Establishing the aims
and outcomes of DHA
First, it’s important to ask what are the aims and desired outcomes of delegation?
Our research suggests that having a clear rationale, a cohering aim and an understanding of desired outcomes is important in securing the commitment and motivation of all stakeholders at inception and during DHA programme implementation. In our study, participants spoke of the overall aim being to improve the lives of people who use services and their carers:
This is about people who live in this borough living good lives. Having that shared vision was a really good starting point.
Improving staff experiences, particularly for district nurses and care workers, was also important. Programmes may have varied aims, so it’s important to think carefully in advance about these and agree them with diverse stakeholders. Programmes may also comprise different DHA, so again think carefully about what these are. We offer more detail on how to decide on which activities to delegate in a later section.
It’s also important to set up the programme’s expected outcomes, so that it is clear what is to achieved and the programme can be evaluated. This is crucial to evidencing its effectiveness and also to support business cases for additional resource. Our research identified potential outcomes at different levels, including:
System: outcomes included improved care, better integration of health and social care, reduced pressure on services e.g. fewer admissions to nursing home and acute services, reduced community demand on e.g. GPs and district nurses and improved prevention through e.g. reduced footfall.
District nurses: outcomes included improved recruitment, recruitment and retention and changes to caseloads that enabled focus on more complex care.
Providers: outcomes included improved recruitment and retention, although our research suggests that DHA was not strategically used to improve recruitment.
Care workers: outcomes included increased knowledge and skills; career progression; job satisfaction/ role enhancement; confidence, autonomy and empowerment; and, pay. Not all these outcomes e.g. pay and career progression, were achieved.
People who use services and carers: outcomes included more timely delivery of care, improved diabetes management, reduction in anxiety and refusals, and receiving care from care workers who they had strong relationships with.
Specifying intended outcomes is central to understanding whether a programme has been successful. It’s important to note that, while participants cited these desired outcomes, very few could evidence their achievement. When identifying desired outcomes, consider how these will be measured, what data is needed and at what stages will evaluation take place. We offer further details on how to do this in a later section.
