Investigation into the perspectives of stakeholders with regards to quality, performance and the use of outcome measures within NHS services

Abstract

Section A
Introduction: Outcome measures are used widely within mental health services to evaluate service performance, provide clinical information and track progress. These can be used to serve a range of, sometimes conflicting, purposes for the different stakeholders. Most research has focused on benefits of measures or characteristics of particular measures. Little research has focussed on what the people using these measures think of them.

Aims: This review aims to summarise the perspectives of clients, carers, clinicians and managers regarding the use of outcome measures in mental health settings.

Method: 11 studies were identified, quality appraised and a narrative synthesis completed.

Results: Four key themes emerged. These were things that impact attitudes and response styles, barriers, the use of outcome measures in clinical practice and a tool for staff and service. Staff knowledge and attitudes appeared to influence how well they presented outcome monitoring to clients. When information was lacking, clients made assumptions regarding the purpose and potential consequences of completing the measures. This could impact how they responded to the measures and therefore their utility to individuals and services. The use of tools to evaluate staff and services was also discussed.

Implications of these findings and future research directions are discussed.

Section B
Purpose: Current quality indicators within Community Learning Disability Teams (CLDTs) are typically quantitative and assigned by management and commissioners, failing to account for things valued by those providing or using the service. This is particularly true for people with a learning disability (PwLD) who are often excluded from having a voice. This study aimed to explore perceptions of those providing and accessing CLDT services regarding indicators of quality and outcomes within CLDTs.

Design: Focus groups, including clients, carers, clinicians and senior managers within CLDTs were facilitated using a semi-structured interview. Template analysis was used to identify key themes.

Findings: Elements of the process of care, skills and attributes of the clinician and the therapeutic relationship were frequently identified as important and impacting outcomes, above and beyond current quality indicators. Participants felt that outcome measures should be individualised in order to be meaningful, and greater importance should be placed on feedback.

Originality: To the authors knowledge, this is the first study to bring together key CLDT stakeholders. The focus group methodology created a space where people with a learning disability could be heard and invited to speak directly to those in positions of power.

Implications: Current quality measures represent things that are easier to measure as opposed to things most valuable to stakeholders. Recommendations for improvement and future research, alongside strengths and limitations are discussed.

Date of Award	2025
Original language	English