Making Best Possible Value Decisions
Caroline Clarke
Deputy CEO and CFO – Royal Free London NHS Foundation Trust
SRO for Best Possible Value programme
London Clinical Senate Forum
29th October 2015
LON
This session will cover:
Overview of Best Possible Value Tools
VALUE
i. Defining Value: The Value Equation
ii. Why Focus on Decisions?
iii. The Decision Effectiveness Framework
DECISIONS
Engagement
i. Understanding Value
ii. Knowledge Transfer
iii. King’s Fund Toolkit
ENGAGEMENT
LON
Value equation and a menu of outcomes and metrics provide a
“common currency” for decision-makers
Outcome
1
Clinical
outcome
e.g. population health,
survival rate, extent of
functional recovery
2
3
Patient
experience
e.g. comfort, treatment
by staff, waiting time,
ease of access
Safety
e.g. diagnostic error,
post-op complications,
infections
Value
Resources
4
5
Revenue costs
Capital costs
e.g. income, time, salaries, system
maintenance, facilities
e.g. Investment in infrastructure /
equipment
Source: based on Michael Porter (HBR, NEJM), HFMA “Value in Health Care”, Delivery Group interviews
LON
To deliver value we must have
effective decision-making
LON
Why focus on decisions? Organisations have become more and
more complex; a new approach is needed to ensure they’re effective
“The matrix is becoming a cube”
CUBE?
MATRIX
EMPOWERED
BUSINESS UNITS
COMMAND
AND CONTROL
A focus on decisions can cut
through this complexity
Source: Adapted from ‘The Future of Work’, Thomas Malone
LON
Why focus on decisions? Research shows a focus on decisions
supports outperformance on financial and people dimensions
5 YEAR AVERAGE PROFITABILITY
(RETURN ON CAPITAL EMPLOYED)
HOW LIKELY WOULD YOU BE TO
RECOMMEND YOUR ORGANISATION
AS A PLACE TO WORK?
Note: High decision effectiveness range = top quintile of “decision multiplier” scores; Low/Mid = all other
Source: Worldscope; Bain decision and organisation effectiveness survey
LON
What makes a decision effective?
Decision effectiveness = quality, speed, yield, effort
Quality
Speed
x
“How quickly do you
make decisions vs.
stakeholder
expectations?”
Yield
Effort
-
“How often do you
execute decisions as
intended?”
“Do you put the right
amount of effort into
making & executing
decisions?”
Faster than…
“How often do you
choose the right
course of action?”
x
Slower than…On par with…
“lower is
better”
Decision Effectiveness Benchmarks
High decision effectiveness range = top quintile of decision effectiveness scores; Low = bottom quintile; Mid = all other
Source: Bain decision and org effectiveness survey Jan 2013 (n=1001)
LON
How well do we make decisions today? NHS performs below
average on each category, particularly on speed
Quality
Speed
x
“How quickly do you
make decisions vs.
stakeholder
expectations?”
Yield
Effort
-
“How often do you
execute decisions as
intended?”
“Do you put the right
amount of effort into
making & executing
decisions?”
Faster than…
“How often do you
choose the right
course of action?”
x
Slower than…On par with…
“lower is
better”
Decision Effectiveness Benchmarks
High decision effectiveness range = top quintile of decision effectiveness scores; Low = bottom quintile; Mid = all other
Source: Bain decision and org effectiveness survey Jan 2013 (n=1001)
LON
A Decision-Effectiveness
Framework
LON
LON
“The decision effectiveness framework is about
looking at value, having good governance
and a clear structured process”
LON
What
Who
When
How
Decision Charter Example: Liverpool CCG
LON
What
Who
When
How
Criteria and metrics: Liverpool
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's
LON prior written consent
The RAPID® framework provides a simple tool
for allocating decision roles
WHAT THE ROLES ARE
HOW THE ROLES INTERACT
Recommend a decision or action
Recommend
Agree
Perform
Input
Formally agree a recommendation
• Must be consulted
• Must work with R to resolve issues
Agree
Input
Input
Recommend
Perform a decision once
made
Decide
Input
Decide
®
Provide input to a recommendation
• Must be consulted, may or may
not be reflected in final view
Perform
Make a final decision and commit
the organisation to action
RAPID is a registered trademark of Bain & Company, Inc.
LON
RAPID should reflect what will
work in 90% of situations
LON
bpv.futurefocusedfinance.nhs.uk
 Training videos and e-learning
module
 Example handbooks
 Demonstration site case studies
and interview feedback
 Collection of other value tools
 Academic library of value in care
systems
 Signposting to affiliates
 Catalogue of data sources
 Community learning and shared
practice area – forum and blogs
LON
TOP TIP:
“Clinicians should be involved as much as possible;
consistent attendance across the board allows for a
more streamlined and effective process.”
LON
How well do we currently
understand value?
LON
“Our level of understanding
is very good / good”
“Clinicians, you have a great deal / fair
amount of understanding”
Where the money to run their service
area comes from
68%
71%
Decisions about workforce levels
Managing costs to an approved budget
61%
69%
Managing costs to an approved budget
The cost of running their service area
60%
62%
Where the money to run their service
area comes from
Decisions about workforce levels
59%
62%
Getting better value for money for
patients from the money available
Getting better value for money for
patients from the money available
55%
60%
The cost of running their service area
Putting in place efficiency savings
plans
53%
59%
Putting in place efficiency savings
plans
Decisions about equipment
replacement
46%
58%
Decisions about equipment
replacement
The procurement process
37%
38%
The procurement process
Base: All valid responses who are clinicians (179)l All valid responses who are finance staff (368) : Fieldwork dates : June to July 2015
LON
Source: Ipsos MORI
“My understanding is
very good / good”
Quality care
“Finance staff have a great deal /
fair amount of understanding”
63%
48%
Quality care
44%
Safety
Safety
59%
The patient experience
58%
40%
The patient experience
Desired clinical outcomes
50%
40%
Desire clinical outcomes
Base: All valid responses who are clinicians (179)l All valid responses who are finance staff (368) : Fieldwork dates : June to July 2015
LON
Source: Ipsos MORI
Mutual knowledge transfer
LON
Finance educator network
SAVE THE DATE
Finance Educator Day
Leeds & Reading
Friday Nov 30th
LON
Knowledge
Attitudes
Behaviour
RELATIONSHIPS
LON
Q32. What in your opinion were the key reasons for this
effective working relationship?
Base: All valid responses who have achieved something by joint working between finance and clinical teams (470) : Fieldwork dates : June to July 2015
LON
Source: Ipsos MORI
Improving relationships using
the King’s Fund Toolkit
LON
The Kings Fund - FFF collaboration toolkit
A clinician and a finance professional agree they want to
improve the way their teams work together
• Identify external peer reviewers through the Future Focused Finance network
• Invite team members and ask them to complete questionnaires
• Team session 1 focuses on the seven factors for effective collaboration
• Peer reviewers write their report
• Team session 2 - Peer reviewers present their findings. Staff have an opportunity to
reflect, ask questions and agree an action plan
• Teams make the identified changes and review again in six months
Staff support their peers by sharing good
practice and offering to be a peer
reviewer for other organisations
LON
Questions:
• Do your clinical and finance colleagues decision makers
understand the components that make up value (most do not)?
• Do you have a finance educator in your organisations?
• Do your clinical and finance colleagues take time to reflect on their
working relationships and how to get the best from them?
• When do you plan to use the Kings Fund – FFF toolkit to promote
collaborative working in your organisations?
LON
Caroline Clarke
Deputy CEO and CFO – Royal Free London NHS Foundation Trust
SRO for Best Possible Value programme
[email protected]
Dr Sanjay Agrawal
Consultant Respiratory Intensivist – University Hospitals of Leicester NHS Trust
SRO for Close Partnering programme
[email protected]
LON