When changes are made in how we organise or deliver health and care services, the aim is for that change to lead to an improvement. That improvement may be better outcomes, reducing staff burden, improving safety, increasing efficiencies, or something else. We set out on a change pathway with an idea of how our change will be of benefit to a group of identified beneficiaries, but how do we go about demonstrating that those anticipated benefits have happened in reality? On the flip side, but related, how do we make sure that we haven’t made a situation worse because of our change? In addition, a reason frequently cited for successful change initiatives failing to sustain and / or spread is the lack of demonstrable evidence of benefit (or impact) to inform and support service planning and resource allocation.
This is no different for an innovation adoption project. There will be evidence out there to show that the ‘innovation’ is safe, effective, and is linked to positive benefits, but we cannot assume that those benefits will be replicated in a new setting. The make-up of the local demographic where the innovation is being adopted can have a huge effect on this, as well as the way that local processes and systems are organised. We also mustn’t forget the complex and significant influence that the human aspect has on the successful realisation of benefits. This may range from organisational culture at one end of the scale, to staff capabilities and skills at the other end. So, we recognise that monitoring and evidencing the potential benefits and impact from a change / innovation adoption is crucial, but how do we go about doing it?
Answering this question has been a priority area of work for the Dorset Innovation Hub. To support this, we have discussed the topic area with experts within the Dorset system and have worked to develop checklists, tools, and guidance documents to facilitate the process of assessing the impact of change from innovation adoption i.e., benefits realisation. In addition, to gain more understanding of the national framework for benefits realisation, I was fortunate enough to attend a one-day Benefits Management and Realisation course run by NHS England on 15 August 2023. This course was a supplementary module run to compliment and support the core Building Better Business Cases training, recognising that benefits are a key aspect of the strategic, economic and management case within the 5-case module. The course was incredibly interesting, and I left with a strengthened appreciation of the specialist level of knowledge experts within this field of work have. But it is a field of work that needs to be accessible to all, as it is a key component of sustainability and spread. Therefore, to support accessibility, understanding and activity, several points of learning have been built into our benefits realisation approach.
- The importance of having a common set of terms and language. This not only assists with communication and understanding across organisations but supports minimising the duplication of efforts if national templates (or similar) need to be completed. For example, when looking at categorising benefit class, the nationally suggested categories for use are; cash releasing, non-cash releasing, quantifiable (not monetizable), and qualitative. Document templates thus need to ensure that a commonality of language is adhered to wherever possible both nationally as well as across the Dorset system.
- The 80 / 20 rule states that 20% of benefits are likely to provide 80% of benefit value. This may be known to some as the Pareto principle. Although we encourage wide thinking when generating a list of potential benefits, in terms of focusing efforts and managing limited capacity, it is worth keeping this principle in mind to identify key areas for attention.
- Planning benefits realisation arrangements should start at the beginning of a project and be tracked throughout a project lifecycle. A crucial part of this is the inclusion of baseline measurements. You have a prime opportunity pre implementation to capture a true picture of activity and outcome, which can be used as a pre implementation baseline. It is so much more difficult and time consuming to try and piece this type of information together from historical system data, with questions of validity and interpretations commonly present.
- Utilise the expert knowledge that you have within your organisation, or even across organisation. This may be colleagues who have experience of undertaking a benefit realisation exercise or may be colleagues within departments such as Finance who have specialist expert understanding of topics such as ‘discounting’ or how much a specific aspect of a care pathway may cost.
- Be mindful of ‘Optimism bias’, which is the natural inclination to underestimate costs, underestimate timeline, and overstate benefits. There is national guidance available to help take account of this (HM Treasury Green Book supplementary guidance and Better Business case guidance) but also, as per point 4 above, discuss with others in your organisation, in particular those who are your organisation’s business case approvers, to try and give as realistic a picture of expectation as possible.
We (Dorset Innovation Hub) will continue to use the above approaches to improve our benefits realisation processes, supported by checklists, tools, and guidance documents, striving to continually improve our ability to demonstrate a true picture of impact. Working together as a team, across the Dorset system, will be key in this, as will be ensuring that all learning generated through these exercises are shared and disseminated to inform and direct service planning and resource allocation in Dorset.
Sandra Courtiour
Acting Innovation Programme Manager – Dorset Innovation Hub
