Developing Benefits Realisation Maturity

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					        ASSIST Meeting


Managing Change to Realise
         Benefits

    Sheffield 11th April 2005

        Presented by Barbara Entwistle
   Informatics Change & Benefits Manager
SECURITY ALERT!! HAVE YOU SEEN THIS MAN?????
Managing Change to Realise Benefits


• Business Change – Programme &
  Project management
• Benefits Management Deliverables
• Benefits Realisation Process
• Benefits Dependencies
• Examples
• Modernisation & NPfIT
What is programme
Management?

• Defined as:
The co-ordinated organisation, direction,
  and implementation of a portfolio of
  projects and activities that together
  achieve outcomes and realise benefits
  that are of strategic importance.

Source: OCG Managing Successful Programmes
Attributes of a Successful
Programme
• Clear & consistent vision of the ‘changed
  business’ or other outcome
• Focus on benefits and the internal & external
  threats to their achievement
• Co-ordinate a number of projects and their
  interdependencies in pursuit of these goals
• Leadership, influence management &
  direction of the transition
• These attributes should run as continuous
  ‘strands’ throughout the programme
Programme Management Structure



     Sponsoring         Senior Responsible Owner
     Group

  Programme                            Business Change
  Manager                                Manager(s)



 Delivering                            Embedding
 capability                            Change
Business Change Manager(s)
Role

• The role is key to providing the bridge
  between the programme and the
  ‘business operations because the
  individual(s) will be an integral part of
  the business operations.
• They represent the ‘sponsoring
  groups’ interest in the final outcome of
  the programme in terms of measurable
  improvements in business
  performance
Business Change Manager(s)
Role
• BCM’s should have appropriate responsibility
  and authority within the business areas within
  which change will take effect & benefits will
  be realised
• May be responsible for creating new
  business structures, operations & working
  practices
Responsibilities

• Ensure the interests of the sponsoring group
  are met
• Obtaining assurance for the sponsoring
  group that the delivery of the new capability
  is compatible with realisation of the benefits
• Work with the programme manager to ensure
  that the work of the prog. covers the
  necessary products or services that will lead
  to operational benefits
• Identify, define & track the benefits &
  outcomes required of the programme
Responsibilities

• Prepare the affected business areas for the
  transition to new ways of working; potentially
  implementing new business processes
• Taking the lead on transition management,
  ensuring’ business as usual’ is maintained
  during the transition and the changes are
  effectively integrated into the business
• Establishing and implementing the
  mechanisms by which benefits can be
  realised & measured.
• As the programme progresses, the BCMs are
  responsible for monitoring outcomes against
  what was predicted
                          NHS PLAN
    National               Modernisation                 Governance
Programme for IT
Output based Spec         Reform, Change &           Controls Assurance
Deliver Functionality     Expand Service Provision   Standards &
                                                     Accreditation
Infrastructure          Patient Choice               Information Gov.
NHS Spine               Access to services           Corporate Gov.
NHS Care                Financial Flows / FT         Clinical Gov.
Record Service
                        Agenda for Change
e-Booking



       Translate into a cohesive and meaningful
          context for different stakeholders by
      prioritising improvement objectives and the
                  local changes required
Benefit management deliverables

  • Benefit statement
      • Forecast benefits & business impact.
      • Identify key business changes.
  • Benefits realisation plan
      •   Align business change with technical implementation.
      •   Plan process and organisational change
      •   Monitoring and reporting
      •   Communication plans / channel alignment
      •   Education, communication
    What is a benefit?
                   “The goals and objectives of the
                  organisation will determine those
                     developments which will be
                 regarded as beneficial. The Benefits
•   Improve       Management regime will take the
                  high-level goals and objectives as
•   Increase           the starting point for the
•   Reduce        identification of the benefits to be
                   achieved through programmes of
•    Eliminate            business change.”
•    Stop                        - OGC


                      A benefit is a result that a
                 stakeholder perceives to be of value.
Benefits Management Dimensions

                            Why do we
                        want improvements?
                                                       Measurement and
                        What improvements do
                        we want / could we get?        evaluation
 Planning & effecting




                                                                Can we           Can a
  business changes




                                                  How can we
                        Where will they occur ?                 quantify     financial value
                                                   measure
                                                                 them?         be put on it
                                                    them?
                          Who is responsible
                          for their delivery?
                          What changes are
                        needed to obtain them

                         Who will be affected
                          by the changes?

                          How & when can
                          changes be made?                Benefits realisation plan

                                                    Have we achieved the benefits?
                                                    if not - why not - further actions?
                                                  What further benefits can we now get?
Benefits Realisation Process

•   Stakeholder (user) engagement
•   Benefits ID & prioritisation
•   Business Change
•   Communication
•   Technical capability
•   Benefits realisation
Stakeholder table
Benefit Dependency Principles

• Chain of connections to realise
  benefits

• NPfIT – Deliverable to Objective

• Local IT – Objective to Deliverable
The Benefits Dependency Chart
Approach to Benefits Management


•   NPfIT process – impact assessments
•   ‘As is process’ - To be Process
•   Focus on deployment of functionality
•   Benefits identified as a bi-product of
    the above process
Approach to Benefits Management


• Local IT Project – Benefits & outcome
  driven
• Organisational change creating
  demand for IT solution
• Clinical engagement !! Executive lead
Benefits & Outcomes

• CRS PAS - Minimal benefits perceived
  by Replacement in one hospital
• Limited enthusiasm for wider
  organisational change – project
  focussed
• A&E Local IT development – minor IT
  deployment – wide organisational
  change
• Benefits exceeded original
  expectations
A&E Example Benefit Dependency Network

O:\BDN A&E for case study.doc
4. Sheffield Approach to Benefits –
 An Example of Service Improvement Aim
       and Objectives Statement
Aim
To Investigate, assess and improve performance specifically in relation
to efficient management of capacity and demand and improvements to
patients’ experience of day surgery services in Sheffield.


Objectives
We wish to ensure the most efficient use of our limited resources to
provide patient focussed services.
1. To improve access to day surgery services
2. Improve the efficiency of Operating lists / sessions
3. Improve patient choice and experience
4. Maintain and improve day case waiting times for treatment
                                             Day Surgery Services
                           Change                     CHANGES or                                  BENEFITS /                                       Service
Technology
                          Enablers /                  New Ways of                                  Outcome                                       Improvement
Change Enablers
                         Management                     Working                                                                                   Objectives
                                                                                                            B1
                                                                 C1                               Reduce waiting times
                                CE 1                                                                 Benefit Owner:
       TE 1            Process map the existing
     Automate                                       Reduced OPD Attendances                   Surg Group General Manager
                       Pathway from ref / Opd /         Accountability:                                                                            SIO 1
    DSU Surgical                                                                                   Benefit Measure:
                        DSU attend / followup         Surgical Services Mgr.                                                            Improve Access to Day Surgery
      diaries                                                                                   No pt waiting > 12 months
                            Resp: Service                                                                                                         Services
                                                                                             Aim < 6 months for Day Surgery
                          Improvement Lead
                                                                 C2
          TE 2                                                                                               B2
      Systems to               CE2                  Referral & follow up protocol        Increased utilisation of DSU theatre slots
     interface with     Redesign pathway(s)          in place for all DSU cases               Benefit Owner: DSU Manager
       PMI / PAS         Resp: Day Surgery            Accountability: Clinical                      Benefit Measure:                                SIO 2
  & enable booking           Manager                       Dir(s) Surgery               Increase capacity/ throughput above 60%:           Improve Efficiency of DSU
   & scheduling of                                                                                Target 90% utilisation
  DSU sessions &
   follow-up appts.                                                C3
                                  CE3               Reduction in time lapse from
                       Engage OPD/WL & DSU          referral to treatment & follow                           B3
                        staff in working group                     up
         TE 3          Resp: Surg. Gp Manager                                             Reduction in the Number of DNA’s and
                                                           Accountability:                       Operation Cancellations
    Access to care                                        Surg. Serv. Mgrs                                                                         SIO 3
     protocols / pt                                                                                  Benefit Owner:                       Improve patient choice &
    info document                                                                          Out patient Services Mgr /DSU Mgr                    experience
                                  CE4
      on ?intranet                                                                                  Benefit Measure:
                        Plan migration of surg.                    C4                               DNA rates < 10%
                        Diaries to DSU Nurses
                                                         Collaborative working               Cancellations < XX per month
                       Resp: Day Surgery Mgr.
                                                           Accountability:
        TE 4                                                   DSU Mgr:                                       B4
                                  CE5
    Automate            Map patient information                                           Improved patient compliance/preparation for
       theatre        giving points along pathway                                                           surgery
  utilisation stat                                                    C5                     Benefit Owner: Surg. Speci. Nurses,
                          and prepare relevant                                                                                                         SIO 4
     reports &           information documents             DSU nurses manage                          Benefit Measure:                     Maintain & Improve Day Case
     Pathway              Resp: Working Group               Surgical Diaries /                      Pt Satisfaction Survey                         Waiting times
       delays                                                  scheduling                      Evidence of Pt Information Docs

                                                                                                                  B5
                                                                      C6
       TE 5                      CE6
                                                                                           Improved patient satisfaction with Daycase
   Pt Access to       Design on-line WL form for
                                                                                                        surgery Services
   relevant info             Consultants                Patient Information booklet
                                                                                             Benefit Owner: Surgical Services Mgr.
     on-line ?          Resp: WL manger(s)              available at time of referral
                                                                                          Measure: Number of Visits per case reduced
      media                                                                              Delays from ref to surgery monitored & reduced
                                             Day Surgery Services

Technology                 Change                               CHANGES or                          BENEFITS /                                      Service
Change Enablers           Enablers /                            New Ways of                          Outcome                                      Improvement
                         Management                               Working                                   B1
                                                                                                  Reduce waiting times
                                                                                                                                                   Objectives
                                                                C1
      TE 1                     CE 1                                                                  Benefit Owner:
    Automate          Process map the existing                                                Surg Group General Manager
                      Pathway from ref / Opd /     Reduced OPD Attendances                         Benefit Measure:
   DSU Surgical                                        Accountability:
     diaries           DSU attend / followup                                                    No pt waiting > 12 months
                           Resp: Service             Surgical Services Mgr.                  Aim < 6 months for Day Surgery                        SIO 1
                         Improvement Lead                                                                                               Improve Access to Day Surgery
                                                                                                                                                  Services
         TE 2                                                   C2                                           B2
     Systems to               CE2                                                        Increased utilisation of DSU theatre slots
    interface with                                 Referral & follow up protocol
                       Redesign pathway(s)                                                    Benefit Owner: DSU Manager
      PMI / PAS                                     in place for all DSU cases
                        Resp: Day Surgery                                                           Benefit Measure:
 & enable booking                                    Accountability: Clinical
                            Manager                                                     Increase capacity/ throughput above 60%:
  & scheduling of                                         Dir(s) Surgery
                                                                                                  Target 90% utilisation
 DSU sessions &                                                                                                                                      SIO 2
  follow-up appts.                                                                                                                          Improve Efficiency of DSU
                                                                  C3
                                 CE3
                      Engage OPD/WL & DSU          Reduction in time lapse from
                                                                                                             B3
                       staff in working group      referral to treatment & follow
        TE 3                                                      up                       Reduction in the Number of DNA’s and
                      Resp: Surg. Gp Manager
   Access to care                                        Accountability:                         Operation Cancellations
    protocols / pt                                       Surg. Serv. Mgrs                             Benefit Owner:
   info document                                                                            Out patient Services Mgr /DSU Mgr
                                 CE4                                                                                                               SIO 3
     on ?intranet                                                                                    Benefit Measure:
                       Plan migration of surg.                                                                                            Improve patient choice &
                                                                                                     DNA rates < 10%
                                                                  C4                                                                            experience
                       Diaries to DSU Nurses                                                  Cancellations < XX per month
                      Resp: Day Surgery Mgr.            Collaborative working
                                                          Accountability:
       TE 4                                                                                                   B4
                                 CE5                          DSU Mgr:
   Automate                                                                               Improved patient compliance/preparation for
      theatre          Map patient information                                                              surgery
 utilisation stat    giving points along pathway                                             Benefit Owner: Surg. Speci. Nurses,
                         and prepare relevant                        C5
    reports &                                                                                         Benefit Measure:
    Pathway             information documents             DSU nurses manage                         Pt Satisfaction Survey
                         Resp: Working Group               Surgical Diaries /                                                                          SIO 4
      delays                                                                                   Evidence of Pt Information Docs
                                                              scheduling                                                                   Maintain & Improve Day Case
                                                                                                                                                   Waiting times
                                                                                                             B5
      TE 5                      CE6                                  C6                  Improved patient satisfaction with Daycase
  Pt Access to       Design on-line WL form for                                                       surgery Services
  relevant info             Consultants                                                    Benefit Owner: Surgical Services Mgr.
    on-line ?                                          Patient Information booklet
                       Resp: WL manger(s)              available at time of referral    Measure: Number of Visits per case reduced
     media                                                                             Delays from ref to surgery monitored & reduced
                     Benefits & Implementation
                     Vision
                                              DH                         NPfIT


                                            Integrated Planning
                                            (inc. Benefits Realisation)
                                                                                             Benefits
                                                                                           Identification




                                                                                                            Benefits Framework
Benefits Framework




                                                         SHA
                                                                                          National &
                                                            Influence through LDP            Cluster
                                                                                            benefits

                       Benefits
                       Reviews           • Refocus implementation
                                         • Exploit unexpected benefits

                                                                                            Benefits
                                             Local Health                                 Prioritisation
                                             Community
                                                                         Implementation
                                                                           objectives
                             Benefits
                           Measurement
                                                               Benefits
                                                               Planning


                                           Benefits Framework
Deliverable
   LHC
                                                   Strategy
                                                Supporting LDP
LDP Technical




                                   Fully signed-off, financially viable,                     Benefits Plan   • Using benefits menu
  Guidance




                                   implementation and benefits plans
                                   demonstrate that benefits from the NPfIT will
                                                                                           Implementation    • A value proposition for each
                                   be realised in support of overall targets,
                                                                                                               year, combining process and                                    National
                                   whilst providing DH assurance that the NPfIT                 Plan
                                                                                                               technology, will be defined                                   Programme
                                   itself is on track
                                                                                                                                                                           Implementation
                                                                                                                                                                               Guide
                                     TRUST




                                                  Identify                                           Trust Change
                                                 Priorities
                                                                               LDP
                                                                                                         Plan
                                                                                                                                                Implement                   Appendix J – Model
                                                                                                                                   Benefits                               Implementation Project
                                                                                                                                  Realisation                                     Plan
                                                                                                                                   Planning                 Deployment
                                                                                                                                                           Deployment 3
                                                                                                                                                         Deployment 1 2
   Benefit Realisation Framework




                                                                                                                     Benefits Realisation
                                                                                                                     Benefits Realisation
                                               Benefits            Agree




                                                                                                                     Benefits Realisation
                                                                                                                      Benefits Realisation
                                                                                                                                                 Implement
                                                                                                                                               Implement     Benefits
                                             Prioritisation       Shared                                                                     Implement
                                                                  Priorities                                                                             Measurement
                                                                                                         LHC
                                    LHC




                                                                                                                             Plan
                                                                                                                             Plan
                                                                                     LHC Benefits




                                                                                                                             Plan
                                                                                                                             Plan
                                                                                                                              Plan
                                                                                                    Implementation                                   Measure
                                                                                                                                                   Measure
                                                                                        Plan                                                      Measure
                                                                                                         Plan
                                                                  Identify
                                                                  Benefits                                                                               Review
                                                                                                                                                       Review
                                                                                                                                                      Review


                                                                                                                                                      Benefits
                                                                  Approve NPfIT Functionality                                                         Reviews
                                    SHA




                                                                          Approve LDP
                                    NPfIT




                                                  Identify       NPfIT Implementation Schedule
                                                  Benefits
                                                                Benefits
                                                              Identification
Changing the Programme’s Centre of Gravity
Implementation will be driven at LHC level under SHA performance management



                Strategic Health Authority

                    Business Plans & priorities                  Much of the shift of balance and focus will be
                    Performance management                       achieved by building on existing programme
                                                                 governance and management arrangements, and
                                                                 on work already being done locally
                                                 Ambulance
                    PCT
                    PCTs          AT
                                  Acute
                                                   Trust
                                  Trusts

                                                                                            Benefits
                         Mental         Social                                               Safety
                         Health          Care
                                                                                 Clinical & cost effectiveness
                                                                                          Governance
                     Shared agenda and plan                                              Patient focus
                                                                                 Accessible & responsive care
                                                                                       Care environment
            Users: patients, clinicians, nurses…
                                                                                         Public health
                         Local Health
                                                                                   PCTs and trusts within a LHC will
                         Community                                                develop a shared change agenda,
                                                                                   articulating how and when NPfIT
                                                                                 solutions and other change initiatives
                                                                                should be implemented and exploited to
    Best clinical                                            Engagement,           contribute most effectively to the
                                   IT                         Training,            achievement of benefits targets.
     practice
                                                               Support

         NPfIT Programme and investment
  Benefits Register – ETP Example
  NPfIT            Outcome                                              Outcome 2              Benefit 2
REGISTER
                  Outcome Group                                          Reference             Reference
    ETP
NPfIT Item 1
                                                                       ETPOUT002              ETPBEN001
               Elimination of illegible
                   prescriptions
NPfIT Item 2                                                            Description           Description
               Enabler / Functional
                                                                                               Reduction in
NPfIT Item 3      Component                      Benefit 1             Fewer dosage           adverse drug
                                                                    errors resulting from   incidents through
               Electronic format for
                                                                        handwritten           dosage errors
                  prescriptions
NPfIT Item 4                                     Reference              prescriptions
                                                                                              Stakeholder
                                               ETPBEN004
NPfIT Item 5                                                          Outcome Type
                                                                                                Patients
                                                Description
                                                                     Process Change
                          Outcome 1
NPfIT Item 6                                Reduction in clerical                           Benefit Category
                                             and clinical effort
                                                dealing with                                     Safety
NPfIT Item 7              Reference
                                            prescription queries
                         ETPOUT001                                                            Benefit Sub-
                                                Stakeholder                                    Category
                          Description                                                        Patient Safety
                                               Management

                     Reduction in queries
                                             Benefit Category
                      due to inability to
                      read handwritten       Clinical and Cost
                        prescriptions         Effectiveness

                                                Benefit Sub-
                        Outcome Type             Category
                          Cost Saving        Clinical Efficiency
Benefits Management – what we do

                 Pre-implementation                          Implementation
      Presentations   Interviews         Workshop(s)       Realisation & review




  Business Benefits   Business         Confirm business     Coaching
  Benefits            Drivers          drivers              Review progress
  management          Context          Set the context
                                                            Identify further
  Impact of IT        Intent           Identify business
                                       opportunities,       opportunities
  related change      Barriers/risks   outcome &
                      Analysis         enabling changes
                      Way forward                               Benefits
                                         Business Case
                                        Realisation plan