Blog by Alison Clare

In preparation for the Yorkshire & Humber Care Record (YHCR) sharing patient data between health and care providers in a live environment it was important to understand our success criteria.  How would we know if we have been successful?  YHCR might be live and clinicians across the region will be using it but will we have saved any money? Increased productivity? Reduced risk to patients and citizens? Or can we demonstrate an improvement in patient and citizen care? Apart from the fact we’re using the YHCR how can we tell if we’ve achieved anything substantial? In order to do this we identified the likely benefits and baselined them prior to go-live.  We will repeat these measurements over the next few months as each Wave 1 pilot site goes live and assess our level of success.

We worked with the teams at the Wave 1 pilot sites:

  • Leeds Teaching Hospitals NHS Trust
  • The Rotherham NHS Foundation Trust
  • Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
  • Humber NHS Foundation Trust
  • Yorkshire Ambulance Service
  • North Yorkshire County Council.

This was to create use cases, develop the technology and gather initial baseline observations where sharing information across both local authorities and NHS organisations will bring benefits.  Support from the local teams was invaluable and allowed them to take ownership of benefits management with central support from the YHCR. LHCRE team.  The initial observations and analysis performed identified the gaps, where the benefits can best be achieved and what type of benefits they will be; qualitative or quantitative.

 

Measuring Success

Traditionally programme or project success is measured against the planned time, quality and budget.  But  NHS England’s Local Health & Care Record Exemplar programme isn’t just about making technology available, we are breaking new ground so scope can change, it may stretch and therefore the time taken to rollout may extend and the allocated budget along with it. A better way for the YHCR was to ask why we are implementing this transformation and what benefits it will bring to the organisations across the region.  By doing this we were able to identify criteria that can be measured against such as;

  • reduced clinical risk
  • improved patient care
  • reduced cost inefficiencies
  • or an improvement in productivity as well as wider societal benefits such as cultural and environmental impacts.

It is important to measure success against such criteria in order to understand if we have received a return on investment (ROI).

 

Identifying Benefits              

We started by identifying the benefits for each pilot by reviewing each use case.  The initial milestones for YHCR were approached from technical proof of concept so we approached the benefits from more unusual perspective than for some projects.  Usually the benefits would drive the programme rather than the aim of proving a technical solution.  Having said this the process has worked well for this phase of the YHCR.   The typical areas where we may be able to still applied;

  • improvement to services such as more productive transfer of patient information
  • improved social care services
  • joined up MDT meetings
  • faster patient discharges
  • or fewer untoward incidents.

We worked through these and captured the detail in a summary table stating what the benefit is, how it will be measured, and what type of benefit it is;  cash-releasing (CR) or non-cash releasing (Non-CR) and Quantifiable (QB) or Non-Quantifiable (Non-QB).  Or in some cases, for example where services may become more productive this could generate an Increase in Revenue (IR).

 

Benefit Type

Description

Example

Cash Releasing – Financial (CR)

 

 

Benefits that will reduce costs by releasing cash into the business or increasing revenue

 

Reduction in headcount, bed closure or where coding has been missed for clinical procedures and can in future be identified and claimed to increase revenue
Non-Cash Releasing – Financial (NCR)

 

 

Benefits that will improve efficiency and can be measured in financial terms but will not release any cash into the business

 

Productivity improvements whereby savings on staff time can be identified but will not lead to a headcount reduction.  I.e. Clinical Staff spend less time searching for information.  The time saved can be financially quantified

 

Quantifiable (Q)

 

 

Benefits that are quantifiable in terms of an improvement but cannot be translated into financial values

 

Where patient care is improved. i.e. where handover between providers improves patient care and reduces the number of untoward incidents

 

Non-Quantifiable (Non-QF)

 

Benefits that cannot be measured in any quantifiable manner

 

Opinion based feedback from staff i.e. “the new EPR allows me to have a tidy desk which makes my clinic a less stressful environment to work in”
Economic – Financial (EF)

 

 

Benefits that are quantifiable financially but will not release cash into the business; will add to the economy of the country

 

Overall improvement in health care across a region

 

 

 

Prioritising Benefits

Once identified we prioritized the benefits.   Which are considered the most important and which can be realised early in the programme.  Some benefits are likely be realised earlier than others and we considered this when you are prioritizing them.   This was to ensure the YHCR will derive the most important benefits sooner rather than later.  The most important risks such as where there are delays in gathering patient information resulting in a slower than necessary patient journey or processes putting patients at increased risk were prioritized.

 

Creating Benefit Profiles

For each benefit on the summary spreadsheet we created a benefit profile.  This was useful in capturing the details.  The profile should contain the following:

 

Benefit Profile

Programme / Project Name

 

Programme this benefit belongs to

 

Benefit Description

 

Summary of the benefit

 

Benefit Type

 

CR, Non-CR, Q, Non-Q

 

Business Change Required

 

Operational changes required to achieve the benefit

 

Outputs contributing to this benefit

 

Activities or projects that will enable the benefit to be realised

 

Benefit Owner

 

Person(s) who are responsible for ensuring the benefit is realised

 

Stakeholder Beneficiary

 

Stakeholders which benefit from this improvement

 

Measurement & Costs

 

Measures that will demonstrate benefit has been achieved

 

Dependencies on other programmes

 

Any other programmes which support this benefit

 

Assumptions

 

Any assumptions made that support this benefit

 

Constraints

 

Any constraints that may impact realising this benefit

 

Risks to Benefit

 

Any risks that may prevent realising this benefit

 

Measures

 

Baseline

 

Target(s)

 

Measurement method & responsibility

 

Description of measure

 

 

 

Starting point from which you will measure this benefit

 

 

Target value and timescales to benefit realisation

 

How the benefit information will be captured, who is responsible and planned timescales for measurement

 

 

Plan the Benefits Realisation

Once we had the detail we began to plan when benefits were likely to be realised by reviewing each profile and capturing the baseline data, the initial measurement for each benefit.   We created a plan of when each benefit could be delivered and what the measurement cycle would be, i.e. weekly, monthly or quarterly.

 

Benefits Management Strategy

Finally it is useful to have a Benefits Management Strategy document to refer back to as the programme continues.  This useful document has helped set out our approach and framework to manage the delivery of benefits.  It is the when, why and how of our benefits management.  It makes it clear how we are approaching our benefits planning, how benefits have been identified, defined and prioritised and will be applied through Wave 2 and onwards as the YHCR rollout.  It also details the resources required, the measurements and steps that will be carried out as part of the realisation process, including the tools and templates we have used to capture the data.

 

By Alison Clare
Programme Manager