Reporting back using a portfolio approach

Continuing from where we left off on the portfolio approach, after I so rudely interrupted myself by inserting a message about the Kings Fund.

People get enthusiastic about things they are INVOLVED in, or perhaps more importantly, have an influence over.

Therefore when you are reporting the successes of each project, the overall workstream, and the health economy, you need to tell the people doing the work and the people driving the changes/ initiatives/ successes forward, so they can see clearly that they ARE having an influence and it IS making a difference. Does this make sense?

Typically the progress report on a project tells you very little. It's presented in the form of a highlight report "we're on task 2.1.14 and it's going according to plan". I've even fallen out with clients because I want to tell them what successes are being achieved, and they want to simply see a highlight report describing the tasks completed and the next tasks. People LOVE to know they're making a difference, making progress.

So you've defined the benefits to be achieved, and how to measure them. Each project has adopted 2 or 3 of the workstream benefits that they will be measured by in order to demonstrate success. You can report on progress in delivering these benefits because the measurement regime is well structured and isn't too onerous, and besides, everyone understands the rationale for measuring their work this way and has built up enthusiasm.

Write the report each month. Remember, board members are human beings too. Of course they want something dry like a highlight report - like a hole in the head. Everyone wants something which celebrates success, which honestly highlights the areas which can be improved and what the project has agreed to do about it. You'll probably need to produce a traditional highlight report at the same time. But write the "real" report in ways that everyone can understand and get enthusiastic about.

Enthusiasm (and energy) is probably the biggest determinant for the success of any project. Anyone can turn up to work 9am - 5pm. They can do a good job, or a bad job. Nobody actually enjoys doing a bad job, but if they've been constantly put down and unappreciated, some people get jaded and start turning up to do the absolute minimum (of course others just leave). So tell them they've done a good job, tell them in print, and of course pat yourself on the back because you deserve it too!

An example of this can be found in the COPD work done in Easington, Co Durham. We made a difference, National Association of Primary Care agreed, and we won the 2008 Partnership category and 2008 overall award.

King's Fund event - The impact of personal health budgets on managing long-term conditions

Thought people might be interested:
The impact of personal health budgets on managing long-term conditionsWednesday 4 March 2009, 9.30am–1.00pm, The King's Fund, London
* Two weeks left to book your place *Dear Hugo
The recent Health Bill introduced measures to allow direct payments for health care to patients, including proposals to pilot direct payments to give patients greater control over their health care. As a health or social care professional this conference will give you the opportunity to focus on the practicalities and challenges of introducing and delivering personal health budgets. There are now only two weeks left to book your place at this conference. To view the programme please visit our website.
Conference features
Keynote speakerStephen Johnson, Head of Long Term Conditions Team, Department of Health, will focus on delivering services for people with long-term conditions. Find out more about our keynote speaker.
Case studiesOur practical case studies will include the local authority experience of individual budgets, how personal health budgets may be applied in the NHS; and the patient experience of using such budgets. Find out more about our case studies.
Delegates attending
chief executive, NHS trust
director for long-term conditions and unplanned care, primary care trust
project manager, local authority
lead community matron, primary care trust
chief executive, hospice
head of transformation, local authority
director of strategic partnerships, primary care trust.
Book your placeTo download the full programme please visit our website. Places are limited at this event, so book early to secure your place. Book online now.Sushma SangyamConference Manager

Continuing a portfolio approach to LTC Workstream

We ended last Wednesday's piece with a portfolio approach to Long Term Conditions. Just to reiterate, this will help to align individual projects to the overall strategic aims of the health economy, organisation, and workstream.

We'd just defined the main benefits across the whole workstream (World Class Commissioning competencies in brackets):

• quality of life (WCC 3)
• care per £ (WCC 5, 9, 11)
• units of appropriate care delivered (WCC 2, 7, 8)
• coverage of target population (WCC 3, 5, 10)
• future improvements (WCC 8, 10, 11)
• staff retention and recruitment (WCC 4)

Taking one particular area, COPD (Chronic Obstructive Pulmonary Disorder - respiratory disease)

In this case, for each of the high-level benefits listed, a benefit can also be measured within the COPD area:

High Level Benefit	in COPD
Quality of life	Motility, ability to get around Pt satisfaction
Care per £	cost of A&E services for COPD (HRG codes . . .) cost of admissions ( . . ) costs of community services 999 attendance and admission costs incurred/ saved using community services
Units of care delivered	numbers receiving treatment for each level of severity
Coverage of total population	estimates of population with COPD from deprivation levels, mapped estimates of population aligned to this using social marketing techniques numbers on register at GPs numbers on care plans
Future Improvements	innovative pathways use of innovative pathways resources needed for new pathways
Staff retention & recruitment	current staff levels & competences future requirements gap analysis completed and reviewed education commissioned

Individual projects within COPD, such as 'Stop Smoking', 'Pulmonary Rehabilitation', 'Home Management' etc) will record improvements to one or more of these benefits.

The benefits from each individual project can be aggregated (for example, if there are 120 fewer people smoking after 12 months than there were at the start, there will always be a question how many were as a result of 'Stop Smoking' which saw 200 clients, and how many as part of 'Get Active', 'Healthy Eating' or any number of other initiatives which could have an impact? The numbers from each programme can't always be added together) and make their contribution. The combined contribution to eg User Experience (to use the four quadrants from earlier) will make a contribution to the overall PE (Patient Experience, another name for User Experience) measure across the whole health economy.

Reporting back - next

Applying Portfolios within public service

So we already use portfolios of goals and benefits to achieve our personal ambitions. How about applying this portfolio approach to a group of service users, a strategic objective, or a whole health economy?
if you can't measure it, you can't manage it
More to the point, if you don't measure it (if the process of measuring is too complicated or time consuming), then you don't manage it and you can't see progress. This is actually quite disheartening.
But defining the benefits, the measures and the collection and analysis of a whole series of measures for each individual project is a step often overlooked in public service - I believe simply because the difference we seek to make is far more complicated than in the world of commerce. Whereas it's fairly easy to say "are we making widgets more profitably than we were before we made this change?", it's a little bit more difficult (and there may be time lags) to say "is the service user happier? is the service user healthier? do we have staff in place to meet our future needs?".

A Portfolio Approach

There's a solution, which solves a number of problems by its sheer elegance. And it is to step back, take a helicopter view.

Take, for example, Long-Term Conditions.

The benefits to NHS (and probably equally social care) locally include:

• quality of life for service users, measured by eg functional ability, social networking, patient satisfaction
• care per £: numbers of people served and to what extent
• units of care delivered, and whether this care is the most appropriate for each service user to meet their current and future needs
• coverage of the target population; are we giving some an exemplary service but neglecting others completely?
• future improvement; prevention, early detection
• staff retention & recruitment; understanding the future need and specific pathways, and ensuring programmes in place to have staff for this

More later

What is a Portfolio Approach?

We all have plans. Or, as the old saying goes, 'if you don't have a plan, you're part of someone else's plan' (in life, this applies equally to goals).
Each goal that you hold should have a plan; and of course each plan should have its goal. But why do you have goals? Usually because of the benefits you will enjoy. The desired benefit may have come first (I'm concerned that I want more energy, therefore I'll set a goal to be fit), or the goal may have come first; it's even possible that the plan came first (you of I joined an existing team and started to see what you would gain at a later stage).

Strategic Goals

We may have Strategic Goals (making a difference to my patient group; a holiday; an investment; the next promotion; director in the job title; family time), and SMART (specific, measurable, ambitious, realistic and timely) benefits attached to these goals.
Each day I hope the things I do will make progress on one or more of the SMART benefits, which in turn contribute to the strategic goals. For example: Tuesday's progress meeting contributes to service user experience, and to my career. Wednesday's course contributes to my career but in two distinct ways - improved skills and qualifications, and improved networking. This additional teaching role brings in extra money as well as all of the other goals. It works like a portfolio - each thing I do contributes to a number of benefits which in turn contribute to a number of goals. But the actual number of strategic goals is finite, in fact probably fairly small. A bit of a matrix.

Benefits by Portfolio - WHY?

I facilitated a group of stakeholders spread right across a health economy a short time ago, 

• to look at all the services they have and initiatives in progress
  
• do a gap analysis
• and work out what they need to do more of, what stays the same, and what to do less of

I usually start such groups by meeting them - not at the beginning (demographics and public health needs analysis), but where their minds and attention are, on the projects themselves.  I find I get quicker engagement and more willingness to subsequently accept change.

Anyhow, we were working through their list of 110 initiatives.  One initiative was to close down primary care-owned facilities in order to save on the facilities bill and raise capital by selling the plots of land.  In spite of an enthusiastic and able team, every time they tried to empty a building, it mysteriously filled up again.

Another initiative was busily moving services out of hospital and into primary care facilities, and had people actively looking for any underused facilities or resources and pressing them into service.  Finance vs. Commissioning - they talked to each other every day but nobody had noticed this clash of interests.

Isolation

Running each project, each service, in isolation is like trying to squeeze a balloon - you make an efficiency saving here, only to cause a problem for some other part of the patient pathway, a bulge in the balloon.

At the same time, having each project understand each other project would be unweildy - I well remember an IT department of 750 staff in a large engineering company.  Of these 750 staff, it appeared only 250 did any productive work - the rest were all liaison: desktops division had to have liaison with networks, applications, remote, database, hardware, security.  Applications division had to have liaison - you get the picture!

Mindnumbing demotivation

This gets incredibly expensive.  It also gets mindnumbingly demotivating for staff - health and care are vocational careers, services from the heart, and people want to make a difference.  Put people in a situation where 2/3 of the time nothing is actually achieved and they will get fed up and clock watch.

Benefits across the organisation

Managing benefits across the organisation, so each service and each initiative can see the difference they will make IN CONTEXT is an attempt to change all of this.

I have a workshop on Portfolio of Benefits on March 3 at the Information Centre in Leeds which formalises my consultancy across PCTs and health economies to date.  If you need to know more, please let me know and I'll send on contact details for the Benefits Network for Yorkshire and the Humber who are hosting this.

Is Nintendo Wii the future of computing?

How do you communicate best? Reports, presentations, web pages? All one-sided push technologies.
For thousands of years, humans (and primates before that) have communicated face to face, with words, tones and sounds, gestures and expressions. There is some work often quoted which says that over 50% of the meaning of a communication is in the body language, and less than 15% by the words used.
And yet, in the developed world, the bulk (numerically) of communication is by email and report. Words.
The position adopted by a computer user doesn't help - a screen between me and thee, fingers tied to the keyboard which limits the gestures I can make, chin on chest reducing the range of my voice.

Then along comes the Wii.  Suddenly expansive gestures are back on the menu; interactivity and making connections, team work whether in the same room or the other side of the world.  There's a room in the film "Minority Report" where Tom Cruise goes to sort through data.  He stands in the middle of the room, surrounded by see-through screens -- not cut off from the world but able to assemble his information and keep it to hand.

Gestures bring up pieces of information, gestures link and overlay them.  You would dismiss it as science fiction but already an enthusiast has demonstrated that this can be done on your computer using little more than a Wii controller and some reflective tape on your fingertips.

Google Earth is another candidate.  It's a way of exploring enormous amounts of data - in this casee physical and geographical features, but it could just as easily be mountains and valleys of statistics, marketing or production data.  Once again, an amateur programmer shows us how to make the leap from using a mouse to press on virtual buttons on a flat screen, to an interactive experience controlled, yes, by a Wii remote.

What do you do currently on a keyboard, that you would prefer to do standing up and with gestures?

• using mindmaps?
• conferencing?
• brainstorming / focussing / action planning?
• monthly progress reports?
• linking and overlaying data?

I wonder how long it will be before these remote controllers become ubiquitous and are used for all the things they could be used for?