Lived Experience and Social Climate

Most evaluation frameworks in social care focus on change: physical outcomes, clinical interventions, or efficiency metrics. At Equal Care Co-op, we take a broader and more human approach — one that values relationships, shared power, emotional well-being and a positive group environment as essential outcomes of care.

This page explores how we measure the lived experience of our service using two key lenses:

• Qureshi’s Outcome Domains (Process, Change, and Maintenance Outcomes)

• Social Climate Theory (Moos)

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Outcomes as Lived Experience

Qureshi’s framework offers a way to look at care outcomes in a fuller, more person-centred way. It identifies three domains:

Process Outcomes

These focus on how care is experienced: the quality of relationships, respect, mutual understanding, and responsiveness to personal or cultural preferences. Our Theory of Change prioritises process outcomes, reflecting our belief that how people feel in their interactions - whether cared for, respected and included - is just as important as any measurable improvement.

Examples from our ToC:

• Care workers feel supported and trusted

• People feel more in control of their care and support

• More trusting, equitable relationships

Change Outcomes

Change outcomes reflect measurable improvements to health or functioning. While we do track these, they are not our sole focus. They include things like:

• Improved physical mobility or mental well-being

• Feeling safer or more socially connected

• Longer independent living at home

Maintenance Outcomes

These focus on preventing deterioration and helping people stay independent, safe, and connected to others over time. Especially important for older adults, maintenance outcomes are supported by:

• Sustained daily routines

• Opportunities for meaningful activity

• Ongoing social contact

By using Qureshi’s framework, we evaluate care not only by what it achieves, but by how it is experienced - and how long that support can last.

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From "Quality of Life" to "Quality of Lives"

We also shift the focus from measuring the quality of life of one person (typically the care receiver) to evaluating the quality of lives across our whole ecosystem: care workers, unpaid supporters, family, volunteers, and community members.

A key lens here is Social Climate - a concept developed by Professor Rudolf Moos to assess how the atmosphere within a group or service shapes people’s behaviour, well-being, and outcomes.

Three Dimensions of Social Climate:

Dimension	What it Looks At	In Our Model
Relationships	Support, involvement, belonging	Peer learning, mutual consent, co-production
Personal Development	Growth, autonomy, skill-building	Flexible roles, coaching, team autonomy
System Maintenance & Change	Structure, fairness, adaptability	Sociocratic governance, shared power, responsiveness to feedback

By evaluating our social climate, we gain insights into the emotional health and culture of the care environment: things that can’t be captured in a spreadsheet, but matter deeply.

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Power as a Health Outcome

Power is a major but often invisible driver of health. At Equal Care, we see the redistribution of power - towards those giving and receiving support - as a fundamental part of creating good care. This shapes:

• How decisions are made (sociocratic governance)

• Who owns the service (multi-stakeholder ownership)

• How services are designed and delivered (co-production)

Our evaluation framework pays attention to:

• Whether people feel able to speak up

• Whether power dynamics feel fair

• Whether trust and autonomy are growing across the co-op

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Why This Matters

Generic evaluation frameworks tend to miss the rich, relational, and often subtle dynamics that make co-operative care effective. We’re creating a bespoke framework not just to measure what we do, but to show that how we do it - together, as equals - makes all the difference.

References Qureshi, H., & Nicholas, E. (2001). A New Conception of Social Care Outcomes and Its Practical Use in Assessment with Older People. Research, Policy and Planning, 19(2), 11-26.

Qureshi, H., Patmore, C., Nicholas, E., & Bamford, C. (1998). Outcomes in Social Care Practice: Developing an Outcome Focus in Care Management and User Surveys. York: Social Policy Research Unit, University of York.

Moos, R. H. (2003). Social contexts: Transcending their power and their fragility. American Journal of Community Psychology, 31(1-2), 1-13.

Moos, R. H. (2003). The Social Climate Scales: A User’s Guide. Menlo Park, CA: Mind Garden, Inc.