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Michigan
Outcome Identification Project
The next challenge for Michigan in outcome utilization is the creation of a framework for an information system that will support the effort to build outcome accountability. The Ecology of Outcomes provides such a framework for operationalizing outcome accountability. This framework maintains that information about clinical or functional outcomes cannot be used to improve service planning and delivery unless the outcomes are understood in the context within which they occur. Simply having outcome information does little to improve services if agencies and providers have no way of understanding outcomes in the context of who the system is serving or what services are being provided.
The Ecology framework has several components that operationalize outcome accountability: Guiding Principles for Outcome Accountability, which drive and shape the accountability approach to the development and implementation of an outcome information system; Prerequisites and Building Blocks, which lay the foundations on which accountability can be built and thrive; and Guidelines for Implementation, which guide agencies and providers to evaluate who has been served, what services have been provided and what outcomes have been produced. The last component, Utilizing the Results, emphasizes the process for using outcome information in decision making associated with service planning and delivery.
Within the guidelines for implementation, the Ecology framework suggests three interrelated components. These are: who is being served, what services have been provided, and what has been accomplished. The process of interpreting outcome information and making decisions about services based on what has been learned from the outcome information requires a comparative analysis of these information components relative to the initial assumptions about who the system intended to serve, what services were intended to be provided, and what was expected to be accomplished.
Using outcome information as a measure of what the system has accomplished requires careful selection of the outcomes and indicators to be tracked. The Ecology framework uses a series of questions to guide the selection of outcomes. These are:
- Is the outcome information useful to managers and administrators?
- Is the outcome information useful to front-line workers?
- Do the outcomes provide opportunity for corrective action?
- Do the outcomes support the achievement of cultural competence?
Once outcomes have been selected, a second level of decision making has to occur in order to select the indicators that will be used to measure these outcomes. The Ecology framework offers several questions which may be used in selecting indicators. These are:
- Does the indicator best represent the status of an outcome?
- Is the indicator easily measured?
- Is the process of data collection and reporting sustainable?
- Does the indicator provide valid and reliable information about the outcomes?
The selection of the best and most appropriate indicators for any designated outcome is critical since the collection of data related to outcome indicators involves time and personnel, and will become a significant public representation of what the system is accomplishing.
Return to The Michigan Outcome Identification Project Home Page
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