Outputs and outcomes in healthcare
Outputs are the 'products' of actions and processes. Yet, some outputs can also be a 'consequence' of previous outputs. We can differentiate between them by referring to the former as 'outputs' and to the latter as 'outcomes'.
The main difference between outputs and outcomes, then, is that an output, produced by actions or processes, can be managed directly (eg, behaviours produce those outputs: correct behaviours lead to appropriate outputs, errors lead to inappropriate outputs). An outcome, on the other hand, can only be managed indirectly, by way of producing the antecedent outputs (eg, a drug administered correctly will probably lead to recovered health, an error in administering the drug may lead to harm or death).
This differentiation may seem a bit too theoretical but it has its practical implications. One such practical implication is that in order to achieve the expected outcomes the appropriate outputs need to be produced first. Yet, sometimes is not possible to fully predict interactions between outputs and, thus, their consequences. In environments such as healthcare, where many unforeseen variables may affect behaviors and outputs, outcomes may not be achieved as expected. There is always uncertainty about the correlation between outputs and outcomes, and healthcare professionals need to be on the lookout for things not proceeding as expected and, therefore, failing to achieve the expected outcomes.
A good example of unforeseen variables and potential complex interactions in healthcare is an allergic reaction leading to anaphylaxis upon injecting a drug. If we didn't know about the potential allergy, then the anaphylactic shock comes as a surprise, such surprise being greater if we actually believed that the patient was not allergic.
|Examples of outputs and outcomes in healthcare environments|
|Behaviour||Outputs / products||Outcomes / consequences|
|Drug administration||Drug administered||recovered health, death…|
|Observation & diagnosis||Diagnosis & prescription||recovered health, waste of time / money, allergic reaction…|
|Food preparation||Meals||nourishment, food poisoning…|
|X-ray processing||X-ray image|
|Operation||Removed tissue||cancer-free patient, complications…|
Another practical implication is that outputs and outcomes may not be the same for different departments and specialties. Even more, the relevant 'definition' of safety / healthcare for different specialties may be different, as well. Some specialties (and activities withing specialties) focus more on controllable outputs while others focus more on correlative outcomes.
For example, a surgeon's main focus is the organ or tissue to be repaired or removed. Surgeons should be quite capable of operating without even needing to know a patient's name or look at his face. Even more, knowing a patient's name or face does not sensibly add to the operation's success1. The organ or tissue is the object.
On the other hand, an anaesthetist may be highly proficient in operating equipment and injecting drugs but her focus is on outcomes such as a well induced amnesia and analgesia, which varies between patients and along time. Analgesia and amnesia are the object, and this requires more than simply turning a knob or a good syringe.
|Examples of outputs and outcomes for different specialties / activities|
|Nurses||outcomes (eg, recovered health)|
|Surgeons||outputs (eg, effective operation)|
|Anesthetists||outcomes (eg, well induced amnesia, analgesia and paralysis)|
|Lab technicians||outputs (eg, good quality X-ray image)|
|Dietitians||outcomes (eg, appropriate nutrition)|
|Physicians||outputs (eg, good diagnosis and prescription )|
|Pharmacists||outputs (eg, good drug preparation and information)|
|Administration||outputs (eg, good filing, timetabling and accountability)|
In summary, even in the word 'healthcare' we can observe both an output and an outcome. 'Care' is, for the most part, an output, something we can achieve professionally by "doing the right thing". 'Health', on the other hand, is an outcome, something we can expect to achieve with 'care' but not always fully predict. We may need 'extra care' if we want to provide better health and safety to our patients, and this 'extra care' is, for the most, not just "more of the same care", but a qualitatively different one. Here is where human factors comes in.
Want to know more?
|Outputs & outcomes: HF issues||Other outputs & outcomes||MRSA as outcome|
Jose D PEREZGONZALEZ (2011). Massey University, New Zealand (JDPerezgonzalez).
|Other interesting sites|
Wiki of Science
The Balanced Nutrition Index