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


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


SGHD investment process

‣ Scottish Government Health Directorates
Capital Planning and Asset Management Division
business case approval process:


SGHD gateway process


Observations of
current practice


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.


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.


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.


Beneﬁts Criteria


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


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.


The problem of beneﬁts


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


Beneﬁts are...

... difﬁcult to
elicit,
operationalise,
evaluate,
demonstrate


Beneﬁts are...

“fun”
“safe” “friendly”
“not scary” “approachable”

Beneﬁts are...

“accessible”

Our response


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


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


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.


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


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


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.

beneﬁtsquantiﬁcation.tumblr.com


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