Introducing benefits management by David Waller, Keldale
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This document discusses lessons learned from implementing benefits management in healthcare organizations. It provides examples of challenges encountered, such as lack of health-specific examples, difficulty balancing stakeholder needs, and pressure to justify existing plans rather than enable radical change. Effective benefits management requires resources for enablers rather than just identifying them as limiting factors. While some local groups adapted the tools quickly, broader training efforts were difficult. The application of existing knowledge could significantly improve healthcare outcomes.
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Introducing benefits management by David Waller, Keldale
- 2. Rule No.1 Strategic decision making starts and ends with subjective events chosen by people
- 3. Thoughts to take away 1) You are not alone 2) You can do something about it
- 5. ISIP Organisation ISIP Leadership • Top-Team sponsorship, SRO within the Service Improvement community. Workforce, National Institute and CfH involved (people, process and technology) ISIP Central Team • Production of guidance, senior stakeholder management and communications ISIP Field Support • One person / SHA to support local planners and implementers as they learn the method and apply it.
- 7. Examples • Lack of health-specific examples • Not invented here • Worked example in a multi-agency environment missed the right balance
- 8. Benefits • What’s a benefit? • How many iterations to get them – 2 workshops for a weak set – 12 workshops for a good set • More 2s than 12s A benefit is a result that a stakeholder perceives to be of value
- 9. Squeezing old plans to fit • Lack of radical change – Poor grasp of strategic objectives – BM to validate / justify existing plans • Some degree of rationalisation
- 11. This is not
- 12. Poor Enablers Enablers without resources are really limiting factors.
- 13. Lip service This is the output of 30 mins management team discussion
- 14. Lip service This is what the project manager brought to the next meeting
- 15. Cancer & Palliative Care Integrated Change Programme Benefits Dependency Network Enablers 1. Commissioning & practice based commissioning Projects Cancer & palliative care NICE guidance implementation Outcomes Effective use of capacity Increased diagnostic capacity 2. Modernising information management & technology Primary care service improvement initiatives 3. Workforce modernisation Secondary & tertiary care service initiatives 4. High impact changes 5. Integrated care pathways Partnership forum initiatives Improved primary care engagement in cancer & palliative care agenda Prevention & screening initiatives Achievement of key waiting times Increased number of diagnosed cancers referred via the USC route Improvement in patient satisfaction Improved care pathways Increased participation in screening, prevention and education programmes for target population All patients better informed about choices 6. Estates & facilities modernisation Benefits Improved communication along whole care pathway Year on year % reduction in incidence of cancer in identified areas of deprivation Achievement of prevention/ screening targets for specific target population Consistent approach to management of cancer & palliative care in all GP practices Priority Objectives Improving access & choice Delivering high quality managed care Reduction of cancer mortality 20% by 2010 Improving patient experience Improving prevention & screening
- 16. Primary Care Service Improvement Benefits Dependency Network Enablers Projects Outcomes Effective use of capacity 1. Commissioning & practice based commissioning Increased diagnostic capacity 2. Modernising information management & technology 3. Workforce modernisation 4. High impact changes 5. Integrated care pathways 6. Estates & facilities modernisation Primary care service improvement initiatives Workstreams: 1. Primary care toolkit 2. End of life initiative (gold standards) 3. Prostate injection therapy 4. Breath testing 5. Mainstream primary care service improvement workforce 6. Cancer referral directory Improved primary care engagement in cancer & palliative care agenda Benefits Achievement of key waiting times Increased number of diagnosed cancers referred via the USC route Improvement in patient satisfaction Improved care pathways Increased participation in screening, prevention and education programmes for target population All patients better informed about choices Improved communication along whole care pathway Year on year % reduction in incidence of cancer in identified areas of deprivation Achievement of prevention/ screening targets for specific target population Consistent approach to management of cancer & palliative care in all GP practices Priority Objectives Improving access & choice Delivering high quality managed care Reduction of cancer mortality 20% by 2010 Improving patient experience Improving prevention & screening
- 17. Dialects • Within three months people had adapted the tools to suit themselves • Five flavours of BDN
- 18. Resourcing and selling • Small groups of local experts • Capable of doing but not capable of training others • Selling the concept within organisations was hard. • Seen as Management School BS
- 19. Rule No.1 Strategic decision making starts and ends with subjective events chosen by people
- 20. Why does all this matter? • “The application of what we know already will have a bigger impact on health and disease than any drug or technology likely to be introduced in the next decade.” Sir Muir Gray Director of Clinical Knowledge, Process and Safety NHS Connecting for Health
- 21. Comments?
Editor's Notes
- Here’s the sort of thing that interferes with rational decision making. There’s some excellent stuff on the ways that psychology affects economic decision making in Daniel Kahnemann’s book Thinking, Fast and Slow. Prediction – pre Business Case Optimism Bias – Expecting too much in terms of results, cost and time despite previous experience. This is now recognised and often included in business cases. Which means people have started gaming with it, claim double . Strategic Misrepresentation – Flyvberg, consciousdeliberatelying to get the business case approved. International analysis of transport infrastructure, just about every business case lied about the potential benefits to be achieved.Anchoring – Anchor on the first estimate, no matter how inaccurate and then fail to change sufficiently despite knowing it was wrong. It’s why salespeople start on an impossibly high note, “This is the best thing since sliced bread”. It will still feel that way even when the facts have destroyed their argument. WYSIATI – What You See Is All There Is (Kahnemann), ignoring the existence of other evidence, failing to look for alternatives.Delivery – work in progressIllusion of Control – Assuming it all goes to plan… Belief that you have full control of the situation, not mitigating the risks.Confirmation Bias – Filtering the evidence to fit your expectations, seeing only what you want to see.Affect Heuristic – Seeing the positive in things (and people)we like, and negative in things we don’t. The halo effect of the singer, not the song. Framing – Making a choice dependent on the way the options are phrased. “It could be you!”, or “It’s almost certain it won’t be you.” Good news / bad news stories in performance reports.Regression to the Mean – A knee-jerk reaction to a one-off. Reward and punishment are both usually followed by a more average result, hence we believe punishment motivates.
- Mental Health has a tremendous number of strategy papers. Initially these were listed as enablers to the project. Then it was realised that they brought no resources. The many MH strategies were enablers without resources. They were really limiting factors. They told people how the job should be done but gave no tools to help do it.In the second draft BDN they were removed from the Enablers and included as limiting factors in the Activities, i.e. business processes designed to meet strategy DH requirements .
- Sometimes people just don’t want to take part. This workshop was 30 mins reluctantly tagged onto the end of another meeting.
- The Project Manager took away the previous diagram and produced this from his existing plans. It met his requirement of taking part in ISIP but bore little resemblance to what his management colleagues had discussed (which may have been a good thing).