Managing Benefits from Projects The NHS Way

Hugo Minney PhD

The Social Return Company

Who am I to talk?

• 1990 – PhD and Computer Salesman (business cases to get investment)

• 2000 – Cap Gemini • 2004 – NHS Modernisation Agency • Followed by South Yorkshire Improvement Academy,

various roles nationally, regionally, locally, with arms length bodies

• Interspersed with For profit and not-for profit NHS and social care facing roles

• CURRENTLY: Company Secretary of GP-led federation with 170,000 registered patients

What is healthcare?

• English NHS – Commissioner / Provider Split – cases for investment – Value for Money requirement – Innovation – Technology – NICE

• Scottish NHS – Central planning – SIGN

• Independent Sector Healthcare – Highly responsive to fluctuating demand – 15% of the sector – Like any business

• My GP-led Federation – Politics and public influence

Benefits Management

Benefits management is the identification, definition, planning, tracking and realisation of

business benefits.

• Recognise what we’re trying to achieve – in context.

Do we still want this? What’s changed? • Who does it affect? The employees are often the

forgotten stakeholder • Do we know what success looks like? (soft measures) • Does everyone agree what success looks like? • People look after Number 1. Are you giving them

what they want?

What is Benefits Management?

• Introduction to Benefits management – WHY do we do this project? – Value for Money in commercial terms – Knock on effects – Social Return on Investment

• Who are the stakeholders? – Patients – Staff – NHS Budget (drugs, hospital, community, GP) – Local Authority budget – Central Government and the voter – The Value of a Life

• Who pays?

Where does BM fit in Project Management?

John Thorp – The Information Paradox

capability

GPES or care.data

• What is it? – Patient activity data formerly in hospital, now mostly in

community and GP practice – Collect anonymised data from GP practices – Combine with same patient data from hospitals & other

environments

• Why do we want it? – Identify best practice and develop new pathways of care – Investment decisions with population prevalence – Track pandemics – Drive innovation – Pay people for the right things, and stop paying for the wrong

things

The Not So Good examples

care.data - what could go wrong?

• What could possibly go wrong?

– Scope shrinkage so that “success” is inevitable

– Project team personalities and politics

– Engagement with the public (and other stakeholders)

– Value for Money studies (*)

• Success for care.data

– Inevitable – at some point

– The business case is too compelling (£x mill in for £1bn / year return)

TPP SystmOne, Lorenzo, etc

• What are they? – TPP SystmOne is GP patient records system, Lorenzo allows

hospitals to read GP system – Both new greenfield developments – Standing on the shoulders of giants, full might of

Department of Health behind them

• Why do we want them? – Single system for GP and District Nursing, shared

information (with potential for wider sharing) – Hospital access to more info than referral letter – GP access to more info than discharge letter – Centralised records: power is where the data are

TPP SystmOne – what could go wrong?

• How do you measure benefits achieved? – Pre-defined measures to demonstrate success

– Things that don’t mean very much – seconds to load a screen, numbers of keystrokes

– Tick sheet to record

– Commercial greed

• Real benefits – Take longer to manifest

– Everyone trained the same (everyone trained!)

– Teething troubles to overcome

Emergency Care Practitioners

• What are ECPs? – First Responders, able to diagnose, treat, discharge and

refer onwards – Paramedics with nursing skills, nurses with paramedic

skills, AHPs with both – First to scene, often last touch with patient

• Why do we want them? – Better patient care – Disruptive innovation works best if it starts early – New forms of care (reduced ambulance, reduced A&E) – Lower cost overall – Career for experienced paramedics

ECPs – what could go wrong?

• Cost-effective, better patient care, better for staff – what could possibly go wrong?

– Who pays, and who benefits? Establishing the stakeholders and their roles

– What else is going on? (senior jobs being threatened, NHS 111)

– A much cheaper alternative?

– The clock start change debacle

Why projects don’t succeed

• Failure – budget, time, quality

• Benefits delivery, contribute to corporate objectives are “nice to have”?

• Internal problems 60% of the reasons for failure – Failure to plan

– Failure to apply governance

– Failure to be motivated?

– Failure to engage BAU at handover?

PricewaterhouseCoopers 2012

Budget Time Quality

Business Objectives

Benefits management can drive successful Projects

What gets you up in the morning?

• Nobody comes in to work to do a bad job (well, almost nobody)

• We all want to make a difference – make the world a better place

• Very few people work just for the money*

• So… what am I going to tell you?

• Osterloh & Frey 2007 Does pay for performance really motivate employees? • PwC NextGen 2013: Millennial workers want …

A Health Economy in Northern England

• 160 initiatives for change – “projects”

• £60 million per year spent on change

• Professional carers resist change – all change represents risk – “what we’re doing now is safe”

• Management targets divorced from both the knowledge, and the need (sometimes)

Benefits Frameworks

• Part time for 4 months

• 7 workstreams,

• Three workshops – Context: what you are doing, what the need is, where

are the gaps? What does success look like?

– Measurement: what means improvement, where can we get that information?

– Delivery: how are you doing? What are you changing because of measurement?

• coaching between workshops

Benefits Mapping

… means People getting involved

… means common sense

Staff Motivation

• “I can tell my grandchildren ‘I did a good job this week’ “

• Lower Sickness/ Absence

• Easier Recruitment/ Retention

• Getting much more done

• Engaged with corporate objectives – even to MAKE MONEY

Driving improvement

• We (the people who talk to the client/ do the work) see the need/problem first!

• We know what to do about it (have the most experience)

• We can inspire*

• We won’t resist our own design for change

• (a new problem – managing configuration)

Malcolm Gladwell – Tipping Point

Other success stories

• IAIP (Improving Access to Information Project) – Government requirement: no turning back (*) – Direct access to team leaders, who developed their own Benefits

Profiles as well as Roll Out Plans (Resistance is Futile) – Nobility

• COPD (lung disease in former mining areas) – Wide engagement, facing up to vested interests – Years of discussions, recognising and owning problems – Compromise, but with a vision and drive – The NIKE factor

• Community Gynaecology – Pilot rolled out rapidly – Patient (and GP) choice – Instant benefits – cost effective & better for patients

Useful Approaches

Some of the tools and approaches which work

Define Benefits

Case for Investment

Quantify and

milestones

Decisions to

maximise

benefits

What benefits

deferred and how

to monitor them

Ben

efi

ts

Fra

mew

ork

Idea

Initiation

Define

Deliverables

Milestones

Resources

Project monitoring

Project delivery

Governance

Clo

sedow

n

Pro

ject

Man

ag

em

en

t

Handover

Benefits Management and PRINCE2

Business as Usual

Reporting & tweaks

WHY WHAT & HOW HAND-OVER ONGOING

Social Return on Investment (SROI)

• Stakeholder Mapping and real Engagement

• Value is only what is described by stakeholder

• 2nd and 3rd level measurements – what does this mean?

• The problem – and solution – of attribution

• Using reliable (and defendable) numbers

• A trusted methodology

• SROI-lite and its detractors

Turning SOFT into HARD – reliable measurement

• Important things like

– Customer Satisfaction

– Net Promoter Score

• The joy of a parent, the value of a life

• What impact on the bottom line?

• When? How much? How reliable? Confidence and sensitivity testing

Lessons to take away

When do you start? When do you finish?

• 4 stages of Benefits Management:

– WHY – business case, sponsor, stakeholders

– WHAT & HOW

• Project planning, measurement schema

• Project delivery, decisions to maximise benefits

– HANDOVER – handover capability, plus motivation

– ONGOING

• Measuring and reporting

• Tweaking and adjusting for even better outcomes

Professionalism

• Like Project Management – follow a tried and tested process*:

– don’t just make it up as you go along

• The right tools for the job

– iBE.net includes Project Management, Time and Billing, EVA; Benefits Management to follow shortly (one time entry, used many times)

– Try it out at www.ibe.net

* PwC 2012 Project Maturity

The foundations of Morale

• The military understand this – Spiritual – because only spiritual foundations can

stand real strain

– Intellectual – because men are swayed by reason as well as feeling • It must be attainable, by the organisation. Confidence

in planning and capability

– Material – last, because the very highest kinds of morale are often met when material conditions are lowest

William Slim “Defeat into Victory”

Measuring & reporting to motivate

• What’s important?*

– We are not just numbers

– We are excellent at what we do

– Our company and our customers recognise our effort and care

– We are doing something useful and valuable

• How do we measure these?

– Team and individual recognition – measure what matters

– Put it into context: “I help people” (identity!)

James Robbins – Nine Minutes on Monday

Step by Step

1. Involve stakeholders

2. Map outcomes to context and drivers for change

3. Evidence – what is important (NOT JUST “what can we measure?”)

4. Establish impact – does our change result in this, or was it something else?

1. Are the numbers trustworthy and trusted?

5. Calculating the outcome so people can use it to make decisions

6. Reporting – and using the results (to make decisions)

Tailored from: Jeremy Nicholls – A guide to Social Return on Investment

When the best leader’s work is done, the people will say:

“We did it ourselves”

Lao Tzu

Hugo Minney

PhD, Acc Prac SROI, M APM, PRINCE2

07786 961837

Hugo.Minney@TheSocialReturnCo.org

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