Benefits Management in Health and Care part 1: Identify and map target benefits presented by Kevin Parry FAPM Thursday 24 October 2019 Write up newstory page URL: https://www.apm.org.uk/news/benefits-management-in-health-and-care-part-1-identify-and-map-target-benefits/

1. Benefits Management in Health
and Care:
Part 1, Identify and Map target
benefits
Kevin Parry FAPM
Consultant Programme Director
Cogenic Services
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2. Format
This presentation is intended to achieve two things: to
contrast the practicality of identifying, planning,
realising and tracking benefits with the theory and to
stimulate some discussion about transformational
change from a human factors point of view.
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3. What I will cover
Part 1: (today)
▪ How do we identify potential benefits? Theory and practice
▪ What does a good articulation look like (mapped to strategic
objectives)?
Part 2: (Jan)
▪ Planning their realisation
▪ Where can this fall down and what can we do if it does?
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4. There is a gap between the theory and the
practice of Benefits Management
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Identify
Define
PlanRealise
Track
This is the core BM
process
It looks simple…
…as indeed it is
The problem is
that implementing
the process is
often much harder.
This is the
knowing/doing gap
and probably the
most important
part
Identify and
structure
benefits
Plan benefits
realisation
Implement the
change
Realise the
benefits
New
opportunity
Who, what,
how, when?
1
2
4
5
3
0

5. 1. Identify: Defining “value”
▪ “A cynic is a man who knows the price of everything and the value of
nothing.” (Oscar Wilde, Lady Windemere’s Fan)
▪ Creating additional value in health and care comes from strategic
objectives turned into, plans and programmes.
▪ However, this process is complex because of the diversity and
complexity of the NHS and Social Care as a system
Government Functional Standard for Projects, 2018
▪ Benefits, therefore depend on your point of view, as do priorities
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6. The BM lifecycle is about maximising
value
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PMI “Pulse of the profession” survey in 2016
suggested that organisations with high benefits
realisation maturity waste 67% less money
than those that don’t
There are three major challenges:
1. To imagine a future change and who it
could benefit
2. That people must make long term
changes in behaviour and belief* and
3. That change is likely to take place after
the programme closes and therefore
requires significant handover to service
delivery teams
* Note that values are personal and so should not need to
change for front line staff.

7. Key differences in agile
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Traditional Agile
Benefits normally defined upfront & tend not to be
revisited much even if related scope and assumptions (and
stakeholders) for project/programme change over time
Makes changes and improvements to derive maximum value
from what is delivered within a broadly defined scope –
benefits often change as scope changes, so BM becomes
iterative
Often a lot of analysis as part of Business Case but to
justify investment/RoI/VFM. Analysis does not tend to be
continuous and is ‘paper based’ because of constraints
Takes opportunity to get user (stakeholder) feedback as early
as possible, based on ‘fail fast’, prototyping, etc. so benefits
based on harder evidence/real feedback and leading indicators
Often realised towards end of / after closure of the
initiative – can be a > a decade gap between full
implementation and project/ programme definition and
often many of benefits assumptions turn out to be no
longer valid. Disbenefits will appear and emergent benefits
can be missed
Benefits are realised incrementally & as early as possible
(Principle 2 of AgilePgM) and build progressively
User/ stakeholder benefits/value often used to prioritise ‘Agile
Backlog’

8. How? Tools and techniques
▪ Using a Benefits Dependency Map will help to focus on the link to
objectives, change and target benefits
▪ This allows us to see how projects and programmes combine and are
dependant on each other as contributors towards a beneficial change.
They can also show where there is a timing dependency and where
there is a risk of overwhelming staff with too many consecutive changes
▪ This tool (set) can also help form a common view of what we are trying
to achieve and gaps in knowledge or understanding. This is a very good
think to know at the outset of launching strategic change programmes.
▪ There are two kinds of benefits dependency maps: definition maps and
change consequences maps
▪ These should be used in combination to help in ensuring that the
proposed solution (s) will, as far as it is possible to predict the future,
be able to achieve the target benefits
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9. Understand the context
▪ Benefits arise from either solving a problem or exploiting an
opportunity to do things differently
▪ This means that understanding the current context and the perspective
of front line staff is key, in addition to a baseline of current measures.
Small sample sizes are very dangerous as are too many assumptions
▪ Step 1: Define the problem in relation to strategic objectives
▪ Step 2: What is the effect, on the service, the staff and patients/service
users?
▪ Step 3: If we make a change, how will it create an advantage for one or
more of the above stakeholders? How might we measure it? The
purpose here is to get an idea of scale and the ratio of cost to benefits.
This is important later
▪ Step 4: Consider the options in terms of, impact, cost, timescales,
dependencies and feasibility
▪ This is traditional Benefits Dependency Network Mapping in reverse
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10. Benefits Realisation pre-requisites
▪ Stakeholder engagement early on is essential. If you have defined the
objectives for the change then only stakeholders can help in
understanding the context of the current way of working and the reasons
that it works as it does.
▪ It is relatively easy to profile potential benefits using activity based cost
savings (number of activities per period minus potential saving/cost of
activity) over the lifetime of the change. This is a non-cash benefit shown
as an efficiency gain. However, this is misleading because:
– It does not include the cost of the change
– It does not show that any beneficial use of saved time will take place
– It does not reflect the time for the change to ripple through the system
– It does not prove that this change alone can produce any benefits
– It may not be permanent
▪ Unless the users are motivated to change and this solves their problem, it
is likely to face resistance and so be diluted by reduced confidence
weighting in the business case
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11. Between the models and the practice of Benefits
Management are human factors and the challenge of
measurement at scale
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Identify
Define
PlanRealise
Track
New
opportunity
1
2
4
5
3
0

12. Getting the basics right
▪ The foundations are important in programmes:
– Quality communications, includes using terms in a standardised way,
writing clearly and using visual tools consistently. The team must all
understand what these mean and keep the articulation of target benefits
up to date (they will change)
– Avoid using BM to justify an investment (this is back to front and a poor
foundation)
– Understand that the enabler will not deliver the benefits. The
programme is the enabler and the change will provide the benefits
– A shared vision is critical
– Dis-benefits are a fact of life and should not stop the programme,
however, it is important to minimise them in the design of the solution
and the way it is implemented
– Consider the chain of changes required in a federated organisation such
as health and care in England and not just the end state you want
– Make sure that the current position and how it varies in different
organisations you want to change, is understood
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13. Planning benefits takes effort, consensus
and the right mind-set
▪ Research by the University of Sheffield, Royal Academy of Engineering,
and the British Computer Society suggests that only 10-25% of potential
benefits are realised from investments in change. This is estimated to cost
the UK >£50bn per annum
▪ One particular challenge is the ready-made solution looking for problems
to solve. Confirmation bias then adds to the problem as we seek
confirming evidence
▪ This is exacerbated when the solution is really an enabler, such as a
building, network, IT system or facility. These have no intrinsic value but
can produce benefits from the way they are used as part of a change
programme
▪ Qualitative benefits are also important as these affect behaviour, belief
and attitude
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14. Benefits Dependency Network Maps –
understanding the consequences of change
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Enablers
Enabling
Changes
Business
Changes
Business
Benefits
Strategic
Objectives
Cyber
Resilience
Patient Safety
Workforce
Training
Improved
Data Access
Healthier
Nation
Reduced
Clinical Errors
Digital
Decision
Support
Integrated
Care
Investment
Provider
Transformation
Plans
Hiring New Skills
Treasury
Guarantees
Provider
Board
Support
Consultation
and
Engagement
This kind of diagram is typically derived from a stakeholder workshop.
Where the strategic objectives are already assigned, the link to
business benefits is shown or can be strengthened from discussion

15. Other mapping tools can also help
▪ Cranfield Benefits Model follows the Managing Successful Programmes logical
flow
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Project Outputs
New Capability is
developed
Implementation
Outcome
Resulting
Benefits
Target Objective
This can be used to see what is the impact of a change in objective on existing
projects, and can be used to show the %age contribution to benefits from
complementary changes in the same service or product.
However, it does not make the underlying assumptions explicit or reflect the time
dimension where there is a dependency.

16. Other tools
▪ Results Chains are complex to build (and so often need skilled facilitation) but
can show the connection between: outcomes, initiatives (objectives),
contributions (products) and assumptions. Note that our assumptions are only as
good as the data they are based on and always filtered by cognitive bias.
▪ Benefits Value Models show the relationship between new capabilities,
operational benefits and strategic objectives. They avoid the more complex
“spider’s web” entity diagram drawbacks and so are sometimes useful to
communicate ideas to less “technical” audiences.
▪ Dependencies Mapping Diagrams show where one or more projects contributes
to the strategic objectives through combining their outputs (products) into new
capabilities and can include the timing dimension, for example, where increasing
digital and data analysis skills must happen before integrating clinical technology
for faster and more accurate diagnostics, or for AI-augmented clinical decisions
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17. Articulate with the end in mind
Strategic
Objective
Assumptions
Outcome
which can
contribute
Enablers
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These are likely to
need to be broken
down into
measurable changes
To do this, we need to
understand why things are
already as they are from
the systems point of view
This informs what
needs to change, what
it would look like and
what the
consequences are
Almost all strategic change
requires enablers,
however, these must not
be confused with the
change itself
Since we can’t have perfect knowledge,
we need to use assumptions, however,
these must be tested continuously and
explicit in the programme plans

18. Credits
▪ APM Body of Knowledge 7th edition (www.apm.org.uk)
▪ Benefits Realisation Management, Gerald Bradley, second
edition 2016
▪ Benefits Management: theory into practice, Anna Lay (APM
Benefits SIG)
▪ Cranfield University research on APM YouTube channel
▪ University of Oxford Research, Said Business School
▪ The Undoing Project, Michael Lewis
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Kevin.parry@cogenic.co.uk