World class healthcare for Wales
Use of the PACER outcome tool
Iain Roberts, National Leadership and Innovation Agency for Healthcare
Context and Problem
Context:
In NHS Wales the National Leadership and Innovation Agency
for Healthcare (NLIAH) Transformation and Change Team (TACT)
include in their range of service improvement support, dedicated
education sessions for staff on leadership, team working, coaching
and change management. Pivotal to these sessions is the PACER
Outcome tool. The abbreviation is explained: Positive, Achievement,
Context, Ecology and Resources. The benefits of PACER are widely
published and promoted by many authors.
A core component often missing from improvement work is a
clearly articulated outcome at the outset. Combined with a lack
of information on change management, coaching, leadership
and team working this decreases the likely success of service
improvement projects.
Assessment of problem and analysis of
its causes:
In our experience we have found progress to be inhibited through
a lack of clarity relating to the outcome that everyone is working
towards. People usually approach change and improvement work in
the same way that they always have; not taking time at the outset
to clearly specify the outcome they want.
The PACER tool enables teams to plan in detail the outcome that
they want from their service improvement work.
Strategy for Change
Sessions have been
provided to a range of
groups, with time set
aside to design a PACER
outcome. “Checking
questions” are asked
against each letter of
PACER, to help staff think
laterally and thoroughly
about their outcome.
The discipline of mapping out a PACER outcome has been used
widely by TACT. On average it takes teams two hours to design
their outcome. The process of completing the PACER uncovers
issues and prompts thinking and discussions that are necessary to
move teams forward. TACT then supports the groups to use their
PACER as a guide to determine whether their service improvement
work is taking them towards their outcome.
Effects of Changes
Measurement of improvement:
Problem:
Intervention:
Strategy for change:
Pacer – Well Formed Outcomes
PACER defines a range of quantifiable and qualitative outputs that
will determine and evidence delivery of the anticipated outcome.
Examples of outcomes from using the PACER include:
•Enabling an Endoscopy department to identify the date that they
would be ready for an external accreditation assessment and to
plan the actions for individual members to undertake in order to
pass the accreditation.
•A team charged with facilitating an organisation wide
improvement project used PACER to plan their work programme
against their completion deadline.
•A newly formed community team used PACER to plan out
the evidence of the impact their new services would have to
illustrate that the team is a success.
Effects of changes:
The most important effect has been to get people thinking about
what they want as opposed to thinking about having less of the
things that they don’t want. This is highly motivational and delegate
feedback has been very positive.
PACER is a tool that can be used repeatedly once learnt by teams.
P - Positive
What do you want? (stated in the positive and in the present tense)
a - achievement
How would you know that you had it? (your outcome)
What do you see, hear, feel? (when you have it)
How would someone else know that you had it?
What are the steps necessary to get there?
What is the first step?
What is the last step?
c - context
When do you want it?
When don’t you want it?
With whom?
Where?
e - ecology
The study of consequences of achieving your goal (positive by-products):
For what purpose do you want it?
Is it representative of who you are and where you want to be?
Does the outcome increase choice?
Checking questions:
What will happen if you get it?
If you get what you want would you lose anything?
What will happen if you don’t get it?
What won’t happen if you don’t get it?
To undertake the PACER,
staff complete a large
poster size template.
r - resources
Pivotal for the basis of
Can you initiate and maintain this outcome?
What do you need to do to get your outcome?
the discussion is the ‘P’ of
What resources do you need? Over what time scale?
Do you know anyone who has done this or achieved this?
PACER stating the positive
thing that people want.
Figure 1
Staff find this hard as
their mindset is usually geared towards minimising the impact of
a current problem. By completing the template they have a clear
outcome to take back to the work place to share with colleagues.
Lessons Learned
Lessons learnt:
PACER is easy to use. It requires discipline to complete it at the
outset. The tool complements visioning exercises and provides
information and clarity about the road ahead.
PACER often identifies that the things people need to do to get
what they want are relatively small and within their control.
Message for others:
The use of the PACER is a discipline that can add a great deal of
value when planning a service improvement; it can help lead to a
greater chance of success.