Master slide deck from the Excel in Health: Proposition event on Thursday 12 March at The Halliwell Jones Stadium, Warrington.

1. Excel in Health
Proposition

2. Three day programme overview
1. Understanding the NHS
2. Relevant knowledge and skills
for success
3. Applying your learning and
pitching your innovation

3. By the end of our session today, you will be able to:
● Write a value proposition
● Understand the importance of real world validation
● Design a business case

4. Find someone you’ve never met:
● Spend TWO MINUTES (each) sharing:
o What was the most valuable thing you learnt about
NHS structures?
o What was the most valuable thing you learnt about
NHS procurement and commissioning?
o What was the most valuable thing you learnt about
NHS culture?

5. ● What specifically are you offering to whom?
● Show how your solution fits into the existing pathway
● Do you complement commonly used technologies, or
do you displace them?
● Do you change the way certain business processes get
executed, or how care is delivered?

6. Discuss the VALUE of your INNOVATION in context of
what you now know about NHS structure, processes and
culture.
Respond to Reflection #1 in your workbook

7. Building your value proposition
Laura Boland
@innovationlaura

8. ● The principles of building an value proposition
● Understanding NHS need
● Evaluation your value
● Planning your value proposition
● What makes a good (and bad!) value proposition

9. ● Think back to reflection #1

10. A promise of value to be delivered and acknowledged and a belief from
the customer that value will be delivered and experienced (Wikipedia)
A statement that proves I know what they want and need, why they
want and need it, and why they should believe I will provide it to them
(Boland)
The value proposition should be a credible and coherent set of claims
that demonstrate the value of the product or service to health and care
providers and patients
The financial director and other decision makers of a Trust or a CCG
will want to see a good value proposition before they commit to your
innovation.

11. The NHS is a risk averse
organisation – they need to feel
it is riskier to maintain the
status quo than to make a
change
Lead your Value Proposition
with the Case for Change

12. Understand
Evaluate
Construct
Test

13. Understand
Evaluate
Construct
Test

14. NHS
Needs
Product
benefits

15. 1. Is the problem Unworkable?
2. Is fixing the problem Unavoidable?
3. Is the problem Urgent?
4. Is the problem Undeserved?
If you don’t fully understand what their problem is and how they’d manage it
without you, you can’t isolate your UNIQUE VALUE.

16. The need behind the need
● Is the need in Primary, Secondary or Social Care?
● What is the burden of that disease or condition?
● Why isn’t current practice sufficient?
● Which professionals will prescribe, recommend or implement
your product?
● Who is going to pay for it?
● What are the higher level strategic drivers as well as
operational need?
● How does the problem impact the lives of the patients?
● What is the cost to the system of both the disease and the
current standard of care?

17. 1. Take a few minutes to think through what you know about
the problem you are trying to address. Can you answer
your 4 U’s?
2. Work through the checklist to understand the need behind
the need. Gaps = a good place to start your research.

21. “Our ultimate objective, as NHS England and central government, is
the provision of better care and improved health outcomes”
“Focusing on the monetary value of the challenge risks missing the
real essence of the task facing the NHS, which is about getting better
value from the NHS budget.
This means maximising the outcomes produced by the activities the
NHS carries out, while minimising their costs.
Framing the debate in terms of efficiency and costs also risks losing
the opportunity to engage clinical staff in the challenge of changing
the way in which care is delivered.” (Kings Fund)

22. Understand
Evaluate
Construct
Test

23. Find out if your breakthrough product or service is unique
and compelling
• Does your product offer transformative benefits over the status quo?
• Is your product unique?
• What measurable value does your product deliver?
• Is it cost-effective compared to the alternatives?
• What resources will the buyer need to implement your solution?
• What are the risks?

24. Value = outcomes / cost
Any cost-effectiveness analysis
should relate back to your core
value proposition:
● What is the need?
● Which outcomes can you
deliver to address that need?
● How much will it cost?

26. 1. Use the EVALUATION CHECKLIST to identify gaps
2. Consider OUTCOMES and COSTS you could measure to
demonstrate your product is a solution to identified unmet
need
Task

27. Supporting evidence
VP
Burden of
Disease Data
Evidence of
Unmet Need
Clinical Trials Cost-Models
Economic
Evaluations
Case Studies

28. Gain / Pain ratio
● NHS is risk averse
● SMEs must offer a higher Gain / Pain ratio
● Non-disruptive innovation is easier to adopt

29. Attributes that aid innovation adoption
Relative advantage *
Low complexity
Compatibility / Interoperability
Observability
Trialability
Potential for customisation
Ease of use

30. 3. Construct
Understand
Evaluate
Construct
Test

31. Constructing your value proposition
Are not:
• Visions or mission statements
• A list of product features
• Catchy slogans (although they can feature)
• A data dump
• A proposition statement
They are:
A statement that proves I know what they want and need, why they want
and need it, and why they should believe I will provide it to them.

32. My experience – fatal flaws
Talking about a benefit
that isn’t of any benefit
Taking the wrong
message to the right
people, or the right
message to the wrong
people
So many messages…and
so much data…and cost
models…and some more
evidence….and what
were you saying again?!

34. The good
• Estimates suggest that around 216,000 individuals are chronically infected
with the hepatitis C virus (HCV) in the UK. Hospitalisations, inpatient days and
mortality linked to HCV diagnoses are all increasing.
• Management of HCV-related end stage liver disease (ESLD) and
hepatocellular carcinoma (HCC) can be very expensive. Could the cost of
managing patient illness be better invested in presenting disease
progression?
• Achieving Sustained Viral response (SVR) with medication improves clinical
outcomes for people with HCV by reducing morbidity, mortality and liver
transplants.
• SVR rates for treatment naïve patients with Peginterferon alpha + Ribaviron
(PR) are less than 50% and less than 22% in treatment-experienced patients
• In treatment-naïve and treatment-experienced patients, an INCIVO-based
regimen offers the potential for significantly higher SVR rates, even in patients
with advanced fibrosis or cirrhosis.

35. Don’t be afraid to keep it simple

36. Value proposition structure
1. The Issue (why it’s risky not to change)
2. The Solution
3. The Gains (benefits over the product or service
alternative)
4. The Value
Make it specific: tailor the language and the need to your
audience and the supporting cost-effectiveness data to the
patient group / Trust / CCG / region.

37. 4. Test
Understand
Evaluate
Construct
Test

38. Fatal flaws
Not identifying a real problem
Not identifying a real patient or system benefit
Right person, wrong message
Lacking evidence
Too much emphasis on minor details
Getting too creative with the numbers
Blinding them with science
Being vague or too complex

39. Summary
Understand
Evaluate
Construct
Test
• Articulate your VALUE clearly.
• Always recognise the constraints of the system into which the innovation is to
be introduced (the IMPLEMENTATION CHALLENGE)

40. Real world validations
What exactly are they and how are they useful?
Laura Boland and Dr Rafaela Neiva Ganga

41. Why evaluate
• Evaluation is essential to prove your product works
• Evaluation data can be evidence, experience and
endorsement
• Your value proposition must be backed up by robust
evaluation
• Why is evaluation of your innovation important to you?

42. Why real world validation?
● Real-World Evidence (RWE) is the clinical evidence regarding the usage and
potential benefits or risks of a medical product derived from analysis of RWD.
● Real-World Data (RWD) is the data relating to patient health status and / or
the delivery of health care routinely collected from a variety of sources, for
example: Electronic Health Records (EHRs), Claims and billing activities,
Product and disease registries, Patient-generated data including in-home
settings, Data gathered from other sources, such as mobile devices.
 RWD and RWE are playing an increasing role in health care decisions. This data holds
the potential to allow us to better design and conduct studies in the health care setting.
 Randomized Controlled Trials (RCT) are time and resource-intensive, lack of
generalisability and typically restricted to evaluating specific interventions one at a time.

43. What is real world validation (RwV)?
• Real world validation is a cost-effective mix-method user inclusive
observational study to assess the impact and benefits to patients, staff and
the health economy, in a non-controlled environment, of an innovation that
has already undergone a pilot process.

44. Task: real world validation of your innovation
Think about your perfect real world validation to demonstrate the
value of your product:
1. In one sentence explain your innovation.
2. Explain how your innovation is different / better / a step forward from your competition.
3. Explain the patient or system benefit you may want to prove (health and economic
outcomes).
4. Has your innovation undergone a pilot study or evaluation?
5. What data do you have that can be used to support the RwV (pre and post intervention,
control group, etc.)?
6. In how many sites has your product been tested? Were the results replicated?
7. If your product hasn’t been piloted, where would your ideal test site be?

45. Task: real world validation of your innovation

46. Task: real world validation of your innovation
Think about your perfect real world validation to demonstrate the value of
your product:
1. In one sentence explain your innovation.
2. Explain how your innovation is different / better / a step forward
from your competition.
3. Explain the patient or system benefit you may want to prove (health
and economic outcomes).
4. Has your innovation undergone a pilot study or evaluation?
5. What data do you have that can be used to support the RwV (pre
and post intervention, control group, etc.)?
6. In how many sites has your product been tested? Were the results
replicated?
7. If your product hasn’t been piloted, where would your ideal test site
be?

47. E.g. RwV – Oxford Academic Health
Science Centre
Point of care flu testing in
emergency departments
• Using the test in the emergency
department enabled quicker
treatment decisions and faster
patient turnaround, leading to
better patient flow and
management during a time of
intense pressure
• After evaluating a different test in
each hospital over the winter of
2017/18, the preliminary health
economics showed that average
lengths of stay were halved, and
there was a saving of roughly
£200 per patient tested.

49. The evaluation pathway
It can help to break evaluation down into an evaluation pathway. The
pathway is made up of four evaluation stages:
1. Setting outcomes
2. Collecting evidence
3. Analysing & reporting
4. Acting on your learning

50. Logic models
What is a logic model?
A logic model presents a picture of how your intervention or initiative is
supposed to work. It explains why your strategy is a good solution to the
problem at hand.

51. Logic models
Inputs
Your time
My time
Venue &
travel costs
Activities
Presentation
Questions
Worksheets
Groupwork
Outcomes
Under-
standing of
real world
validation
First drafts of
a logic model
Ability to
make a start
on your real
world
validation
Impacts
The
programme
is a
success.
You can
demonstrate
the value of
your product
to the NHS

52. Logic models
Logic models capture and summarise your validation project. There are
different approaches, but all share core elements*
Inputs
Resources
used
Activities
Things
done
(measured
by outputs)
Outcomes
Effects of
activities
Impacts
Broader
societal
‘goods’
Typically broken down into
initial / intermediate and final,
or short- and medium- term
* Terminology may vary, but the
basic concepts remain constant

53. Logic models
Why use a logic model approach?
● Visually engaging approach
● Brings together existing evidence (and identifies gaps)
● Logically links activities and effects:
● Identifying barriers
● Clarifying assumptions making success more likely
● Provoking thought and triggers questions
● Builds understanding and promotes consensus
● Provides a common language
● Provides common point of reference

54. Practical exercise
• Have a go at a logic model. Think about the inputs,
activities and outputs that would best validate your
innovation.

55. Innovation Agency Online Course:
Evaluating your innovation
A six module course:
1. Introduction to Evaluation
2. Types of Evaluations
3. Economic Evaluation
4. Real World Validation vs Randomised Control Trials
5. Planning an Evaluation
6. Getting the best out of your findings
Self-paced course, 1-3 hours per module.
Intended to develop your understanding of the methodologies of evaluation and
the ways you can use your findings to demonstrate the value of your innovation in
a health and care setting.

56. Business case
Lorna Green

57. A business case is used throughout the NHS to provide
the basis for change and transformation.
It could also be used for the basis of a funding or
tendering application.
The content of a business case can vary depending
upon the specific purpose but generally all have key
elements
A business case is the bringing together of all these key
elements in a coherent way.

58. Your Product / Service will not be adopted (or
funded)!
But if luckily adopted, a poor business case will…
Limit opportunity for spread.
Good Business Case will facilitate both spread and
adoption.

59. NHS unmet
clinical need
Key Activities Value
Propositions – the
Benefits
Patient Engagement Management
Team
Risks
Evidence Base Commercialisation
– route to market

60. What is the health or social care problem to be
addressed?
What is the impact on patients as well as health and social
care services?
How does your solution support the NHS Long Term Plan
and other strategy policies?
What is the market size?
Which patient population is affected?
What is the NHS cost burden?

61. Presenting your product that meets the System Needs.
Concise summary of the products or services to be
offered
Priorities focus - Answer the Exam Question not your
own Question!
How is your solution different to existing practise?
Any Intellectual Property?

62. What is your Value / Benefit that you
are offering?
Discussed in earlier session so take the
learnings from that.
Should consider:
NHS Cost savings
Patient Outcomes
Operational Efficiencies

63. How have patients been included within your
product / service development?
What is the impact on patient experience?
What feedback have you had from patients?
Are there any barriers from utilisation by patients?

64. Channels to the NHS
Commissioning intentions
procurement routes
Size of market
Pricing structure
Comparison with existing products?
Requirements for, and barriers to, entry

65. The basis on which the efficacy of your product / service
is supported?
Ideally with a RwV – Real World Validation
As a minimum, theoretical evidence or other research
evidence that may exist
Stronger the evidence base, the easier the adoption.

66. Clinical adoption
Technology/functionality
Competition
Operational / financial risk
Legislation/regulation
Product liability

67. Who are the key members of the team – brief summaries
of background & experience?
How will the company be organised?
Who will do what?
How will they be monitored?
Are there any gaps in the team currently – if so, how will
they be filled?