Moving on from quality assurance: Exploring systems that measure both process and personal outcomes in disability services

Systems that measure service quality in disability organizations commonly review service delivery processes, rather than quality of life outcomes for service users. Disadvantages of measuring processes rather than outcomes are that funders and regulators may fail to identify poor quality support until major crises occur. One solution has been the development of quality systems that combine measuring processes and the personal outcomes of service users, though the efficacy of such systems has not been explored. The aim of this article was to identify quality systems that combine measurement of processes and personal outcomes, and explore the advantages and limitations of these to inform future development of quality assurance systems. The study used an internationally accepted eight domain quality of life framework and a qualitative content analysis to map and evaluate the characteristics of three combined quality systems currently used in the disability sector; the Care Quality Commission framework for community adult social care services, the adult social care outcomes framework and personal outcome measures. The three systems were unbalanced,focusing more on procedure than personal outcomes. None of the systems measured personal outcomes comprehensively against all eight quality of life domains and the rigor applied to such measurement varied markedly. Combined systems have potential to compensate for limitations of systems that measure either processes or outcomes, but could be improved by a greater focus on measuring service user outcomes, including all quality of life domains and use of mixed methods such as interviews and observation of the support people receive.