Benefits Driven Change Using some examples from the ISIP Demonstrator Programme, this guide shows how a benefits approach to change can be used to deliver sustainable service transformation more quickly. It also helps the care community, including

1
Benefits Driven ChangeUsing some examples from
the ISIP Demonstrator Programme, this guide shows
how a benefits approach to change can be used to
deliver sustainable service transformation more
quickly. It also helps the care community,
including external partnerships, to be more
flexible in responding to changing circumstances.
A Practical Guide for the NHS
2
What is a Benefits Approach?
A Benefits Approach is a cultural thing it
applies to every stage of the project or change
programme and should support, not get in the way
Programme or Project Planning At the planning
stage, engage stakeholders in the process of
identifying shared benefits as well as potential
individual benefits or disbenefits.
Implementation To keep stakeholders and staff
engaged and focussed, when reporting progress use
this means and remind people of the benefits
sought. Use easy-to-understand measures and
presentation e.g. Dashboard.
Case for further investment If the project has
been a success then you may want to expand
alternately another organisation may want to copy
your project. Report in terms of benefits.
Delivery and Achievement Focus on the benefits to
patients, to clinical outcomes, to stakeholders,
to the whole community. LOS or admissions
avoided are not benefits, though they can lead to
benefits.
3
Why does a Benefits Approach matter?
A benefits approach will help you to engage
different stakeholders and organisations, and
also enable you to establish baselines and
quantify improvements. Whether you are trying to
motivate yourself or another (e.g. Cognitive
Behavioural Therapy CBT), or changing a
community, the principle is the same.
4
Stakeholder Benefits
Priority Objectives are national or local targets
e.g. reducing inequalities Benefits may be
stakeholder-specific or shared, and are the
motivating force Outcomes represent the future
state of the service, what it has to be like to
deliver the benefits Projects and Actions to
Change are what you do to achieve the outcomes
Progress isnt always direct, but it should
always be progress
See also NHS ISIP Practical Guide on Stakeholder
Engagement
New Economics Foundation Measuring real value
A DIY guide to Social Return on Investment
5
Project-led approach to Benefits

• Asset or Investment exploitation Method
• From the Project Plan, work forwards to determine
  where the benefits will be

Project led approach starts here
More patient contacts deliver more care at home
More care at home reduces need for hospital
attendance and admission
More community staff to attain more patient
contacts
6
Benefits PlanningAn alternate approach that has
been adopted in the LHC Demonstrators

• See ISIP Benefits Dependency Mapping Tools
• Decide what you want, and whats important about
  that
• Measure whats important, not just whats easy
• Make sure each project or output delivers the
  benefits that you set out to achieve, and
  contributes to the priority objective

7
Demonstrator Experience Illustrating a Benefits
Approach
8
Demonstrator Experience The Tees ENT

• Our situation
• 74 of patients seen in an outpatient setting and
  then discharged probably suitable for a
  community setting
• National targets to deliver care closer to home
• Enthusiasm for changes to service from the
  Practice-Based Commissioning consortia
• Independent Reconfiguration Panel report
  recommendations, supported by Secretary of State
  approval, indicate that out of date buildings
  should be replaced and that new services should
  be in a well-situated location complemented by
  well-developed primary care community services
• ENT service currently provided across two
  hospital sites which has made patient
  satisfaction difficult to gauge.

• What we did
• Clinicians reviewed the existing data on waits
  and cases referred, to examine scope for redesign
  and anticipated benefits
• Soft market assessment and evaluation of
  expressions of interest from potential service
  providers
• Worked in partnership with local ENT providers to
  develop new patient-centred services
• Specifications for facilities and equipment
  requirements were developed by a working team
  including specialists, GP, audiologists and
  nursing staff with additional input and guidance
  from infection control colleagues
• Detailed work around patient pathways, service
  exclusions, diagnostic requirements,
  administration pathways and reporting commenced
  after the overall care model was agreed between
  partners.

• What we achieved
• Referring appropriate cases direct to the
  community-based service will reduce waiting times
  to below 4 weeks and the location and
  reassurance of an early appointment should be
  more convenient to patients evaluation of
  patient and GP satisfaction will be a priority
  post go-live (October 2007)
• Project contributes to national local targets
  including 18 week target, delivery of Care Closer
  to Home and supporting Practice Based
  Commissioning
• Anticipated financial savings are significant.
  One of the major benefits of the project is the
  release of savings to invest in additional care
• Development of a skills and knowledge base within
  the PCT around service redesign.

9
Demonstrator Experience Walsall Dashboard

• Our situation
• During 2006, Walsall tPCT started to use the ISIP
  process to plan transformational change
  programmes for Urgent Care, LTC the 18 Weeks
  Referral to Treatment initiative
• Readiness to Change had been assessed by a
  group of Directors from across the LHC showing
  early development of capability
• The aim of the demonstrator project was to
  develop a whole systems benefits realisation
  framework a high level dashboard, to ensure
  that programmes of benefits led change were
  delivered
• The PCT improved its capability to deliver change
  realise benefits across the programme portfolio
  
• Help from the local change consultant was
  required to improve capability across the whole
  process.

• What we did
• Completed a diagnostic process, which made
  recommendations to address gaps and areas for
  improvement
• Recruited and trained programme managers and
  commissioners to expand capability
• Reviewed the Benefits Realisation Plans
  finalised benefits at programme level (UC, LTC,18
  wks palliative care) with a basket of
  supporting metrics
• Developed a benefits realisation framework
  covering project, programme and portfolio levels
• Portfolio level benefits
• Improved clinical outcomes
• Improved business processes
• Improved patient experience
• Best use of resources
• Agreed a process to develop the dashboard
• Developed an approach to mainstreaming ISIP.

• What we achieved
• Good governance structure across LHC to support
  delivery
• Trained programme managers and commissioners in
  place
• A well-developed reporting structure to monitor
  progress, including dashboards (at-a-glance
  performance and benefits achievement reports) for
  the steering panel and protocols for dashboards
  specific to each organisation
• Agreed approach mainstreaming ISIP
• Programmes are being delivered to timescale and
  benefits are being realised.

10
Demonstrator Experience Liverpool Scheduled Care

• Our situation
• The stakeholders (PCT and acute Trust) in
  Liverpool were clear about the aims of the
  overall programme
• There were a number of existing projects set up
  to achieve specific parts of this, but they were
  not coordinated well
• Each project had its own project manager and
  project support office, and in many cases its own
  steering group.

• What we did
• Using the Benefits Dependency Network Planning
  Tool, we were able to identify all of the
  existing projects and all of their expected
  outcomes and the benefits that they contributed
• Our first attempt was too messy it was
  difficult to follow through on an individual
  project and see where it contributed, and
  difficult to see which projects contributed to
  specific priorities and benefits
• The Benefits Dependency Network planning tool
  enabled us to group together similar projects and
  develop a governance framework and an overarching
  steering group, with project groups responsible
  for clusters of projects.

• What we achieved
• A single governance structure reduced
  administration, made best use of scarce skills,
  and delivered more, faster within finite
  resources
• We understood the connections for example
  reducing waste (objective) meant resources being
  applied effectively and freed up resources for
  new services (benefit), and we could demonstrate
  this
• Working together on projects encouraged us to
  come up with new services which could benefit the
  whole community provider, commissioner, patient
  and service user, and staff.

the difference is everybodys working together,
whereas before it was more fragmented Programme
Manager
11
Demonstrator Experience Walsall Stroke Project

• What we achieved
• Measures to demonstrate financial efficiency,
  clinical outcome, care and efficiency have been
  agreed and are being reported
• LOS has fallen
• The new pathway has been implemented
• Community resources are in place
• 18 beds have been removed
• Transitional financial arrangements are in place
  to support risk sharing between hospital and PCT
• Planning unbundling of tariff to embed changes.

• Objectives
• Improve patient care by implementing a new care
  pathway
• Redesign Stroke Rehabilitation to shift care into
  a range of community settings home or
  intermediate care settings
• Thus reduce ALOS (Average Length of Stay)
• Thus reduce number of stroke beds by 18 to enable
  PFI.

• Our situation
• Length of Stay (LOS) for stroke patients in
  Walsall was longer than national benchmarks
• The hospital needed to reduce beds to support the
  PFI development
• Management of financial risk for the hospital was
  an important consideration
• Commissioners will need to demonstrate maximum
  efficiency in the longer term.

• What we did
• PCT and hospital jointly developed a new pathway
• The pathway involved hospital AHPs in outreach
  and early handover to community teams
• Community teams are in place to provide
  rehabilitation in the community, which will
  integrate people back into their social networks
  leading to better health outcomes
• We reported the current LOS regularly so everyone
  could see progress.

12
Demonstrator Experience West Herts Dermatology

• Our situation
• Some of the benefits sought by the PCT
  (commissioner) were perceived by the hospital
  (provider) as a disbenefit, e.g. loss of income
• As we mapped the stakeholders (patient, staff,
  PCT commissioner, provider) and their direct and
  indirect benefits, we realised that this effect
  (of conflicting views of benefits) got worse.

• What we did
• We focussed on each benefit in turn, starting
  with the most important
• This allowed us to examine what contribution each
  benefit would make, and what needed to be in
  place to achieve that from each side
• A key challenge was to access data which would
  verify the benefits profile projected.

• What we achieved
• Stakeholders who might have been rivals now work
  together to deliver patient-centred services
• Where transfer of care outside hospital will
  release capacity, the hospital trust is planning
  to reuse this to provide new services (see map
  below)
• A coordinated approach retains the capacity and
  flexibility.

Creative use of spare provider capacity
13
Key Messages
You will always meet opposition to change, and it
will always take longer than you thought focus
on the benefits you will achieve, and if you
cant do it all in one go then take smaller steps.
Be flexible when priorities or circumstances
change, review what actions are needed to ensure
the benefits get delivered.

• Group existing and new projects into programmes,
  with a single steering group and governance
  structure. Understand cause and effect without
  causes (action) the effects (delivery) wont
  happen.

• Keep it simple dashboard-style reporting, with
  the benefits relevant to the stakeholder group,
  will be easier to follow. Different stakeholders
  may need different dashboards.

Where is the evidence? Data which shows the
current situation (baseline) and monitors
progress can be hard to obtain (e.g. IMT systems
dont align), but is vital when demonstrating
that benefits are being delivered.
Report achievements regularly and widely keep
people motivated and involved.
14
Where to go for more information

• External references
• Delivering Quality and Value ISIP Guide
  http//www.isip.nhs.uk/guidance
• ISIP Practical Guide Developing a Shared Vision
  http//www.isip.nhs.uk
• ISIP Practical Guide Stakeholder Engagement
  http//www.isip.nhs.uk
• RTC Stage I Benefits Planning http//www.isip.nhs
  .uk/roadmap
• Measuring real value A DIY guide to Social
  Return on Investment (New Economics Foundation)
  http//www.neweconomics.org/gen/z_sys_PublicationD
  etail.aspx?pid241

Named contacts Leonie Beavers, Director of
Strategy / SRO, Liverpool PCT, leonie.beavers_at_live
rpoolpct.nhs.uk Nicola Allen, Head of Planned
Care Commissioning / Programme Manager, Liverpool
PCT, nicola.allen_at_liverpoolpct.nhs.uk Andrea
Bigmore, Head of Change Programmes, Walsall tPCT,
andrea.bigmore_at_walsall.nhs.uk Julia Schofield,
Consultant Dermatologist, West Herts Healthcare
Trust, julia.schofield_at_whht.nhs.uk Amanda Yeates,
Project Manager, West Herts Healthcare Trust,
amanda.yeates_at_whht.nhs.uk Phil Whitfield,
Associate Director of Planning and Performance,
Hartlepool PCT, philip.whitfield_at_hartlepoolpct.nhs
.uk