Measuring What Matters: Rethinking Performance Monitoring in Supported Living Services

Local authority commissioners face a crucial challenge when measuring the effectiveness of supported living services for people with learning disabilities:?

How do we ensure we're measuring what truly matters for improving people's lives, rather than just what's easy to measure??

This article explores different approaches to performance monitoring and commissioning, examining their strengths and limitations in the context of promoting individual wellbeing as mandated by the Care Act.

The Limitations of Traditional KPI Approaches

Traditional performance management in supported living services has often relied heavily on Key Performance Indicators (KPIs) and output measures such as:

- Number of support hours delivered

- Staff training completion rates

- Documentation compliance

- Incident reporting rates

- Occupancy levels

Whilst these metrics provide clear, quantifiable data, they fall prey to Goodhart's Law:?

"When a measure becomes a target, it ceases to be a good measure."?

For example, focusing solely on delivering contracted support hours may incentivise services to maintain high staffing levels regardless of whether this best serves individuals' needs for independence.

The New Public Management Legacy

The "Markets, Managers and Metrics" approach of New Public Management has dominated commissioning for decades.?

This approach assumes that:

- Services can be broken down into standardised, measurable units

- Competition between providers drives improvement

- Target-setting and monitoring leads to better performance

However, for people with learning disabilities, positive outcomes emerge from complex interactions between individual circumstances, relationships, community connections and professional support.?

These cannot be reduced to simple metrics without losing crucial context about what enables wellbeing.

Moving Towards Outcomes-Based Approaches

More recent outcomes-based commissioning attempts to measure what matters to individuals by:

- Starting with personal goals and aspirations

- Using tools like the Outcomes Star to track progress

- Gathering qualitative feedback from individuals and families

- Measuring improvements in quality of life domains

This aligns better with the Care Act's emphasis on wellbeing and the principle that:

"the individual is best-placed to judge their individual wellbeing."?

However, standardised outcome frameworks can still miss the unique ways different people define and achieve wellbeing.

The Human Learning Systems Alternative

The Human Learning Systems (HLS) approach offers a radical rethinking of performance monitoring.?

Rather than trying to standardise measurements across services, it:

1. Recognises each person's life as a unique complex system

2. Frames support as a continuous learning process between individual and practitioner

3. Uses rapid feedback loops to understand what works

4. Focuses on creating conditions for positive relationships and experimentation

For supported living services, this might mean:

- Regular reflective conversations between individuals and support workers about what's working

- Team meetings structured around learning from experiences

- Commissioners participating in sense-making discussions about emerging patterns

- Flexible contracts that allow services to adapt based on learning

4 Practical Recommendations for Commissioners

1. Maintain minimum safety and quality standards through basic KPIs but don't let these drive service delivery

2. Create learning partnerships with providers focused on understanding:

- What enables good lives for different individuals

- How support can flex around changing needs

- Where system conditions help or hinder positive outcomes

3. Design commissioning frameworks that:

- Enable relationship-building

- Support honest dialogue about challenges

- Allow for experimentation and adaptation

- Value qualitative insights alongside quantitative data

4. Develop governance approaches that ask:

- Are we learning about what creates wellbeing?

- How are insights being used to improve support?

- Are individuals genuinely shaping their support?

The complexity of supporting people with learning disabilities to live good lives demands more sophisticated approaches than traditional performance monitoring.?

The shift from "monitoring compliance" to "enabling learning" represents a significant change in commissioning practice.?

However, it offers the potential to create services that are more responsive to individual needs and better able to demonstrate their real impact on people's lives.

Thanks for reading,

Daniel