Closing the loop: engaging with clinical outcomes in routine evaluation data

This work based project concerns the use of the CORE PC system within the Adur, Arun and Worthing Primary Care Counselling Service, which I manage. The system has been in use for 3 years and is currently used by some 200 services nationally. My objectives in this project were to establish and critically examine the use of CORE data within the service, ensuring that data collected is reflected on to inform clinical practice. This is a very broad study of a previously unexplored area, and I have therefore taken a broad-brush approach. Using a methodology influenced by action research, and to a lesser extent the case study approach, I examine the process of feeding back and critically reflecting on the data produced to inform our clinical practice. I also reflect on the introduction and management of the system. Evidence is presented from action reflection cycles as well as focus groups and a questionnaire given to counsellors. There are a number of outcomes to this project: I conclude that, notwithstanding the limitations of the instrument, CORE-PC can be used and experienced as useful in clinical practice by both counsellors and service managers. A tool such as CORE cannot be simply taken off the shelf and used uncritically however. We need to carefully attend to and manage the process of introducing and using CORE to ensure that the data is used in a thoughtful and sophisticated manner to inform our practice. I further conclude that making significant use of CORE (or any other audit data) and to extend its potential, has major implications for the culture of a service. We need to manage the process of introduction and use in order to encourage an environment where we can engage in critical discussions regarding the meaning and implications of the data. Attention to process is critical. There is a tension at the heart of using CORE between its use as a performance management tool and its use as a developmental tool. This tension needs to be acknowledged and worked with rather than ignored. CORE PC allows for the creation of individual as well as service wide data. This brings many potential benefits and difficulties as we begin to develop the capacity to look behind the consulting room door at how any individual clinician is performing. If we are to really generate meaning from our data we need to be examining it in clinical supervision. This service is in the vanguard of making critical and sophisticated use of the data provided. Three themes are identified as important in creating the kind of learning organisation where CORE data can be engaged with and used to generate useful knowledge. These are leadership, especially in attending to the process of introducing CORE and interpreting data correctly, ownership and relationship.