Sunday, 23 November 2008

5-Case Business Case

I've often advocated the preparation of business cases specific to each of your target audiences.
Certainly you need to understand the financial case and return on investment. Each initiative needs to justify the investment made.
But in public service, the quality outcomes are what justify the investment (when Labour came to power, we as a nation invested approx £42billion in NHS each year. We now invest £100billion - if we wanted to SAVE MONEY we wouldn't go on putting more in).
This means that the business case needs to appeal to each of the major stakeholder groups: those investing the money, the main providers of service (staff, employers), the receivers of service (could be patients and public, though for improvements in process the customer will be other staff), and those who look for quality in public services (politicians, OSC, etc). In my terminology, Quality outcomes, User Experience, Staff Experience and Effectiveness.
I used to write a different business case for each one. Then I found that by combining the business cases, we ended up with a shorter more succinct document that answered every audience, and since everyone used the same document there was no suspicion.
Connecting for Health promotes the 5-Case model, which is broadly along the same lines (a business case for each stakeholder). In their case the 5 Business Cases are:

  • Strategic Case

  • Economic Case

  • Financial Case

  • Commercial Case

  • Management Case

ScorecardIt makes a lot of sense to follow a structured template and you can find out more by examining this example on the Connecting for Health web site.

Monday, 10 November 2008

A new politic

Boris Johnson, Barak Obama, both men without the "old school" political networks.
I hear the Lord Mayor of London is getting rid of some of the prestige projects of his predecessor, on the grounds that they cost too much for the benefits they bring. The President Elect seems to be prepared to turn his back on decades of 'pork barrels'(favours done for each other to win support for the policy they want to get through, famously named after inclusion of the building of a pork barrel factory in one congressman's home state, to support increased budget to the armed forces).
These outsiders may be a good thing. So much of what is eventually agreed by the powers that be (that be what?) are more about ego and prestige than actually doing some good for average Joe s and Jo s.
I will rejoice the day that the most beneficial (especially where this is backed up by evidence) projects go through! I would love to call those to account who cancel or undermine beneficial projects because the presence of a successful solution highlights how little they themselves have achieved.

Thursday, 6 November 2008

Obama's America - is prevention really better than cure?

During campaigning, President-elect Barak Obama hinted at a UK-style health service, with access to healthcare for all.
It does make a lot of sense - healthcare in USA is bringing the economy to its knees, as it simply costs too much for the economy to bear. UK-style healthcare not only costs a great deal less, but provides an excellent standard of care universally from before the cradle (maternity care) to beyond the grave (grief counselling). It's so good that many European countries are emulating it.
But is prevention (the UK model) better than cure?
That depends. Taking age-related conditions such as CVD (cardio-vascular disease), diabetes and cancer; prevention in the form of medication to control the symptoms certainly improves quality of life and probably allows an individual to contribute to society for many years. But it appears to cost much more. An early diagnosis leads to early treatment, which may continue for 40 years. At say $10,000 per year, this is a lot of money. Whereas a late diagnosis may cost $100,000 over a 6 month stay in hospital, after which the patient dies and the costs stop.
In practice, those PCTs (the NHS bodies responsible for purchasing care in each district or county) who have a higher average length of life are in deficit (spend more than they receive) although the average across the country evens out. This reinforces the above assertion - keeping your population alive costs more! As a society, we determinedly add life to years and years to life. For the USA, you need to make a clear decision that you are prepared to foot the bill.

Sunday, 2 November 2008

Successful Benefits Realisation

A bit like golf - keep your sight on the aims, but be aware of the pitfalls along the way.
Do you have compelling benefits that will result if this project is achieved? Does everyone involved agree that they are compelling? If not, does everyone involved have a compelling benefit relevant to themselves, that will be achieved through successful delivery of this project?
What about those who will lose from successful delivery. have you identified them and how they will lose, and have you plans in place to minimise the damage?

This is where a Benefits Framework is applied:

Creating a benefits framework ensures that everybody's benefits - and dis-benefits - are understood
Using a benefits framework tracks the delivery of BENEFITS (as opposed to MILESTONES)and ensures the stakeholder with the most to gain, knows all about the achievement
Effectively, you have PERFORMANCE MANAGEMENT but with the agreement, or even enthusiasm, of staff and stakeholders

Right Skill, Right Place, Right Time

We're all trying to look at workforce across multiple organisations. Emergency Preparedness, Flu Pandemic, Children's Trusts, Health and Social Care workforce groups (regional), and so on.
The key blockage appears to be motivation. Organisations want to know WIIFM (What's in it for me) or they aren't interested. Primary Care Trusts - PCTs (sorry, the local NHS) can give money to independent contractors (GPs, Dentists, Pharmacists - and more) to give up the information, but children's trusts, with the requirement to gather the information across health (multiple parts), social care, education, justice and housing, anyone I've missed? are required to find this information without the cash to offer incentives.
Blockage 2 is comparing like with like. A competence in an aspect of child protection may be called different things by different organisations/ services, and may be a whole course or multiple courses for one service, but a part of a qualification for another. How do you know what you've got?
What about people who aren't using all their skills in their current role (and do we ever?). They are part of the available workforce but they aren't in the current workforce. They need to be factored in when deciding how many more to train.
This is a key interest for me and I'd like to hear from more organisations wishing to understand their children's workforce. Contact me at