Practical Guide to delivering benefits, and designing services around benefits, for public good

1. Benefits Driven Change Using some examples from the ISIP Demonstrator Programme, this guide shows how a benefits approach to change can be used to deliver sustainable service transformation more quickly. It also helps the care community, including external partnerships, to be more flexible in responding to changing circumstances . A Practical Guide for the NHS

2. What is a Benefits Approach? Programme or Project Planning At the planning stage, engage stakeholders in the process of identifying shared benefits as well as potential individual benefits or disbenefits. A Benefits Approach is a cultural thing – it applies to every stage of the project or change programme and should support, not get in the way Implementation To keep stakeholders and staff engaged and focussed, when reporting progress use “this means” and remind people of the benefits sought. Use easy-to-understand measures and presentation e.g. Dashboard. Delivery and Achievement Focus on the benefits to patients, to clinical outcomes, to stakeholders, to the whole community. LOS or admissions avoided are not benefits, though they can lead to benefits. Case for further investment If the project has been a success then you may want to expand; alternately another organisation may want to copy your project. Report in terms of benefits.

3. Why does a Benefits Approach matter? A benefits approach will help you to engage different stakeholders and organisations, and also enable you to establish baselines and quantify improvements. Whether you are trying to motivate yourself or another (e.g. Cognitive Behavioural Therapy CBT), or changing a community, the principle is the same. LONG TERM SHORT TERM PERSONAL Outcome : How would I like to be? Benefits : What will that give me? These could be in health, time, growth, happiness. Outcome : What will I achieve this week? Benefits : What value do I get from achieving this? (and does the value I get contribute to my longer-term aim?) ORGANISATIONAL Outcome : What will we as a community / organisation look like at the end of this transformational programme? Benefits : What will the value-add be? Organisational or community benefits are more likely to be population health, quality of life / length of active life for a segment of the population, resources freed up and used to deliver additional services, staff career opportunities, etc. Outcome : For each project: what is the outcome of this project? Projects may have milestones indicating a particular achievement etc. Benefits : What are the short-term benefits or values of achieving this? (Once again, do the short-term benefits contribute to the longer-term benefits? If not, do they represent ‘quick wins’ which keep people motivated and engaged?)

4. Stakeholder Benefits Priority Objectives are national or local targets e.g. “reducing inequalities” Benefits may be stakeholder-specific or shared, and are the motivating force Outcomes represent the future state of the service, what it has to be like to deliver the benefits Projects and Actions to Change are what you do to achieve the outcomes New Economics Foundation – Measuring real value: A DIY guide to Social Return on Investment See also NHS ISIP Practical Guide on Stakeholder Engagement Progress isn’t always direct, but it should always be progress Projects, Actions to Change Outcomes Benefit Priority Objective Stakeholder 1 Stakeholder 2 Stakeholder 3 Stakeholder 4

7. Demonstrator Experience: Illustrating a Benefits Approach LHC Demonstrator Case Studies: Benefits Approach in Action The Tees ENT Walsall Stroke Project Clinicians made the decisions on the basis of clear evidence – better care brings financial benefits Walsall Dashboard Decide a clear mechanism for reporting, which shows how the benefits are being delivered Liverpool Scheduled Care Ensure everyone agrees the aims and benefits – clarify in writing; simplify many projects into a few programmes with an overall governance structure West Herts Dermatology Keep it simple – work on one benefit at a time and acknowledge and respond to disbenefits

13. Key Messages You will always meet opposition to change, and it will always take longer than you thought; focus on the benefits you will achieve, and if you can’t do it all in one go then take smaller steps. Where is the evidence? Data which shows the current situation (baseline) and monitors progress can be hard to obtain (e.g. IM&T systems don’t align), but is vital when demonstrating that benefits are being delivered. Be flexible: when priorities or circumstances change, review what actions are needed to ensure the benefits get delivered. Group existing and new projects into programmes, with a single steering group and governance structure. Understand cause and effect – without causes (action) the effects (delivery) won’t happen. Keep it simple: dashboard-style reporting, with the benefits relevant to the stakeholder group, will be easier to follow. Different stakeholders may need different dashboards. Report achievements regularly and widely – keep people motivated and involved.