The topic of our table was ‘Leading change in: Understanding wellbeing impact’. Our goal was to hear participants’ thoughts on what wellbeing means to them, if capturing wellbeing impact is valuable, and how the capture and analysis of wellbeing impact could be practically implemented. On the second day we took the opportunity to hear the feedback of participants on work that Noted has undertaken in this area.
To help structure the discussion we initially divided the session into three main sections:
After reviewing our notes from the discussions it was decided to add two further sections to this review:
While there was pretty common agreement on what wellbeing is, and common themes emerged on other topics, we found the table discussions surprisingly diverse and highly valuable.
To summarise the definition of ‘wellbeing’, it was seen as more holistic than ‘health’, or to put it another way ‘the absence of disease’. It was discussed that wellbeing covers all aspects of a person, whānau, or community, including (but not limited to) relationships, education, employment, housing, physical and mental health, and spirituality.
While it was generally agreed that measuring wellbeing is useful, the idea was most certainly challenged. To generalise, it is felt that there was an issue of scope. If a service is focussed on a healthcare speciality, how can it impact a person’s housing situation, and what value is there in asking about it? Responses to this question included, shifting the emphasis to ‘putting the ambulance at the top of the cliff’, knowing if ‘we are any better off’, and directing funding to get the best value.
Most participants referred to some type of agreed measure as a means of measuring wellbeing. These ranged from extremely high level scores, such as asking a person to measure their wellbeing on a single 1-10 scale, to utilising models such as Te Whare Tapa Whā. As a starting point, most participants approached the idea of wellbeing as being measured from the perspective of the person, but after discussion, it was generally accepted that some aspects of wellbeing could also be measured objectively, by another. The idea of measuring wellbeing aspects, whereby a person’s wellbeing could be broken down into many facets was also discussed.
The question of how to measure wellbeing in practice was a challenging one, as participants were very aware of the workload of frontline staff and there was a strong feeling that any additional information capture would be unwelcome and difficult to implement. Other issues raised were the lack of agreed measures, lack of appropriate systems, and the lack of shared data across sectors and government agencies.
On the second day, we sought feedback on the solutions Noted has developed in regard to measuring wellbeing impact, including standardised wellbeing aspects that can be transparently captured by frontline staff without adding additional work, and data discovery tools that enable synthesis and analysis of wellbeing impact. The response from participants was overwhelmingly positive.
There were three main themes that came out of the question, ‘What is wellbeing?:
It seems safe to say that it was universally accepted that wellbeing relates to the state of being of people in their entirety, extending beyond their state of health. Example phrases included:
It also came through very clearly that the definition of wellbeing can be expected to change according to the person asked and the context of the question. It came up regularly that wellbeing is not limited to individuals and that wellbeing can also apply to whānau, workforces, communities and entire populations. It was also discussed that the requirements for positive wellbeing may vary according to culture, stage of life, and other factors. Examples from the discussions included:
An important recurring theme was that ‘wellbeing’ is not the same as ‘quality of life’, and that the social determinants of health nonetheless impact wellbeing. Wellbeing was seen as a person’s or people’s perception about their life, not just external factors, such as employment, that are presumed to influence it. Key phrases included:
Participants in many of the discussion groups challenged the value of measuring wellbeing, which led to some animated conversations. To summarise, the feeling seemed to be that staff in the health system are not in a position to impact a person’s wider circumstances, e.g. housing, and therefore information capture outside of their work is seen as out of scope. At least part of this sentiment would appear to have been driven by a fear of unnecessarily increasing the workload of frontline staff for no obvious gain. Comments included:
Proposed answers were varied. A common idea was that focussing on wellbeing at a high level could support people to stay well and out of secondary care, and measuring wellbeing offers an opportunity to know the impact of services provided and resources invested. Some statements included:
There were two main themes that came out of the question, ‘How can wellbeing be measured?':
As wellbeing has a personal dimension, there was a fair bit of debate on whether anyone, other than the individual, can have an opinion on their own wellbeing. Another area of debate was whether wellbeing is effectively a single score, or whether it can be broken down into many facets.
On discussion, the wider consensus was that wellbeing is multifactorial and can be a composite of views and observations from both an individual and workers they interact with. In multiple instances, participants shared that the most valuable information about a person’s wellbeing are captured in the narrative part of their case notes. It was also said that wellbeing needs to be tracked over time to be useful. Some key examples included:
There were more challenges listed for measuring well being than in any other category! The main themes were concerns about adding to the workload of frontline staff, how to measure something that is subjective and prone to change, and a lack of systems that allow staff to capture and aggregate the required information. Examples included:
The question of how wellbeing impact capture could be implemented can be split into two main areas of focus:
In summary, the requirements of an eventual solution were that it needed to be simple to use and not impose an additional burden on staff, it would need to be cross-sector, capture a variety of voices, and have a standardised data set. Comments from participants included:
Ideas for implementation included adding relevant questions to the census, analysing keywords from case notes, re-looking at how services are funded, and providing appropriate systems to providers so that it is possible to capture the required data. Examples of what was said include:
Working with complex community-based health and social providers, Noted has developed a range of solutions to enable many, diverse teams to work from a unified system with end-to-end data capture and analytics, out of the box. This work has included developing a taxonomy of data domains, including wellbeing aspects.
The solution enables workers to easily take comprehensive case notes that transparently capture required standardised data, so there is no additional load placed on frontline staff.
The data domains enable Noted to provide standardised data discovery tools to customers as well as making it possible to aggregate data from multiple sources to enable commissioning agencies to obtain a population view of information relevant to them.