can actually change the way the system operates. Too often the initial focus is on funding and organisational issues.

Dr Nick Goodwin, CEO, The International Foundation for Integrated Care

Logic modelling often takes place at an early stage of the process. However, it is also possible to use logic modelling at a later point to review the relevance and strength of existing programmes. Read more here about How logic models deliver care changes that work.

Logic model


What resources are required for the intervention?

How many people will enter the intervention?

(Consider the inclusion / exclusion criteria)

Examples: Resources, people, technology, and locations.


What activities are required to use the inputs and achieve the outputs?

What actions taken by providers to prevent or improve a social outcome, a medical disorder, a community/population health or a social situation?

Examples: New models of care, projects or programmes of activity.


What are the expected ‘products’ of this process?

How many people have completed the intervention? (define completion)

Examples: Increase in activity such as percentage change of case reviews, increased capabilities or new capabilities such as greater data-sharing mechanisms.

Whole system outcomes

Outcomes are benefits that are delivered as a result of a service.

  • Short-term outcomes
  • Medium-term outcomes
  • Long-term outcomes.

Supplemented by SMARTER measures (see Selecting the right measures)

  • Measures
  • Measures
  • Measures


What is expected to happen long after the intervention has finished?

Delivering person centred coordinated care through:

  • Improving service user experience
  • Achieving health and well being outcomes
  • Using resources effectively

Five steps to build a strong logic model

Logic modelling in practice

Healthwatch has developed an outcomes and impact development tool to assist local organisations in understanding what outcomes and impacts they can achieve through the delivery of their functions. The table below shows the draft template and how the sections relate to the logic model presented above. It also shows how outcomes have been split into short-, medium- and long-term.

For more tips on how to use logic models, please see Midlands and Lancashire Commissioning Support Unit’s guide to using Logic Models. It provides key insights into the theory and principles, as well as practical use.

What do we want the OUTCOMES to be?

To establish outcomes, remember the following:

Engagement is not only a topic of academic interest; it has enormous practical significance. Put simply, organisations with more engaged clinicians and staff achieve better outcomes and experiences for the patients they serve.

The King’s Fund. Source: Leadership and engagement for improvement in the NHS, King’s Fund (2012)

The Social Care Institute for Excellence (SCIE) Co-production in social care resource gives recommendations on how to develop co-productive approaches in organisations and projects based on a framework for change management.

In summary: top tips to establish whole-system outcomes

How to... understand and measure impact of integrated care
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