Digging deeper: the value of the conversation

Julie Gardner, VOCAL

I work for an organisation called Voice of Carers Across Lothian (VOCAL). We moved to an outcomes approach four years ago and have been collecting statistical data on carers' outcomes for over two years. Through this we can identify patterns, including that health and wellbeing is consistently the strongest theme and most important issue for carers in Edinburgh and Midlothian. I had also been thinking about looking at the qualitative data for months, and finally decided to just get on and try to do some analysis. Team leaders provide summaries on a quarterly basis of the comments recorded in their team's baseline and reviews. Our team leaders are not counting the frequency of themes, but they are reporting on what comes up, bearing in mind that the comments recorded are brief.

Understanding and measuring outcomes: the role of qualitative data

Based on their returns, I sat and just wrote out which themes were coming up. I was anxious not to put too much of my interpretation on the data and erred on the side of caution. This meant I ended up with long lists of themes, to ensure that I stayed true to what had been reported. I then carefully summarised these down a bit to produce a condensed list. I can confidently assert key themes, and can clearly track these back through the process undertaken. I have to admit I didn't feel comfortable with what felt like taking risks with the data. However, I would like to be able to do something more in depth and there is something about needing licence to do this type of analysis. Although there were no surprises for VOCAL in the data, it does give us an evidence base and you can see how that could be useful in planning our services and also in the commissioning process. We also did a piece of research based on a finding from our data. It was clear that the conversation between staff and carers is key, and identified as being linked to the following outcomes:

  • Carers feel understood
  • Carers feel listened to and valued
  • Carers feel less anxious and stressed
  • Clear boundaries in place
  • Carers feels less guilty
  • Carers has had a chance to reflect on issues

It seemed important to understand what kind of conversations our staff were having, so we could understand what works for carers, to build this into training and induction, and for our funders. So I invited representatives from two teams to a meeting. Some of the themes that came up included:

  • Active listening is crucial
  • Using reflection - reflecting the carer's words back to them
  • Asking 'what about you?' can be powerful as the carer may not have been asked this before
  • We emphasise progress, even if small steps. This helps to build the carer's confidence.
  • Acknowledging their expertise -'If you were advising yourself what would you say?'
  • Enabling, breaking it down to manageable steps, giving the carer manageable goals
  • Must always remember the carer owns the outcomes - it is about what is important to them
  • Acknowledging loss - 'We always planned to travel when we retired.'
  • 'Reframing the picture' to help the carer to look at the situation differently.

We are still working on how best to combine and present quantitative and qualitative data. A next step for us will be to take the qualitative analysis a stage further to make sure that we are hearing what carers are telling us