This document discusses lessons learned from implementing benefits management in healthcare organizations. It provides examples of challenges encountered, such as lack of health-specific examples, difficulty balancing stakeholder needs, and pressure to justify existing plans rather than enable radical change. Effective benefits management requires resources for enablers rather than just identifying them as limiting factors. While some local groups adapted the tools quickly, broader training efforts were difficult. The application of existing knowledge could significantly improve healthcare outcomes.
5. ISIP Organisation
ISIP Leadership
• Top-Team sponsorship, SRO within the Service
Improvement community. Workforce, National Institute
and CfH involved (people, process and technology)
ISIP Central Team
• Production of guidance, senior stakeholder management
and communications
ISIP Field Support
• One person / SHA to support local planners and
implementers as they learn the method and apply it.
7. Examples
• Lack of health-specific examples
• Not invented here
• Worked example in a multi-agency
environment missed the right balance
8. Benefits
• What’s a benefit?
• How many iterations to get them
– 2 workshops for a weak set
– 12 workshops for a good set
• More 2s than 12s
A benefit is a result that a
stakeholder perceives to be of
value
9. Squeezing old plans to fit
• Lack of radical change
– Poor grasp of strategic objectives
– BM to validate / justify existing plans
• Some degree of rationalisation
15. Cancer & Palliative Care Integrated Change
Programme Benefits Dependency Network
Enablers
1. Commissioning &
practice based
commissioning
Projects
Cancer & palliative
care NICE guidance
implementation
Outcomes
Effective use of
capacity
Increased diagnostic
capacity
2. Modernising
information
management &
technology
Primary care service
improvement initiatives
3. Workforce
modernisation
Secondary & tertiary
care service initiatives
4. High impact
changes
5. Integrated care
pathways
Partnership forum
initiatives
Improved primary care
engagement in cancer
& palliative care agenda
Prevention & screening
initiatives
Achievement of key waiting
times
Increased number of
diagnosed cancers
referred via the USC route
Improvement in patient
satisfaction
Improved care
pathways
Increased participation
in screening,
prevention and
education programmes
for target population
All patients better
informed about choices
6. Estates &
facilities
modernisation
Benefits
Improved
communication along
whole care pathway
Year on year % reduction in
incidence of cancer in
identified areas of
deprivation
Achievement of prevention/
screening targets for
specific target population
Consistent approach to
management of cancer &
palliative care in all GP
practices
Priority
Objectives
Improving
access &
choice
Delivering
high quality
managed
care
Reduction of
cancer
mortality 20%
by 2010
Improving
patient
experience
Improving
prevention &
screening
16. Primary Care Service Improvement
Benefits Dependency Network
Enablers
Projects
Outcomes
Effective use of
capacity
1. Commissioning &
practice based
commissioning
Increased diagnostic
capacity
2. Modernising
information
management &
technology
3. Workforce
modernisation
4. High impact
changes
5. Integrated care
pathways
6. Estates &
facilities
modernisation
Primary care service
improvement
initiatives
Workstreams:
1. Primary care toolkit
2. End of life initiative
(gold standards)
3. Prostate injection
therapy
4. Breath testing
5. Mainstream
primary care service
improvement
workforce
6. Cancer referral
directory
Improved primary care
engagement in cancer
& palliative care agenda
Benefits
Achievement of key waiting
times
Increased number of
diagnosed cancers
referred via the USC route
Improvement in patient
satisfaction
Improved care
pathways
Increased participation
in screening,
prevention and
education programmes
for target population
All patients better
informed about choices
Improved
communication along
whole care pathway
Year on year % reduction in
incidence of cancer in
identified areas of
deprivation
Achievement of prevention/
screening targets for
specific target population
Consistent approach to
management of cancer &
palliative care in all GP
practices
Priority
Objectives
Improving
access &
choice
Delivering
high quality
managed
care
Reduction of
cancer
mortality 20%
by 2010
Improving
patient
experience
Improving
prevention &
screening
17. Dialects
• Within three months people had adapted
the tools to suit themselves
• Five flavours of BDN
18. Resourcing and selling
• Small groups of local experts
• Capable of doing but not capable of
training others
• Selling the concept within organisations
was hard.
• Seen as Management School BS
20. Why does all this matter?
• “The application of what we know
already will have a bigger impact on
health and disease than any drug or
technology likely to be introduced in
the next decade.”
Sir Muir Gray Director of Clinical Knowledge, Process and Safety
NHS Connecting for Health
Here’s the sort of thing that interferes with rational decision making. There’s some excellent stuff on the ways that psychology affects economic decision making in Daniel Kahnemann’s book Thinking, Fast and Slow. Prediction – pre Business Case Optimism Bias – Expecting too much in terms of results, cost and time despite previous experience. This is now recognised and often included in business cases. Which means people have started gaming with it, claim double . Strategic Misrepresentation – Flyvberg, consciousdeliberatelying to get the business case approved. International analysis of transport infrastructure, just about every business case lied about the potential benefits to be achieved.Anchoring – Anchor on the first estimate, no matter how inaccurate and then fail to change sufficiently despite knowing it was wrong. It’s why salespeople start on an impossibly high note, “This is the best thing since sliced bread”. It will still feel that way even when the facts have destroyed their argument. WYSIATI – What You See Is All There Is (Kahnemann), ignoring the existence of other evidence, failing to look for alternatives.Delivery – work in progressIllusion of Control – Assuming it all goes to plan… Belief that you have full control of the situation, not mitigating the risks.Confirmation Bias – Filtering the evidence to fit your expectations, seeing only what you want to see.Affect Heuristic – Seeing the positive in things (and people)we like, and negative in things we don’t. The halo effect of the singer, not the song. Framing – Making a choice dependent on the way the options are phrased. “It could be you!”, or “It’s almost certain it won’t be you.” Good news / bad news stories in performance reports.Regression to the Mean – A knee-jerk reaction to a one-off. Reward and punishment are both usually followed by a more average result, hence we believe punishment motivates.
Mental Health has a tremendous number of strategy papers. Initially these were listed as enablers to the project. Then it was realised that they brought no resources. The many MH strategies were enablers without resources. They were really limiting factors. They told people how the job should be done but gave no tools to help do it.In the second draft BDN they were removed from the Enablers and included as limiting factors in the Activities, i.e. business processes designed to meet strategy DH requirements .
Sometimes people just don’t want to take part. This workshop was 30 mins reluctantly tagged onto the end of another meeting.
The Project Manager took away the previous diagram and produced this from his existing plans. It met his requirement of taking part in ISIP but bore little resemblance to what his management colleagues had discussed (which may have been a good thing).