HaCIRIC Conference Presentation

Quantifying the Beneﬁts of Healthcare Infrastructure Investment Dr. Thomson,✢ Dr. Pronk,✢ Dr. Alalouch,✢ Prof. Kaka✢ ✢ School of the Built Environment, Heriot-Watt University, Edinburgh

Study objectives ‣ Characterise how “benefits” are currently operationalised in NHSScotland procurement practice. ‣ Critique current practice against policy intent. ‣ Inform the development of mechanisms to support better benefits realisation practice. ‣ Inform and support other HaCIRIC projects. Thomson, Pronk, Alalouch and Kaka Quantifying the Benefits of Healthcare Infrastructure Investment

Current policy intent Thomson, Pronk, Alalouch and Kaka Quantifying the Beneﬁts of Healthcare Infrastructure Investment

Scottish Government health intent ‣ NHSScotland Performance Targets: ‣ Health Improvement for the people of Scotland - improving life expectancy and healthy life expectancy ‣ Efficiency and Governance Improvements - continually improve the efficiency and effectiveness of the NHS ‣ Access to Services - recognising patients’ need for quicker and easier use of NHS services ‣ Treatment Appropriate to Individuals - ensuring patients receive high quality services that meet their needs Thomson, Pronk, Alalouch and Kaka Quantifying the Benefits of Healthcare Infrastructure Investment

SGHD investment process ‣ Scottish Government Health Directorates Capital Planning and Asset Management Division business case approval process: Thomson, Pronk, Alalouch and Kaka Quantifying the Beneﬁts of Healthcare Infrastructure Investment

SGHD gateway process Thomson, Pronk, Alalouch and Kaka Quantifying the Beneﬁts of Healthcare Infrastructure Investment

Observations of current practice Thomson, Pronk, Alalouch and Kaka Quantifying the Beneﬁts of Healthcare Infrastructure Investment

Initial Agreements (IA) ‣ IAs “establish the need for change and set out the proposal in the context of the NHS Board’s strategy” ‣ The Initial Agreement establishes the project rationale. ‣ Benefits at IA: ‣ Should be project-specific interpretations of the benefits sought by strategic investment programmes. ‣ Tend to be interpretations of Scottish Government policy. Thomson, Pronk, Alalouch and Kaka Quantifying the Benefits of Healthcare Infrastructure Investment

Outline Business Case (OBC) ‣ OBCs “identify the preferred option and support and justify the case for investment.” ‣ The Benefits Realisation Plan is formed: ‣ “At OBC stage, projects should capture the benefits already outlined for the project ... within a benefits register. This register should also indicate how those benefits are to be realised.” ‣ Benefits at OBC: ‣ Should be brought forward from the IA to plan their realisation. ‣ Tend to be new “Benefits Criteria” instead. Thomson, Pronk, Alalouch and Kaka Quantifying the Benefits of Healthcare Infrastructure Investment

Full Business Case (FBC) ‣ FBCs “explain how the preferred option (from the OBC) would be implemented and how it can best be delivered.” ‣ Benefits at FBC: ‣ Should be implementing the Benefits Realisation Plan ‣ Tend to be: ‣ redefined as project-level benefits sought from the chosen option. ‣ disaggregated into detailed sub-benefits/objectives. Thomson, Pronk, Alalouch and Kaka Quantifying the Benefits of Healthcare Infrastructure Investment

Beneﬁts Criteria Thomson, Pronk, Alalouch and Kaka Quantifying the Beneﬁts of Healthcare Infrastructure Investment

Benefits Criteria Integration and improvement of service provision Accessibility of service to users Flexibility of service provision Quality of the physical environment Strategic fit Clinical effectiveness Adaptability of the service to the user Sustainable service provision Interaction of services Thomson, Pronk, Alalouch and Kaka Quantifying the Benefits of Healthcare Infrastructure Investment

The problem in a nutshell ‣ Benefits ≠ benefits. ‣ Policy compliance is symbolic rather than substantive. ‣ Policy-derived benefits tend to supplant stakeholder-derived sought benefits. ‣ Project approval process is gamed to secure funding. ‣ Project managers are scared of benefits because they don’t understand them. (anecdotal evidence) ‣ Stakeholder perceptions of benefits must be articulated in a way that can usefully inform investment appraisal. Thomson, Pronk, Alalouch and Kaka Quantifying the Benefits of Healthcare Infrastructure Investment

The problem of beneﬁts Thomson, Pronk, Alalouch and Kaka Quantifying the Beneﬁts of Healthcare Infrastructure Investment

Beneﬁts are... ‣ ... outcomes of change desired by stakeholders ‣ ... perceived, judged and evaluated ‣ ... often intangible ‣ ... often related to experience and expectations ‣ ... framed by stakeholders’ beliefs and values ‣ ... without bound (in the mind of stakeholders) ‣ ... bound by available resources Thomson, Pronk, Alalouch and Kaka Quantifying the Beneﬁts of Healthcare Infrastructure Investment

Benefits are... ... difficult to elicit, operationalise, evaluate, demonstrate Thomson, Pronk, Alalouch and Kaka Quantifying the Benefits of Healthcare Infrastructure Investment

Beneﬁts are... “fun” “safe” “friendly” “not scary” “approachable” Thomson, Pronk, Alalouch and Kaka Quantifying the Beneﬁts of Healthcare Infrastructure Investment

Beneﬁts are... “accessible” Thomson, Pronk, Alalouch and Kaka Quantifying the Beneﬁts of Healthcare Infrastructure Investment

Our response Thomson, Pronk, Alalouch and Kaka Quantifying the Beneﬁts of Healthcare Infrastructure Investment

A Benefits Quantification Method ‣ A Benefits Quantification Method needs to: ‣ capture stakeholders’ judgements of benefit worth ‣ be readily operationalised ‣ give stakeholders an interpretable voice ‣ let projects identify and monitor genuinely sought benefits ‣ easily generate useful and timely information ‣ inform Benefits Realisation Management Processes (e.g. BeReal) ‣ have a low management overhead Thomson, Pronk, Alalouch and Kaka Quantifying the Benefits of Healthcare Infrastructure Investment

BQM conceptual model Subjective Objective Benefit Domain Domain Domain Stakeholders The Project Judgement The project’s Values Infrastructure & preference qualities Experience Operation Expectations Service Provision Benefit Realisation Target Worth Thomson, Pronk, Alalouch and Kaka Quantifying the Benefits of Healthcare Infrastructure Investment

Step 1: Elicit benefits ‣ Would prefer to inherit benefits. ‣ If eliciting from first principles: ‣ Prompt stakeholders with “what are the desired outcomes of the investment?” ‣ Then brainstorm and card-sort. ‣ Verbalise during card-sorting to socially construct meaning. ‣ Stakeholders understand the words describing the benefits. Thomson, Pronk, Alalouch and Kaka Quantifying the Benefits of Healthcare Infrastructure Investment

Step 2: Identify benefit generating qualities ‣ Disaggregate each benefit into the “Accessibility” evidence of its delivery. Physical location ‣ Identify the qualities (physical, Proximity of public transport functional, financial) that stakeholders consider evidence Entrance orientation and external wayfinding of benefit realisation. Parking ‣ A variety of methods can be used. Design accessibility / welcoming Minimum pt to pt travelling Access for staff to other depts. Wayfinding Thomson, Pronk, Alalouch and Kaka Quantifying the Benefits of Healthcare Infrastructure Investment

Step 3: Assign worths ‣ Synthesise the project benefit function from each stakeholder’s willingness to pay for comparator project offerings. Relative Worth ‣ Benefit-realising performance of comparator projects determined by evaluating benefit generating qualities. ‣ “Notional tokens” WTP method BGQ Score used with starting anchor. Comparator A ‣ Consensus round if needed. Comparator B Thomson, Pronk, Alalouch and Kaka Quantifying the Benefits of Healthcare Infrastructure Investment

Step 4: Evaluate performance ‣ Iteratively, through delivery: ‣ Ask stakeholders to judge the extent to which each benefit generating quality is currently realised in the project solution. ‣ Calculate a “BGQ Score” for the current solution to represent the extent to which qualities are judged to be present. ‣ Use benefit function to translate qualities magnitude into benefit worth. Quantify target fulfilment. Thomson, Pronk, Alalouch and Kaka Quantifying the Benefits of Healthcare Infrastructure Investment

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HaCIRIC Conference Presentation

by Dr. Derek Thomson on Oct 06, 2010

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HaCIRIC Conference Presentation — Presentation Transcript