Best Possible Value
Decision Effectiveness Framework
HFMA Step Up! Webinar
26th July 2016
What we’ll cover in this webinar:
 Introduction to the Best Possible Value work stream
 Why focus on making effective decisions?
 Decision Effectiveness Framework overview
 Feedback from demonstration site, Liverpool CCG
 Resources available for free at our website
 Question and Answer session
Our place in the Future-Focused Finance family
Future-Focused Finance (FFF) is designed to build capability in the finance
profession. There is widespread senior support in the system for the initiative:
Best Possible Value is one of six complementary work streams in the
programme. Value is a critical foundation for the entire programme and supports
realisation of the other streams:
Best Possible
Value
Close
Partnering
Skills and
Strengths
Efficient
Processes and
Systems
Great Place to
Work
Foundations
for sustained
improvement
Our ambition: putting value at the heart of what we do
Porter’s Value Equation
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
What makes a decision effective?
Quality
Speed
x
“How quickly do you
make decisions vs.
stakeholder
expectations?”
Yield
“How often do you
execute decisions as
intended?”
Faster than…
“How often do you
choose the right course
of action?”
x
-
Effort
“Do you put the right amount
of effort into making &
executing decisions?”
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)
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
“How often do you
execute decisions as
intended?”
Faster than…
“How often do you
choose the right course
of action?”
x
-
Effort
“Do you put the right amount
of effort into making &
executing decisions?”
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)
Across drivers of decision effectiveness, NHS performs
particularly strongly on culture but low on clarity and structure
High decision effectiveness range n=324
Low/Mid decision effectiveness range n=677
NHS n=153
Leadership &
behaviours
Skills &
Capabilities
Tools &
Tech
Processes &
Information
Accountability
& Structure
Context &
Alignment
1
Context around what drives value
Communication and alignment
Clear accountability for critical decisions
Structure that enables key decisions
Effective decision processes
Right information, right form, right time
Tools and technology align with needs
People equipped with right skills & capabilities
Cohesive leadership
Winning culture and workplace behaviour
Source: Bain decision and org effectiveness database (Jan 2013) n=1001 ; NHS diagnostic (n=153)
Weak
2
Average
3
Strong
4
Does this ever happen in the NHS?
Someone needs to get a
decision made, but it’s not clear
who has the final say
Someone doesn’t like the
direction a decision is heading,
so escalates it up the chain
A group debates
extensively in a
meeting but
doesn’t agree, so
adjourns without a
decision
Someone doesn’t make
it to a critical meeting,
and questions the
decisions that were
made there
Someone is asked for input on a
critical decision, but doesn’t
respond in a timely fashion
Someone doesn’t like a
decision, and so doesn’t
implement it
Decision styles – a simple tool for behaviours
Consensus
• Decision reached
when everyone
agrees
Democratic
Participative
Directive
• Decisions are
reached based on
majority vote
• Single point
accountability for
decisions
• Dissenting views
must support the
final decision
• Collaborative
• Directives issued that
approach with input
are expected to be
from those with
followed
knowledge and
expertise
• Once decision made,
all are expected to
support it
• One person has
decision authority for
any given decision
NHS decision styles
THE DECISION STYLE IS…
• Directive:
- Decision making authority rests
exclusively with one person, who issues
directives that are expected to be followed
• Democratic:
- Decisions are reached based on vote (e.g.
majority rules)
- Dissenting views are expected to support
the final decision
• Consensus-driven:
- Decisions are reached when all involved
reach agreement
• Participative:
- Single-point accountability for a decision,
with input taken from those with relevant
knowledge and expertise
- Once a decision is made, all are expected
to support it
Source: Bain Client diagnostic (n=153)
In the NHS as a whole
The structure of the Decision Effectiveness Framework
LON
Our 1st Experience: Liverpool Healthy Lung
 Successful in application to become part of FFF BPV Pilot of Decision
Effectiveness Toolkit
 Support from Bain & Co applying the toolkit to our ‘Healthy Lung’ Investment:
Should Healthy Liverpool Programme make an additional
investment to improve lung health in Liverpool, and if so, how
can it do so in a way that delivers best value?
Getting Started: Decision Roadmap
1
•
•
•
•
Define the decision
Frame the decision
Define value criteria & metrics
Split into sub-decisions
4
•
What
When
Clarify timelines & milestones
2
•
•
Who
Identify stakeholders
Clarify decision roles (RAPIDs)
for each sub-decision
3
How
• Install structured decision
approach
- Interactions
- Critical meetings / committees
- Closure and commitment
- Feedback loops
What
Who
When
How
Decision Charter
What
Who
When
How
Decision Architecture
Learning: Gathering Decision Stakeholders Upfront
 Organise a workshop and invite key stakeholders to discuss the
decision at hand
 Gain clarity on why action needs to be taken and what needs to
be done
 Individuals will feel ownership / involvement of the decision
 Build relationships
 Invest upfront to save later
What
Who
When
How
Value Criteria and Metrics
Learning: Value-Based Thinking
 Define what the outcomes of the decision should be
 What do we want to achieve and how we are going to measure
success?
 Value Equation is great for capturing and displaying this
information
 Assess any ‘options’ generated against this Value Equation
What
Who
When
How
RAPID™ Roles and Responsibilities
Learning: Governance & Roles of Committees
 Importance of ‘not marking your own homework’
 Separating the ‘R’ and the ‘D’ Roles
 What is the role of a committee?
 What IS NOT the role of a committee?
What
Who
When
How
Critical Steps
Applying the Toolkit to Healthy Lung
 We were on a track but we practiced the Value-Based Decision Approach…
 Solutions; versus defining problems
 Whose decision?
 Mandate and associated governance?
 People and groups can have multiple roles – governance?
 Options?
 We had our metrics already; and had reviewed evidence
Learning: Decision-Making Style
 The importance of a ‘Participative’ decision making style
 Crucial to protect the speed of decisions
 Avoiding the ‘proliferation of Is’
 Lots of debate at Liverpool CCG during the workshops
Next Steps at Liverpool CCG
 Mobilise Healthy Lung Investment
 Need to embed Decision Effectiveness Approach within LCCG
 Training of PMO staff to facilitate workshops and produce outputs
 Use of a ‘Lite’ Version of the Toolkit for smaller decisions
 Widening the Value Conversation
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
#bpvFFF
bpv.futurefocusedfinance.nhs.uk
Questions?