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DRAFT

Best Possible Value

Our mission and our approach

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Our mission is to deliver a Best Possible Value health service

• Devolved authority, cross-accountability, and conflicting

incentives produce deadlocks, inefficient processes and sub-

optimal results

Situation

Challenges

Resolution • A new approach that moves beyond organisation structures is

needed to deliver the best possible value for patient and public

• Demand for health services is growing faster than funding

• There is consensus that the health service must deliver better

value

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Our aspiration for the Finance function is to be leaders in

delivering value

FINANCE TODAY FINANCE TOMORROW

Focused on cost

Work with financial metrics

Analyse challenges

Input into decisions

Focused on value

Combine the best in financial

informatics and health economics

Solve biggest challenges

Leadership role as drivers of robust

decision-making based on value

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To deliver value we must have

effective decision-making

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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”

Source: Adapted from ‘The Future of Work’, Thomas Malone

COMMAND

AND CONTROL

EMPOWERED

BUSINESS UNITS

MATRIX

CUBE?

A focus on decisions can cut through this complexity

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Note: High decision effectiveness range = top quintile of “decision multiplier” scores; Low/Mid = all other Source: Worldscope; Bain decision and organisation effectiveness survey

5 YEAR AVERAGE PROFITABILITY

(RETURN ON CAPITAL EMPLOYED)

HOW LIKELY WOULD YOU BE TO

RECOMMEND YOUR ORGANISATION

AS A PLACE TO WORK?

Why focus on decisions? Research shows a focus on decisions

supports outperformance on financial and people dimensions

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What makes a decision effective?

Decision effectiveness = quality, speed, yield, effort

Quality Speed Effort Yield x - x “How often do you choose the right

course of action?”

“How often do you execute decisions as

intended?”

“How quickly do you make decisions vs.

stakeholder expectations?”

“Do you put the right amount of effort into making & executing

decisions?”

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)

Decision Effectiveness Benchmarks

“lower is

better”

Slo

wer

than…

Faste

r th

an…

O

n p

ar

with…

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Organisational drivers

What makes a decision effective? Organisational drivers must

be aligned to support decision effectiveness

Performance

Decision effectiveness

• Quality

• Speed

• Yield

• Effort Tools & technology

Critical decisions

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Quality Speed Effort Yield x - x “How often do you choose the right

course of action?”

“How often do you execute decisions as

intended?”

“How quickly do you make decisions vs.

stakeholder expectations?”

“Do you put the right amount of effort into making & executing

decisions?”

How well do we make decisions today? NHS performs below

average on each category, particularly on speed

Decision Effectiveness Benchmarks

“lower is

better”

Slo

wer

than…

Faste

r th

an…

O

n p

ar

with…

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)

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2 3 4 Strong Average Weak 1

How well do we make decisions today? The NHS performs

particularly strongly on culture but low on clarity and structure

Source: Bain decision and org effectiveness database (Jan 2013) n=1001 ; NHS diagnostic (n=153)

High decision effectiveness range n=324 Low/Mid decision effectiveness range n=677 NHS n=153

Context around what drives value

Clear accountability for critical decisions

Winning culture and workplace behaviour

People equipped with right skills & capabilities

Communication and alignment

Structure that enables key decisions

Right information, right form, right time

Cohesive leadership

Effective decision processes

Co

nte

xt

&

Ali

gn

men

t A

cco

un

tab

ilit

y

& S

tru

ctu

re

Pro

cesses &

In

form

ati

on

Lead

ersh

ip &

b

eh

avio

urs

Skil

ls &

C

ap

ab

i-

liti

es

To

ols

&

Tech

Tools and technology align with needs

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How will the future be different? At an individual decision level

outcomes can be significantly improved if focused on value

NOT FOCUSED ON VALUE FOCUSED ON VALUE

• Focused on service delivery

• Different people in charge of different parts of pathway

• Considered as an isolated unit not part of a system

• Consultants not empowered to make decisions

• Lack of tools / financial framework

• Focused on clinical outcomes, particularly failed

interventions for most unwell

• Holistic pathway view: 16% of patients use 50% resource

• Best practice, data and patient / family input considered

• Consultants empowered and given the financial

framework

• Stroke unit clogged

• Failed interventions

• Sub-optimal recovery for healthy patients due to delays

• Improved clinical outcomes for healthy patients

• Improved experience for most unwell

• Resource reduction: 50% of beds and 24 staff

Decision example: Decide stroke care pathway and service configuration within a hospital

Source: Delivery Group member interview – based on a decision made within a London hospital

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What’s our plan for improving decision-making? We’ve adapted

a proven decision-making approach to the NHS and are rolling it out

HOW FAR WE’VE COME WHERE NEXT

• Developed a “Decision Handbook” that

provides a framework and approach for

managing and making value-based

decisions

• Developed a definition of value, a menu

of outcomes and example metrics to help

make an assessment

• Defined a set of organisation enablers

and behaviours to equip the NHS to make

value-based decisions, based on a survey

of over 150 finance and non-finance

professionals

• Prioritised a set of actions to implement

change across the NHS

• Roll-out and optimise the “Decision

Handbook” by working with organisations

to implement the approach on real

decisions

• Train finance and non-finance

professionals across all levels on the

approach to effective decision-making and

how to use the toolkit to help

• Collaborate with other Future Focused

Finance initiatives to ensure organisation

enablers are set up to support value-based

decision-making

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How to learn more or get involved?

Read the “Decision Handbook” introduction on the FFF website to get a taste of

what’s to come and sample a few of the basic tools e.g. RAPID decision roles

framework

Read the “Organisation Enablers” introduction on the FFF website to discover the

characteristics of high-value healthcare organisations around the world and what the

NHS can learn from them

Tell us about your experiences of making value-based decisions on the FFF website

blog

Contact us if your organisation would like to apply the Decision Handbook to a key

decision and be part of the roll-out programme