Outcome-focused approaches: LEAP and Outcome Frameworks

The approaches of LEAP (Learning, Evaluation and Planning) and NHS Health Scotland´s Outcome Frameworks are distinct but complementary in five ways.

Both approaches focus on outcomes, and the outputs, processes and inputs required to achieve them and the indicators that assess whether they have been achieved.

LEAP has a particular value base to promote social justice in relation to health; whereas the NHS HS Outcome Frameworks are essentially value-free.

The Outcomes Frameworks certainly can assist in the planning of activities to address health inequalities and which use approaches that support social justice, however they do not have the values built into the model.

The NHS Health Scotland’s Outcome Frameworks include community capacity development among various intermediate outcomes, whereas community capacity-building processes and outcomes are emphasised within LEAP.

This point relates to the difference in the value-base of NHS Health Scotland’s Outcome Frameworks and LEAP as described in (a) above. Because LEAP is a resource to support health improvement in community settings, it focuses much more on creating the infrastructure and processes in communities and/or for involving communities, to support health improvement.

This is based on the principle that strong communities and community involvement are key ingredients of successful strategies to promote health and well-being. This is also recognised in the NHS Health Scotland’s Outcome Frameworks.

The NHS HS Outcome Frameworks approach focuses more on the topic-based behaviour changes that strengthened communities are more likely to achieve.

Many of the outcomes in LEAP relate to the creation of the structures and processes that would support health improvement in community settings e.g. ‘Building Community Strengths’ and includes outcomes such as shared visions achieved across communities, plans that better reflect community needs, people being aware of and demanding the services they need.

In contrast, the NHS HS outcomes frameworks focus more on behaviour changes and health consequences that strengthened communities are more likely to achieve in relation to particular topics, e.g. diet, mental wellbeing, physical activity.

The HS Outcome Frameworks recognise the importance of stronger communities, but they do not major on them because they are not solely or primarily tools for supporting health improvement in community settings.

The NHS HS Outcomes Frameworks are designed to map the contributions of multiple actors working in partnership.

LEAP focuses on the contribution a particular organisation may make – either singly or in partnership. The NHS HS outcomes frameworks explicitly consider the implications of multiple actors within a partnership landscape each making contributions to working towards various outcomes eg. the National Performance Framework, and SOAs.

What the NHS HS outcomes frameworks and tools are attempting to do is map out how the multiple contributions contribute to agreed shared outcomes in an interdependent way. LEAP is designed more to support an organisation’s planning of its own activities but it does also map how these will contribute to broader outcomes.

How do the NHS HS outcomes frameworks and LEAP relate to the Scottish Government´s National Performance Framework (NPF)?

The focus in the NHS HS Outcomes Frameworks on intermediate outcomes and the contributions different sectors make to these directly relates to the National Performance Framework (NPF).

The NPF requires partners to demonstrate a ‘golden thread’ running from the services delivered, to the short-term outcomes (sometimes the outputs e.g. due to available data) of these services and the intermediate and higher-level outcomes that partners are trying to achieve and that they sign up to in their SOAs (single outcome agreements).

LEAP (by picking up the golden thread in the community) and the NHS HS outcomes frameworks (by running this thread and other threads from other partners, through to the higher level outcomes) offer distinct but complementary approaches.

Reviewed 29 July 2014

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