A pathway to achieving outcomes
If we are to view health care from a whole population as well as an individual perspective, then services to individuals must be provided with the wider context clearly in mind. This wider context is our higher-level societal outcomes.
In Leading for Outcomes we explore the actions needed to achieve one of the key societal outcomes for health sector activity - "reducing inequalities in health".
The focus is diabetes and CVD because of the size of their impact. These conditions are causing increasing suffering and put increasing demands on the resources and capabilities of our health system.
An outcomes hierarchy presents layers of outcomes. Below are levels of operational detail that function as signposts along the path to reaching those more general goals or societal outcomes.
Those actions and institutional structures most conducive to progress upward through the outcomes hierarchy relate directly with the intervention points along the disease progression model.
An indicator framework makes it possible to monitor progress toward achieving outcomes. For example, levels of retinal screening among people with diabetes indicates the degree of success in achieving the outcome of systematically managing this condition.
These 'impact indicators' monitoring the effectiveness of actions give way to 'state indicators' demonstrating the degree of success in achieving outcomes further up the hierarchy. For example, increased life expectancy among Māori would be a marker of success in managing those long-term conditions that so disproportionately affect Māori. In this way an outcome hierarchy, accompanied by indicators, can provide a frame for evaluation, system performance monitoring, and continuous learning and improvement.
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