our focus on benefits realisation >> delivering accelerated and sustainable business benefits...

Our Focus On Benefits Realisation

>> Delivering Accelerated and Sustainable Business

Benefits An introduction to our Project Definition & Benefits Templates

Version As At_November 2009

Introduction

Provide an overview of our Project Definition and Benefits Templates which will help ensure we deliver integrated quality and efficiency outcomes from our improvement projects. It is being used to:

Agree what projects should be started and what delivery outcomes (quality and efficiency) should be

targeted

Allow the key benefits to be achieved by the project to be defined in more detail, including agreement on measures, any interim outcomes to be achieved and the changes that need to happen to make benefits realisation possible (People, Process, Technology, Other)

The use of these templates will help ensure there Shared understanding across the Project Teams State the case for changeBenefits being targetedCurrent delivery statusBenefits that have been achievedand where support to maximise benefits is required.

Our Service Improvement Context

We need to focus on achieving quality and efficiency outcomes.

Safe

Our focus on achieving balanced benefits

Safe: Avoiding injuries to patients from the care that is intended to help them

Effective: Improving clinical decision making, supporting multidisciplinary care and supporting clinical audit

Timely: Reducing waits and sometimes harmful delays for both those who receive and those who provide care

Efficient: Avoiding waste, releasing time to care, and reducing unnecessary expenditure

Equitable: Providing care that does not vary in quality because of personal characteristics or circumstances

Patient Centred: Providing care that is respectful of, and responsive to individual patient preferences, needs, and values

Effective

Timely

Efficient

Equitable

Patient Centred


Our focus on continuous

service improvement

Track our performance

Identify where improvements are required

Agree minimum outcomes to be achieved

Track benefits delivery

Intervene where required

Agree when and how benefits will be realised

Prioritise our projects

Start the projects

Target the benefits

Manage the changes

We need to link Performance Improvement, Project Delivery and Benefits Realisation.

Performance Improvement

Project Delivery

Benefits Realisation


We need to build on the strategic improvement work that is already on-going.

Lean Expert

Lean Leader

4 Day Classroom Training

Lean Facilitator


On Project Skills Transfer

& Coaching

Lean Awareness

Lean Pocket Guide

e-Learning Master Classes

Good News

Stories

Lean Expert

Lean Leader


Lean Facilitator


On Project Skills Transfer

& Coaching

Lean Awareness

Lean Pocket Guide

e-Learning Master Classes

Good News

Stories

We have modelled many areas of our health system and we are now doing this across Mental Health

= Constraint

A&E

in-patient

out-patient

rehab

day case

acute services

acutereceiving

ward(Med/Surg)

MIU

SAS

OOH

OOH, urgent & emergency services (community)

NHS 24

GDP

GP

Community Pharmacists

family health services

Optom

refer to GP

sub-contractout-reach

Specialist acute care

tertiary services

routinedischarge

complexdischarge

LocalAuthorities

Partner & Vol organisations

refer on-going community care

Walk-In

Radiology

Endoscopy

GP referral

GP direct

access

GP referral

day patient

OutpatientClinic

Community Services – partnership model with LA

Home Visit

district nursinghealth visitingspecialist nursingAHP (e.g. physio, OT)

elderly care

Care in the community

Community (day) Hospitals

mental health

Day Patient

Inpatient

other

OutpatientClinic


Home Visit


elderly care



mental health

Day Patient

Inpatient

other

Laboratory

GP feedback

= Queue Before Activity

= Target Challenge

= Trend in Volume

= Known Issue

= Suspected Issue

Q

T

T

T

acutereceiving

ward(Med/Surg)

out-patient

Q

routinedischarge

complexdischarge

Q

T

Q

C

Q

Q

C = Constraint

A&E

in-patient

out-patient

rehab

day case

acute services

acutereceiving

ward(Med/Surg)

MIU

SAS

OOH

OOH, urgent & emergency services (community)

NHS 24

GDP

GP

Community Pharmacists

family health services

Optom

refer to GP

sub-contractout-reach

Specialist acute care

tertiary services

routinedischarge

complexdischarge

LocalAuthorities

Partner & Vol organisations

refer on-going community care

Walk-In

Radiology

Endoscopy

GP referral

GP direct

access

GP referral

day patient

OutpatientClinic


Home Visit


elderly care



mental health

Day Patient

Inpatient

other

OutpatientClinic


Home Visit


elderly care



mental health

Day Patient

Inpatient

other

Laboratory

GP feedback

= Queue Before Activity

= Target Challenge

= Trend in Volume

= Known Issue

= Suspected Issue

Q

T

T

T

acutereceiving

ward(Med/Surg)

out-patient

Q

routinedischarge

complexdischarge

Q

T

Q

C

Q

Q

C

We have started to roll out a training programme focused on Lean-enabled improvement (Facilitator, Expert and Leader)

Community Care Services

Prescribing

Patient focused mgt plan approach to reducing multiple admissions in

over 75's

Improve Capacity & Flow in Medicine and

RVH

Enhance the Ambulatory Care service offered in

Ward 15

Streaming Access A/E

Quality Discharge Communications

End to end Orthopaedic pathway hip/knees

Variation in GP referral rates

Efficiencies in General Surgery OP Clinics

Information provision and coding (e.g. The

Gap)

Develop use of Community Hospitals -

improve use/flow

Community Nursing -patient contact

time/anticipatory care

AHP activity -rebalance the activity towards community

Community Diagnostics - to support Community

Hospital model

Prescribing PracticeAnti-microbials

Patients still on medicines they no

longer needMedicines

at Admission

ElectiveUrgent & Emergency

Projects overlapping more than one stream will require cross cutting team resource

CKD - IT enabled Pathway

Pre-assessment screening

Virtual Ward Self Management

Community Care Services

Prescribing

Patient focused mgt plan approach to reducing multiple admissions in

over 75's

Improve Capacity & Flow in Medicine and

RVH

Enhance the Ambulatory Care service offered in

Ward 15

Streaming Access A/E

Quality Discharge Communications

End to end Orthopaedic pathway hip/knees

Variation in GP referral rates

Efficiencies in General Surgery OP Clinics

Information provision and coding (e.g. The

Gap)

Develop use of Community Hospitals -

improve use/flow

Community Nursing -patient contact

time/anticipatory care

AHP activity -rebalance the activity towards community

Community Diagnostics - to support Community

Hospital model

Prescribing PracticeAnti-microbials

Patients still on medicines they no

longer needMedicines

at Admission

ElectiveUrgent & Emergency

Projects overlapping more than one stream will require cross cutting team resource

CKD - IT enabled Pathway

Pre-assessment screening

Virtual Ward Self Management

We defined a 1st phase Service Improvement Programme having analysed and prioritised our whole system challenges with key stakeholders

Our Approach To Benefits Realisation

Only around 25% of benefits from change programmes are usually achieved….costing the UK economy over £50B per annum.

A lack of focus on benefits realisation is at the heart of this sorry tale.

- London School of Economics

Over 80% of CEOs are disappointed in the Return on Investment following major change initiatives.

A stronger focus on benefits planning and realisation must be a priority for all public sector organisations.

- Audit Commission

We need a stronger focus on benefits realisation across our organisation.

A stronger focus on benefits management

will support us in...

Achieving stronger and quicker returns on investment (quality & efficiency)

Stating the case for change and prioritising projects

Linking project activity more directly to strategic objectivesLinking business

performance to projects to benefits

Building a performance improvement culture

Encouraging better information capture and use for decision making

Building evidence of success to share across our organisation

A stronger focus on benefits management

will support us in...

Achieving stronger and quicker returns on investment (quality & efficiency)

Stating the case for change and prioritising projects

Linking project activity more directly to strategic objectivesLinking business

performance to projects to benefits

Building a performance improvement culture

Encouraging better information capture and use for decision making

Building evidence of success to share across our organisation


We need to recognise there are different types of benefit.

Quantifiable Benefits

Measurable Benefits

Observable Benefits

=

We understand what we are trying to achieve

=

=

We have agreed the measures we will use to track benefits delivery


We have agreed the measures we will use to track benefits delivery


subjective assessments of whether benefits are being realised

Mo

ve tow

ards m

easurab

le and

qu

antifiab

le ben

efits wh

erever po

ssible


We need to recognise there are different categories of benefit.

Quality Improvement

Direct Cost Saving

Resource Release

Cost Avoidance

=

=

=

=

We are targeting changes that will improve patient safety, improve the patient’s experience, improve clinical outcomes, minimise delays, and remove variation

We are targeting changes that will allow us to reduce unnecessary expenditure and actually reduce budgets year on year

We are targeting changes that will allow us to release resources to focus on “value adding” activities: staff (release time to care), clinics/theatres (increase utilisation)

We are targeting changes that will allow us to avoid having to make future investments that would have been incurred


We need to recognise what actually needs to change to realise the benefits.

People Changes

Process Changes

Technology Changes

=

=

=

We will need to change: Roles? Training? Stakeholders? Communications? Organisational Structure? Behaviours? Terms & Conditions?

We will need to change: Ways of working? Procedures? Locations? Performance Measures? Governance? Reporting? Contracts?

We will need to change: IT systems? IT infrastructure? Data availability? Data access? Data sharing?

Other Changes =Any other changes required to move from an opportunity for benefits to be realised to actually realising the benefits?


We need to work as a team to make it happen.

The Information Team should be engaged as early as possible to help understand the current performance (the baseline) and to agree how benefits will be measured (how & when)

The Finance Team should be engaged as early as possible to help understand the current cost position (the baseline) and to determine what savings should be targeted

The eHealth Team should be engaged as early as possible if any IT changes are required to help realise benefits

The Modernisation Team should be engaged as early as possible to help define the project and to ensure that learning and evidence from other projects is shared

Clinical staff

Our Benefits Realisation Templates

We are using the following templates (double click to launch the templates)

Project Definition Statement

Project Status Report

Benefit Statement/s

Is used to:

State your Case For Change (What & Why?)

Summarise the current performance, including evidence (Measure & Baseline?)

State what changes will be targeted

Summarise what benefits will be targeted (Quality and Efficiency)

Is used to:

Define each key benefit in more detail

Define the appropriate measure/s

Summarise the enabling changes that are required (people, process, technology)

Summarise the milestones that will be tracked (What & By When?)

Is used to:

Report on delivery progress

Report on benefits realisation against plan

Escalate any requests for support, issues or decisions to the Project Sponsor or Executive Team

Microsoft Office Excel Worksheet


The Project Definition Statement:

1

2

3

Sponsor

1st Review Date Approved2nd Review Date Review3rd Review Date Reject Approved Date

>> What measure/s will we track?

Project Definition Statement - The Case For Change

Project Information Benefits Information

This project will effect the following dimensions of quality:

Who is leading the project? Who is the project Sponsor?1. Quality ImprovementBenefit Category ID Target Date?

Timeliness

3. Resource Release

2. Direct Cost Saving

>> What improvement is being targeted?

Safety

4. Cost Avoidance

ABC2


What improvements will be achieved?


Key Success Measures

Efficiency

What will be changed? Measure?

The Benefits Case

Category>> What measure/s will we track?

How will we measure success?


>> By when?

12/06/10 Approved

Review12/02/10

12/06/10

12/12/09Review


Effectiveness

ABC5 >> What benefit is being targeted >> Measured by?

>> What improvement is being targeted? >> What measure/s will we track?

Panel Review Status

Patient Centred

Equitable




>> What risks to successful project completion and benefits realisation need to be recorded?

In Scope Statement

The Change Rationale>> Why do anything?

>> What needs to change?

>> Who will benefit?

>> What are we trying to achieve?

Opportunity and Evidence Statement You should talk with the Information Team and your Senior Accountant as early as possible to help complete this section:

>> What is the current level of performance and what measures are available?

>> What improvements are we targeting in terms of Quality and Efficiency?

>> How will success be measured - achieve what and by when?

>> What learning points from other projects can be used?

>> What dependencies need to be recorded, if any?

What is the title of the project? ABC?

Dependency Statement

Out of Scope Statement>> What areas will be involved in/impacted by the proposed project? >> What potentially "in scope" areas need to be recorded as being

"out of scope", if any?

Project Name

Project Lead

Risk Statement

IDABC1 >> What benefit is being targeted >> Measured by? >> By when?

>> What benefit is being targeted >> Measured by? >> By when?

ABC3 >> What benefit is being targeted >> Measured by? >> By when?

ABC4 >> What benefit is being targeted >> Measured by? >> By when?

Safe Efficient Timely Patient Centered EquitableEffective


Use the Project Definition Statement to: (nb: read the completion comments that are available)

Summarise the change rationale – why do anything?

Summarise the opportunity for improvement and the evidence that is available – how will success be measured?

Summarise the position in terms of realising benefits – Safety, Efficiency, Effectiveness, Timeliness, Patient Centred, and Equitable

Summarise how success will be measured against each benefit and by when?

The focus is on outlining the Case For Change to allow the Project Sponsor and Executive Team to approve the project, to understand what benefits are being targeted (Quality & Efficiency), and to understand how success will be measured (What & By When?)


The Benefit/s Statement:

ID

Target OutcomeSponsor OwnerQuality BenefitsEfficiency BenefitsImpact LikelihoodBenefit Score

Target Date

Change Area By When? Owner?What key things need to change?Insert statement on what needs to change

Insert statement on what needs to change

Benefit Realisation Actions






Benefit Statement - The Outcomes To Be Realised

Other Changes

Measure

Benefit Tracking Milestones

Benefit Measures DefinitionCollection Mechanism (Who/How?)

Final Outcome To AchieveOutcome/Date

Outcome/DateOutcome/Date

Calculation

Description of 1st Measure

Monthly

Outcome/Date

Benefit HeadlinesABC1 (As Per Project Definition)

What benefit is being targeted? (As Per Project Definition)

Who is the Sponsor who will track whether the benefit is being realised?






2 - Difficult To Achieve (High Effort, Worth It AND Some Confidence)

What is the Impact x Likelihood score?

What measure will be used to track benefits realisation? (As Per Project Definition)

What is the current performance using this measure?

Who is resposnsible for realising the benefit?

Timely: Reducing waits and sometimes harmful delays for both those who receive and those who provide care

Resource Release: Release time, increase productivity and increase utilisation

4 - High Impact

When will the benefit be fully realised - target date? (As Per Project Definition)

Tracking Point 3Tracking Point 2Tracking Point 1

Outcome/Date Outcome/Date

Outcome/Date

Description of 2nd Measure

Numerator

Monthly

Denominator

Calculation

Numerator

Denominator

Benefit Measure/s What measure will be used to track benefits realisation? (As Per Project Definition)

MeasureDescription of 1st Measure

Baseline Position

People Changes

What is the current performance using this measure?

Process Changes

Technology Changes

Outcome/Date

Description of 2nd Measure

Collection FrequencyCalculation To Be UsedWeekly

Weekly


Use the Benefit/s Statement to: (nb: read the completion comments that are available)

Provide more detail on each benefit to be targeted (x “n”)

Provide clarity on what measures will be used to track each (if >1) benefits

Agree what people, process, technology, and other changes are required to actually realise the target benefits

Summarise how success will be measured against each benefit and by when?

The focus is on outlining what benefits are being targeted and what will be achieved against each of the Quality and Efficiency categories


The Project Status Report

Review 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

X X X

X X X X X

green 0 0

IDProject Leader 1 2 3 4 5 6

Project Start DateTarget End Date

Benefits Realisation

Red

Green

Amber

StatusDate

enter 'x' to fill

Project Status Report - <Insert Project Name>

Summary Benefits Status

Target Total Saving To

DateActual

Summary Delivery Status

Green

Key Achievements This Week

green Stakeholders Are Committed

Direct Cost Saving

ABC2 Resource Release

ABC3 Timely

Team is High Performing

Scope is Realistic and Managed

Key Actions For Next Week

amber

Benefits Will Be Realisedamber

Act

Name

13/04/2009

Project Week

Insert Name

Team and High Level PlanMonth

Phase

The 6 Keys To Success

PlanRole Do

Study

TeamFT/PT

amberred

Delivery Is On Trackgreen

Risks are Being MitigatedFor Escalation (Requests, Issues or Decisions)

Insert statement on what requests, issues or decions need to be escalated for action (if any)

Target Outcome Target DateCategory StatusProgress StatementABC1


Use the Project Status Report to: (nb: read the completion comments that are available)

Summarise achievements over the last period (week?)

Summarise the focus of change activities to be completed over the next period (week?)

Escalate any delivery issues that need to be addressed

Highlight progress in terms of realising the target benefits

The focus is on providing comfort that the approved changes are being delivered and the targeted benefits are being achieved – or at least the “conditions” for potential achievement are in place

our focus on benefits realisation >> delivering accelerated and sustainable business benefits...

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