This was presentation given by Dr Hugo Minney from the APM Benefits Management Specific Interest Group (SIG). The SIG was established in May 2009 for the benefit of members, the APM and the profession in general and their vision is to: "develop and promote benefits management as a core driver of successful project, programme portfolio and change management". The APM Scotland branch welcomed Dr Minney to the Blythswood hotel in Glasgow to make this presentation. A large audience attended Hugo’s presentation entitled “Managing benefits from projects – the NHS way”. Hugo has extensive experience within the English NHS and his presentation included lessons which are applicable to the Scottish NHS. Hugo has a particular focus on social return on investment (SROI) – identifying, measuring and maximising the economic, environmental and social success. He also has expertise in proposal and bid writing, and in identifying the "hard to measure" things so important for investment decisions such as the value of staff sickness, employee inspiration, customer retention. Hugo is currently company secretary of a GP-led federation with 170,000 registered patients. The presentation explored the question “what is benefits management?” and where it fits into project management. Hugo used examples from NHS England to illustrate why projects failed and looked at how benefits management can drive successful projects. He then contrasted this with some success stories and examined the tools and approaches that made them work.

1. Managing Benefits from Projects The NHS Way
Hugo Minney PhD
The Social Return Company

2. Who am I to talk?
•1990 – PhD and Computer Salesman (business cases to get investment)
•2000 – Cap Gemini
•2004 – NHS Modernisation Agency
•Followed by South Yorkshire Improvement Academy, various roles nationally, regionally, locally, with arms length bodies
•Interspersed with For profit and not-for profit NHS and social care facing roles
•CURRENTLY: Company Secretary of GP-led federation with 170,000 registered patients

3. What is healthcare?
•English NHS
–Commissioner / Provider Split – cases for investment
–Value for Money requirement
–Innovation
–Technology
–NICE
•Scottish NHS
–Central planning
–SIGN
•Independent Sector Healthcare
–Highly responsive to fluctuating demand
–15% of the sector
–Like any business
•My GP-led Federation
–Politics and public influence

4. Benefits Management
Benefits management is the identification, definition, planning, tracking and realisation of business benefits.
•Recognise what we’re trying to achieve – in context. Do we still want this? What’s changed?
•Who does it affect? The employees are often the forgotten stakeholder
•Do we know what success looks like? (soft measures)
•Does everyone agree what success looks like?
•People look after Number 1. Are you giving them what they want?

5. What is Benefits Management?
•Introduction to Benefits management
–WHY do we do this project?
–Value for Money in commercial terms
–Knock on effects
–Social Return on Investment
•Who are the stakeholders?
–Patients
–Staff
–NHS Budget (drugs, hospital, community, GP)
–Local Authority budget
–Central Government and the voter
–The Value of a Life
•Who pays?

6. Where does BM fit in Project Management?
John Thorp – The Information Paradox
capability

7. GPES or care.data
•What is it?
–Patient activity data formerly in hospital, now mostly in community and GP practice
–Collect anonymised data from GP practices
–Combine with same patient data from hospitals & other environments
•Why do we want it?
–Identify best practice and develop new pathways of care
–Investment decisions with population prevalence
–Track pandemics
–Drive innovation
–Pay people for the right things, and stop paying for the wrong things

8. The Not So Good examples

9. care.data - what could go wrong?
•What could possibly go wrong?
–Scope shrinkage so that “success” is inevitable
–Project team personalities and politics
–Engagement with the public (and other stakeholders)
–Value for Money studies (*)
•Success for care.data
–Inevitable – at some point
–The business case is too compelling (£x mill in for £1bn / year return)

10. TPP SystmOne, Lorenzo, etc
•What are they?
–TPP SystmOne is GP patient records system, Lorenzo allows hospitals to read GP system
–Both new greenfield developments
–Standing on the shoulders of giants, full might of Department of Health behind them
•Why do we want them?
–Single system for GP and District Nursing, shared information (with potential for wider sharing)
–Hospital access to more info than referral letter
–GP access to more info than discharge letter
–Centralised records: power is where the data are

11. TPP SystmOne – what could go wrong?
•How do you measure benefits achieved?
–Pre-defined measures to demonstrate success
–Things that don’t mean very much – seconds to load a screen, numbers of keystrokes
–Tick sheet to record
–Commercial greed
•Real benefits
–Take longer to manifest
–Everyone trained the same (everyone trained!)
–Teething troubles to overcome

12. Emergency Care Practitioners
•What are ECPs?
–First Responders, able to diagnose, treat, discharge and refer onwards
–Paramedics with nursing skills, nurses with paramedic skills, AHPs with both
–First to scene, often last touch with patient
•Why do we want them?
–Better patient care
–Disruptive innovation works best if it starts early
–New forms of care (reduced ambulance, reduced A&E)
–Lower cost overall
–Career for experienced paramedics

13. ECPs – what could go wrong?
•Cost-effective, better patient care, better for staff – what could possibly go wrong?
–Who pays, and who benefits? Establishing the stakeholders and their roles
–What else is going on? (senior jobs being threatened, NHS 111)
–A much cheaper alternative?
–The clock start change debacle

14. Why projects don’t succeed
•Failure – budget, time, quality
•Benefits delivery, contribute to corporate objectives are “nice to have”?
•Internal problems 60% of the reasons for failure
–Failure to plan
–Failure to apply governance
–Failure to be motivated?
–Failure to engage BAU at handover?
PricewaterhouseCoopers 2012
Budget Time Quality
Business Objectives

15. Benefits management can drive successful Projects

16. What gets you up in the morning?
•Nobody comes in to work to do a bad job (well, almost nobody)
•We all want to make a difference – make the world a better place
•Very few people work just for the money*
•So… what am I going to tell you?
•Osterloh & Frey 2007 Does pay for performance really motivate employees?
•PwC NextGen 2013: Millennial workers want …

17. A Health Economy in Northern England
•160 initiatives for change – “projects”
•£60 million per year spent on change
•Professional carers resist change – all change represents risk – “what we’re doing now is safe”
•Management targets divorced from both the knowledge, and the need (sometimes)

18. Benefits Frameworks
•Part time for 4 months
•7 workstreams,
•Three workshops
–Context: what you are doing, what the need is, where are the gaps? What does success look like?
–Measurement: what means improvement, where can we get that information?
–Delivery: how are you doing? What are you changing because of measurement?
•coaching between workshops

19. Benefits Mapping

20. … means People getting involved

21. … means common sense

22. Staff Motivation
•“I can tell my grandchildren ‘I did a good job this week’ “
•Lower Sickness/ Absence
•Easier Recruitment/ Retention
•Getting much more done
•Engaged with corporate objectives – even to MAKE MONEY

23. Driving improvement
•We (the people who talk to the client/ do the work) see the need/problem first!
•We know what to do about it (have the most experience)
•We can inspire*
•We won’t resist our own design for change
•(a new problem – managing configuration)
Malcolm Gladwell – Tipping Point

24. Other success stories
•IAIP (Improving Access to Information Project)
–Government requirement: no turning back (*)
–Direct access to team leaders, who developed their own Benefits Profiles as well as Roll Out Plans (Resistance is Futile)
–Nobility
•COPD (lung disease in former mining areas)
–Wide engagement, facing up to vested interests
–Years of discussions, recognising and owning problems
–Compromise, but with a vision and drive
–The NIKE factor
•Community Gynaecology
–Pilot rolled out rapidly
–Patient (and GP) choice
–Instant benefits – cost effective & better for patients

25. Useful Approaches
Some of the tools and approaches which work

26. Define Benefits Case for Investment Quantify and milestones
Decisions to maximise benefits
What benefits deferred and how to monitor them
Benefits Framework
Idea
Initiation
Define Deliverables Milestones Resources
Project monitoring
Project delivery
Governance
Closedown
Project Management
Handover
Benefits Management and PRINCE2
Business as Usual
Reporting & tweaks
WHY
WHAT & HOW
HAND-OVER
ONGOING

27. Social Return on Investment (SROI)
•Stakeholder Mapping and real Engagement
•Value is only what is described by stakeholder
•2nd and 3rd level measurements – what does this mean?
•The problem – and solution – of attribution
•Using reliable (and defendable) numbers
•A trusted methodology
•SROI-lite and its detractors

28. Turning SOFT into HARD – reliable measurement
•Important things like
–Customer Satisfaction
–Net Promoter Score
•The joy of a parent, the value of a life
•What impact on the bottom line?
•When? How much? How reliable? Confidence and sensitivity testing

29. Lessons to take away

30. When do you start? When do you finish?
•4 stages of Benefits Management:
–WHY – business case, sponsor, stakeholders
–WHAT & HOW
•Project planning, measurement schema
•Project delivery, decisions to maximise benefits
–HANDOVER – handover capability, plus motivation
–ONGOING
•Measuring and reporting
•Tweaking and adjusting for even better outcomes

31. Professionalism
•Like Project Management – follow a tried and tested process*:
–don’t just make it up as you go along
•The right tools for the job
–iBE.net includes Project Management, Time and Billing, EVA; Benefits Management to follow shortly (one time entry, used many times)
–Try it out at www.ibe.net
* PwC 2012 Project Maturity

32. The foundations of Morale
•The military understand this
–Spiritual – because only spiritual foundations can stand real strain
–Intellectual – because men are swayed by reason as well as feeling
•It must be attainable, by the organisation. Confidence in planning and capability
–Material – last, because the very highest kinds of morale are often met when material conditions are lowest
William Slim “Defeat into Victory”

33. Measuring & reporting to motivate
•What’s important?*
–We are not just numbers
–We are excellent at what we do
–Our company and our customers recognise our effort and care
–We are doing something useful and valuable
•How do we measure these?
–Team and individual recognition – measure what matters
–Put it into context: “I help people” (identity!)
James Robbins – Nine Minutes on Monday

34. Step by Step
1.Involve stakeholders
2.Map outcomes to context and drivers for change
3.Evidence – what is important (NOT JUST “what can we measure?”)
4.Establish impact – does our change result in this, or was it something else?
1.Are the numbers trustworthy and trusted?
5.Calculating the outcome so people can use it to make decisions
6.Reporting – and using the results (to make decisions)
Tailored from:
Jeremy Nicholls – A guide to Social Return on Investment

35. When the best leader’s work is done, the people will say:
“We did it ourselves”
Lao Tzu

36. Hugo Minney
PhD, Acc Prac SROI, M APM, PRINCE2
07786 961837
Hugo.Minney@TheSocialReturnCo.org

37. This presentation was delivered at an APM event
•To find out more about upcoming events please visit our website www.apm.org.uk/events