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Session 3: Benefits Definition and Measurement

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1 Session 3: Benefits Definition and Measurement
eHealth Benefits Management Toolkit Session 3: Benefits Definition and Measurement [Facilitator’s note: The list of benefits should be obtained in advance of the workshop. It will be needed to complete the group exercises.] v4.0 May 2009

2 Session 3 Outline Benefits measurement categorisation
Benefits profile template Benefits Realisation Plan Transition to business as usual In this session, we will cover: Benefits measurement categorisation Benefits profile template Benefits Realisation Plan Transition to business as usual There will be opportunity at the end to ask questions, however, if you have any questions during the presentation please ask. (Ask if there are any questions at this point, for instance about using the methodology in practice so far, before proceeding with the session.) (allow 5 mins in case of questions)

3 Session 3 purpose At the end of the session you will have an understanding of: what methods can be used to define quantifiable benefits and estimate their value; how to finalise detailed benefit definitions using SMARTT and ensure the benefits are measurable; how to pull all the outputs of the previous sessions together to create the Benefits Realisation Plan; and what further activities need to take place at the end of the project. (1 min)

4 Benefits Measurement Categorisation
Benefits profile template Benefits Realisation Plan Transition to business as usual

5 Specific Definitions of Benefits
Benefits should be: clearly and succinctly defined aligned with the projects objectives and the overall NHS strategy focused on improving service and patient care, not focused on IT Effective measurement and monitoring will: indicate the extent to which benefits are being realised; give early warning of potential problems; create the opportunity to adapt the benefits or changes to enable the overall objectives; and ensure that achieved benefits are measured, reported and communicated. It is important to define the benefits at the beginning of the project or programme to ensure that they are consistently understood and measured. This will avoid misunderstandings about objectives and priorities later in the project, which could results in delays, additional costs, and/or some of the benefits not being realised. Having appropriate measures in place and monitoring them regularly will allow you to track progress against targets (or the baseline) and to identify any benefits that are not being achieved. This can be used as the basis for agreeing remedial actions in terms of the changes or IT capabilities required or whether the benefits are achievable. Monitoring will also allow you to demonstrate that you have achieved what you have set out to do. (1 min)

6 Measurable Outcomes The next step is to:
devise measures that will show when the benefits have been delivered and to what degree; determine which benefits can be quantified; determine the financial value of benefits where possible; investigate additional data capture activities required; and establish baseline, targets and benchmarking figures. Detailed measures will be applied to the individual benefits rather than the objectives themselves. The realisation of the benefits will indicate that the objectives have been met. Demonstrating benefits for patients and the NHS helps make the case for change and implementation of new IM&T. Identifying the benefits resulting from changing processes is a useful mechanism for gaining the support of stakeholders affected by this change. You identified desired benefits in the first session. This next activity will be to prove that the benefits can be measured and to determine which can be quantified and expressed in financial terms. Attaching costs to these benefits can difficult and you may need input from an accountant or economist to do this. Remember, before you make any the planned changes, get baseline measures so you can measure improvements later. (1 min)

7 Defining Measures Use existing measures where possible
Agree all new measures with those concerned Ask yourself: Is it achievable? Is it an appropriate and valid indication that the benefit has been delivered? Is it directly attributable to a particular change in the project? Consider the effort and cost of capturing and collating the data Decide who will be responsible for ensuring that the data is available Ensure the measures encourage the right type of behaviour Define when and how often the measurements should be taken Wherever possible, existing measures should be used (e.g. KPIs, balanced scorecards) so achieving the benefits is seen as an integral part of general performance improvement. It will also ensure that baseline figures are available and that collecting the data or recording the information will not be an extra burden. Where no measures exist, new ones should be carefully designed and agreed. The cost of capturing the extra data should be considered: if it is going to require system customisation and a disproportionate amount of effort to input, is the value of the benefit such that it is still worth measuring in that way? If it is deemed to difficult or expensive, the benefit should be relegated to “observable” (see next slide for definition). Another important aspect is whether the measure will encourage the right type of behaviour. Consider whether clinicians and admin staff will be encouraged to adopt the new process or just “tick the box” to achieve a target. For instance, would the 18 week RTT, if it didn’t take account of case complexity, encourage hospitals to provide the best care available within the 18 week window instead of the treatment which will provide the best possible outcome for the patient regardless of waiting time? Or the recent example in England of hospital staff entering paper referrals manually on their eReferral system (Choose and Book) to boost their usage figures, increasing staff workload (instead of reducing it) and concealing inherent problems. One last consideration is how long after implementation can the measurements be made and what degree of realisation is expected on that date (partial or full). Remember to schedule in your baseline measurements before any of the changes have occurred. (3 mins)

8 Benefits Categorisation (JW)
Degree of explicitness of measures Financial By applying a cost, price or other valid financial formula to a quantifiable benefit, a financial value can be calculated. Quantifiable Sufficient evidence exists to forecast how much improvement / benefit should result from the changes. Measurable This aspect of performance is currently being measured or an appropriate measure could be implemented. But it is not possible to estimate by how much performance will improve. Observable By use of agreed criteria, specific individuals or groups will decide to what extent the benefits has been realised, based on their experience and judgement. Benefits can be categorised by the degree to which their can be translated into explicit measures of success. For instance, a benefit that can only be measure by asking someone or a group of stakeholders for their opinion is on the low end of explicitness. This could be, for instance, having to run surveys to compare patients’ satisfaction with “clinicians’ knowledge of their previous history” before and after the implementation of a new information system. On the other hand, a benefits that has a clear financial value and can be relatively accurately predicted is high on the scale. This will usually be where a well embedded process is being cut out, for example where patient information becoming available electronically through a handheld device would do away with the need to request, retrieve and deliver a paper file. This would lead to a time release, to which the pay rate of the staff concerned could be applied to translate into a hard cash figure. The 4 categories are: observable, measurable, quantifiable and financial. (1 min)

9 Non Quantifiable Benefits
Observable benefits lowest category of benefits in term of robust measuring often the softer / people benefits can help get buy-in essential to the implementation of changes and the realisation of their resulting benefits agree realisation criteria and who will say whether they are met Measurable benefits performance is easily measured; but potential improvement won’t be known until after the event take baseline measurements before any changes are made for comparison Observable benefits should not be trivialised because of their potentially subjective measures (e.g. satisfaction surveys). They often are the benefits that are accrued for the key stakeholders and can play an important part in the change of behaviours essential to the implementation of change and therefore the realisation of the more substantial organisational benefits (e.g. where shorter working hours, more time to spend with patients or more autonomy are seen as trade-offs for having to learn to use a new system or do more data entry). Measurable benefits are where performance currently is or can easily be measured so the improvement can be tracked. However, the potential improvement cannot be predicted and won’t be known until after the event. It is important that the activity is measured before implementation of the changes to establish a baseline. The improvement also needs to be specifically attributed to the project rather than other factors. It may be necessary to have more than one measure to determine whether the benefit has been realised and whether this is due to the changes. For instance, if the number of cancelled appointments has been reduced: is it because the new patient self-booking system is more effective in ensuring suitability of time and therefore attendance? or because the patient information required by the consultants has been made more readily available by the new integrated database? or is it for reasons not attributable to any of the project’s changes (i.e. less appointments overall so proportionally no improvement, or better patient responsibility due to an awareness campaign on resources wasted due to non attendance). (3 mins)

10 Quantifiable Benefits
aspect of performance easily and consistently measured improvement can be predicted and targets defined usually applicable to embedded processes where performance is well documented and predictable Financial benefits highest category of benefits in term of robust measuring focus on benefits that can easily be translated in terms of financial gain or reduced cost: if it is too complicated or not robust don’t assign a monetary value to it don’t confuse value with savings Quantifiable benefits can be difficult to find in projects as the latter deal principally with implementing new processes and ways of doing things. Quantifiable benefits usually relate to embedded processes that are and have been consistently measured and monitored in the past. This allows a reliable prediction of future performance and of the impact of the project. A target can therefore be estimated and agreed. Quantifying benefits is more difficult and can require comprehensive activity and process measurement and analysis. This makes it more likely for organisations to use softer measures (observable and measurable). For example, it will be far easier to put a value to the cessation of an activity (e.g. stopping to do one thing can release resources to do something else; these resources can be attributed a financial value which will become the measure of the benefit) than estimate the value of doing something new, or in a new way. Don’t confuse value with savings. Reduction in the time spent on an activity will release some staff time which can be given a financial value. However this time is most likely to be re-assigned to another task (e.g. having an electronic patient record means that clinician spend less time getting patient record and asking questions but this time will be re-invested in the consultation) and will not result in a savings (e.g. reduced number of clinicians). (1 min)

11 Progressing Non Quantifiable Measures to Quantifiable Measures
The following methods can be used to get from measurable to quantifiable measures: Modelling or simulation: extrapolate expected benefits from existing data. It may be necessary to establish trends/times series. Benchmarking: evaluate changes in relation to “best practices” in the comparable organisations. References sites: can also be used to establish a comparative base but assess relevance and feasibility in your own organisation. Pilots: test the new way of working and system on a small scale. The following approaches can help convert measurable benefits into quantifiable ones: Modelling or simulation may be extrapolated from the existing data in the system if enough process related data is being captured as part of business as usual. It may be necessary to establish trends over a period of time or through a series of data samples. Benchmarking can be a valuable approach to quantifying benefits, by evaluating the changes in relation to “best practices” in the comparable organisations. This however works best for established processes and is less useful when the benefits come from innovative practices. References sites, or data collected from other organisations who have implemented the new system (e.g. best practice visits) can also be used to establish a comparative base. It is important to understand where the organisation started from, how much improvement they can attribute to the product and how much change was required, to assess whether what they have achieved is relevant and feasible in your own organisation. Pilots will normally test the new way of working and system on a small scale so that the total benefits can be extrapolated. This requires the identification of a comparable control group still working to the old ways to establish the baseline. (3 mins)

12 Examples for Benefits Template
Category Benefit Descriptions and Numbers Measure Value / Improvement Level Financial e.g. “increase utilisation of theatres resources by allowing patient-cancelled appointments to be filled at short notice from reserve list”  expected increase in utilisation = 1 in 3 cancellations filled = 200 slots = £1000 per slot = £200,000 cancellations filled x resource value (£1,000) £200,000 Quantifiable e.g. “elimination of referrals from SCI gateway being printed onto paper for transfer to secondary care system”  number of referrals, and therefore those being printed, known before implementation; integration will eliminate these % of referrals processed through new system 100% Measurable e.g. “reduce unnecessary x-rays by avoiding repeat request”  not known how many x-ray requests are repeats, but assumption is that these will be eliminated, reducing overall number of x-ray requests number of x-ray requests N/A Observable e.g. “reduce staff frustration due to need for double data entry”  staff satisfaction survey with regard to duplicate data entry % of satisfied or very satisfied Here are examples of each category of benefits.

13 Benefits Profile Template
Benefits measurement categorisation Benefits profile template Benefits Realisation Plan Transition to business as usual Any questions?

14 SMARTT Benefits Detailed benefit descriptions contain the following categories: Benefit Characteristic Definition Example Specific Description of the benefits Number of re-xray forms completed. Quality dimensions enabled Safety, efficiency, timeliness Measureable Variable to be evaluated Number of forms filled in per month Achieveable How high a priority is the benefit? Scored on a scale of 1-5 (where 5 is the highest priority) How likely is the benefit to be realised? Scored on a scale of 1-5 (where 5 is the highest likelihood) Realistic What is the benefit dependent on? Strategic direction, process, information management, skills/ behaviours, organisation/ roles, infrastructure/ physical environment, technology integration Time-bound Realisation timeframe E.G. Measure benefit from 3 months pre-go-live until 1 year post go-live Measurement interval recommendation E.G. Per minute, per hour, per week, etc. Frequency of measurements E.G. One week out of each month, one month out of each year, etc. Targeted Benchmark E.G. 20 forms/month Target E.G. 20% reduction The benefit profile has been built around the SMARTT framework to ensure that all benefit measures defined are fit for purpose. Some of the work required to produce this information has already been done: You have just refined the description (Specific) from the benefit descriptions produced in session 1 for the BDN and reassessed their viability in session 2 after the change identification and stakeholder analysis. Mapping to the 6 dimensions of quality (Specific) was covered in session 1. For the priority and likelihood (Achievable), remember the impact vs likelihood matrix used in session 1 to prioritise benefits. The dependencies (Realistic) can be picked up from the Benefits Dependency Network started in session 1 and completed in session 2. What remains is to decide what measures should be used, when and how often data will be collected, and to agree an appropriate benchmark or target (or when the baseline data will be gathered for non-quantifiable benefits). (2 min)

15 Filling in the Benefit Profiles
Benefit ID Enter ID number from BDN Benefit description Enter benefit description Benefit owner Enter the name of the person or group who will receive the benefit Benefit sponsor Enter name and role of the person who will ensure that the benefit is achieved and instigate remedial actions if required Safe Tick if relevant Effective Timely Efficient Patient-centred Equitable Measure/Variable to be evaluated Enter description of measure to be collected Benefit explicitness Enter category: financial (high), quantifiable, measurable, observable (low) Value/Level of improvement Only applicable for quantifiable and financial benefits Impact How important is the benefit? Scale of 1 (low) to 5 (high) Likelihood How likely is the benefit to be realised? 1 (low) to 5 (high) Strategic direction Enter ID and description of objective(s) the benefit contributes to Changes required Enter ID and owner of required changes (see change profile for details) IM&T required Enter ID and description of required IM&T capabilities Benefit realisation date Enter date the benefit will be realised (or dates and degree of realisation for staged roll-out) Measurement timeframe Enter start and end dates of monitoring and reporting Measure interval Enter description of the period of time the measurement covers Baseline Enter value, source and date if applicable Benchmark or target Filling in the Benefit Profiles ACTION: Expand on the benefits information from the previous workshops in the template for each priority benefit identified: Utilise measurements that are already being used by the Health Board where possible Take into account pre-existing government targets of efficiency estimates when setting benchmarks and targets for benefits Ensure that dependencies are taken into account when setting realisation timelines Completing the benefit profiles will be an iterative process. It is unlikely that all those who need to be consulted can be brought together in a workshop, so a manageable group of stakeholders will produce the first draft and this will need to be circulated for feedback and sign-off. The benefits may have to be defined for a particular stakeholder group as the same improvement may be perceived of different value for different groups. For instance, reduced appointments cancellation due to lack of patient information will mean: Patient: less time wasted and faster access to care, Clinicians: less time wasted, and Management: less waste of staff time (booked clinician and admin who have to re-arrange appointment) and resources (room) and increased patient satisfaction. When devising measurements, consider: What would be a relevant measure of success? Can a value be calculated or the level of improvement predicted? Keep a record of the calculations and assumptions used in calculating financial benefits to ensure an audit trail of the final figures. [Facilitator’s note: The BDN and list of benefits should be obtained prior to the workshop.] Exercise - Facilitator to distribute copies of the benefit template. Break up delegates into smaller groups if required to facilitate discussion (ideally 4-8 per group) Divide the benefits between the groups. Ask delegates to refine the description and agree the measure, targets, dates, ... At the end of the exercise, one representative from each group presents their completed benefit profiles. The facilitator allows other attendees to comment, and gives feedback.] (timing will depend on whether the aim of the exercise is to complete one template for knowledge reinforcement; or whether it is to complete a template for all the benefits so delegates can leave the workshop with a completed set.)

16 Preparing to Measure Are there pre-set requirements for benefits realisation timelines? Who is going to be collecting the measurements? How will the measurement be collected? (data sources) Who will oversee the benefits collection? Where will the results be reported to? Who will conduct benefits reviews? Who will be responsible for communicating about the benefits side of the project? Once that all of the benefits have been established and defined in detail, that process and role changes have been identified and that the change management planning has commenced, what remains is to start measuring benefits. The benefit realisation plan should include an initial data collection date to establish the baseline measures at the beginning of the project (“as is” state). Projects should then regularly track actual measurements against the baseline or targets as they are recorded over time. Benefits realisation will extend beyond the project lifecycle and so should benefits measurement and reporting. Ensure that governance is in place to ensure that data is being collected, reported, analysed and communicated. (1 min)

17 Preparing for Benefits Monitoring
In order that the benefits monitoring is as productive as possible: define a robust mechanism to monitor progress and ensure that reports are distributed to the appropriate people; ensure that the Benefits Management templates are up to date; hold regular benefits reviews to track the progress of benefits realisation against the project and programme objectives; use benefits reviews as an opportunity to highlight areas where benefits are not being achieved, and identify the barriers to achieving them; for those benefits that are under-realised, refer to the dependencies shown in the BDN for potential root causes; assign responsibilities for taking and coordinating corrective actions where benefits are not being met; and identify and communicate successes too! u should aim to revisit the benefits realisation plan at agreed review points once changes and IT capabilities have started being implemented to track the progress of benefits realisation. This may be before the end of the project for staged roll outs. Assessing and demonstrating benefits realisation is how you will be able to demonstrate that the project is delivering the business case. Regular reviews will also help you decide whether the changes made are delivering the desired benefits. If this is not the case, you need to consider corrective action and refine the change strategy. If the measures are not improving, the benefits defined may not have been realistic and achievable from the outset. They should be reviewed and, if necessary, removed from the business case, with the reasons clearly explained. The benefit strategy should include a robust mechanism to monitor progress and ensure that reports are distributed to the appropriate people. Those responsible for taking and coordinating corrective actions where benefits are not being met should be clearly defined. It is critical to demonstrate impact and success as the project is proceeding. Engaging busy clinicians and managers in the project will be made substantially easier if early success stories can be demonstrated. Communicate continually to demonstrate progress and to show that issues raised are being taken seriously and addressed. (2 min)

18 Benefits Realisation Plan
Benefits measurement categorisation Benefits profile template Benefits Realisation Plan Transition to business as usual Any questions?

19 Formalising it The Benefit Realisation Plan provides evidence to:
Justify investment decisions Prioritise competing work in context of finite resources Establish clear ownership / governance arrangements Realise benefits Demonstrate value and effective use of resources Store the Benefit Realisation Plan with the other key project management work. A high level BRP is required for the national programme lifecycle, and it is useful to create a benefits plan at project level as well. This plan will allow programmes and projects to publish realistic expected timetables for benefits realisation that take into account resource requirements and dependencies. With a comprehensive and detailed benefits plan, it is easier to assess the implications of events that occur during implementation and then adjust the relevant elements accordingly. Detailed planning (BRP) and early identification of contentious issues (stakeholder analysis) will lead to higher levels of success. (1 min)

20 Benefits Realisation Plan (BRP)
When drafting the Benefit Realisation Plan remember to: Consider the dependencies identified between benefits, changes and IS&T capabilities; Identify timeline and milestones that take those dependencies into account; Work with stakeholders towards minimising the negative impact of identified disbenefits; and Extend the plan beyond the system implementation date (often viewed as the end of the project) to schedule regular reviews of benefits realised and consider potential further benefits. (1 min)

21 BRP Content The Benefit Realisation Plan should include:
the completed Benefits Dependency Network (BDN) the completed benefit profiles, including dates for capture of baseline figures at an early stage the completed change templates the completed stakeholders analysis Prioritise the benefits so that the most important always has the most focus. This ensures that the project makes the greatest impact. Identify dates for expected delivery of the benefits. For the purpose of the business case, a list of benefits is not enough. Measurements to quantify the improvements also need to be established, and so do the dependencies between the benefits and enabling changes and activites. The changes required and how likely or difficult they will be to implement together with the technology sought to support the investment need to be defined. The possible impact of stakeholders’ attitude on the success of the project needs to be evaluated. You have completed all these Benefits Management activities and documented your outputs in the previous sessions. It is now important to pull all of your hard work together into the Benefits Realisation Plan and save it with your other key project documents. (1 min)

22 Benefits Strategy A benefits strategy should also be prepared for the business case, including: the rationale linking the drivers, objectives and benefits defined roles and responsibilities a mechanism for regular measurements and reporting a mechanism for regular reviews and corrective action arrangements for the transfer of responsibilities at close of project To avoid misunderstanding regarding accountability and responsibilities, a benefits strategy detailing governance principles should be produced and included in the business case. This is important as the size and scope of the project will affect governance (for instance one person may hold more than one role in small projects, or there may be a separate project team and benefits realisation team in large programmes and the relationship between the two will need defined). There isn’t a one-fit-for-all and the project team should carefully consider what will work best for them. (1 min)

23 Linking Business Case & Benefits Management
Providing all this, the business case will demonstrate that: benefits outweigh disbenefits; a shared vision is held which is strategically aligned; the BDN clearly shows how the shared vision will be achieved; the change required, when considered in relation to the overall schedule of change planned, is not overwhelming for any stakeholders; and, the benefits realised will be worth the effort required to achieve them. It will also show that: there is a clear process for identifying, monitoring and realising the benefits; and the baseline benefits position has been recorded to enable comparison with projected targets for monitoring the achievement of benefits. The business case is the key document in a project. The business case should demonstrate that the expected benefits are worth the predicted costs of achieving them – not just financially, but in terms of organisational capacity to change and deliver. According to a study by Brynjolfsson and Hit (2000), the complementary financial investment required to fully exploit IM&T assets can often be 5 times the cost of the technology itself. It is therefore important to carefully plan and define those complementary activities and to build the business case around, not only the financial return expected of IM&T, but also the soft benefits and additional organisational capabilities. (2 mins)

24 Transition to Business as Usual
Benefits measurement categorisation Benefits profile template Benefits Realisation Plan Transition to business as usual Any questions?

25 Close of project activities
Following full implementation of information systems, the achievement of the business case should be reviewed. The review will produce 3 reports: formal end-of-project review lessons learned potential further benefits Following full implementation of IM&T, the achievement of the business case should be reviewed by a review team. The review team should comprise both key responsible members of the project team - namely the project sponsor, the project manager, benefit sponsors, the benefits and the change owners - and key stakeholders representative - who didn’t hold any role in the project team and are therefore independent and objective of the achievements of the project. Contrarily to the project, which is very finite, benefits monitoring will have a more flexible end date and can be expected to extend well beyond the project’s end date. There may be a delay between the system implementation and the realisation of the benefits (e.g. if the benefits depends on the capture of additional data which will be populated over a period of time; or on the adoption of a new working practice which may take time to become embedded). The date of the formal review should take account of this and be agreed by the Project Manager and the Change Owners. On the other hand, the benefits may peak soon after implementation but then sloped down as the initial enthusiasm for the improvement wanes and staff fall back into “old habits”. It can therefore be useful to schedule another benefits review after a few months or a year. A second review may also be necessary for projects with long term benefits, although the more time has elapsed (e.g. more than a year), the more organisational performance will be affected by other projects and changes and attributing benefits to the old project may become difficult. (2 mins)

26 End of Project Review The end of project review will:
assess to what extend the project was successful in delivering the benefits; decide what further actions are required, by whom and when they should be reviewed; and detail handover arrangements for any tasks outstanding (including benefits monitoring and reporting). The Benefits Plan should be updated as relevant to ensure a reference document is available to handover to the “business as usual” team. The review should be viewed as a useful opportunity to take stock of achievements and experience and identify any unachieved benefits and objectives. The Review Team should consider: the benefits that have been achieved; the benefits that haven’t, the reason why and whether any remedial action can be undertaken; and the benefits that have been abandoned and why. Specific actions to recover benefits that have not been achieved or to address disbenefits that have emerged from changes should be identified, together with the responsibility for carrying them out. In larger projects or programmes, where there may be a separate project team and benefits realisation team, it may be decided that there should be separate reviews: one assessing the way the project was managed and focusing on deliverables, the other looking at the benefit realisation management and to what degree the benefits were realised. This is a matter of governance and should be agreed and defined in the business case. (1 min)

27 Lessons Learned The purpose of the “lessons learned report” is to:
reflect on the lessons learned for future investments; disseminate useful lessons learned during the project for the benefit of other projects, internal and external; provide a useful control as part of the functions of an independent quality assurance group; consider how much effort was required to complete the benefits management documentation and monitor the benefits; and make recommendations for future enhancement or modification of the benefits management method. Lessons learned (both good and bad) should be identified to be shared with other projects. They should be recorded and made available to others to ensure that best quality can be achieved in future projects through repeated use of good practice and avoidance of unsuccessful approaches. Communicating findings, lessons learned and successes with the stakeholders will also help maintain interest and ensure future commitment. The benefits management methodology and toolkit are relatively new and feedback on their suitability and usability is essential to ensure they are fit for purpose. (1 min)

28 Further Benefits The Review Team should also consider and communicate:
what opportunities exist for the identification and realisation of additional benefits; and who will take the business case for them forward. Additional benefits should be defined, planned and implemented following the same methodology as the initial project benefits. Any further benefits that weren’t included in the initial business case but could now be achieved should be listed for consideration. These will be likely to require business and enabling changes to be realised, and potentially additional system capabilities. It is therefore important to go through the benefits management process again to defined those benefits and assess their viability in terms of time and resources required versus gain. (1 min)

29 Transition to Business As Usual
Leave no loose ends: each outstanding activity needs to be allocated to a named individual Have end dates for decommissioning of legacy systems to ensure the new IM&T are used – this will ensure new processes are used too and related benefits are delivered Monitor the implementation of change over a period: people may revert to the “old ways” once the initial enthusiasm has worn off people may find work-arounds where the technology or new processes are not working instead of reporting the problems address teething problems The project and benefit plans should have well thought out arrangements for the handover of change management and benefits monitoring responsibilities after closing of the project. Legacy systems decommissioning should happen some time after the implementation of the new system to allow a smooth transition and a back up in case of teething problems. It should however not be left too long or users may not switch to the new system and hence not adopt the new ways of working, leading to limited benefits realisation. Use the stakeholder analysis to identify potential resistance pockets and devise an action plan to gain their commitment to implementing the changes. Remember to continue communicating further progress and successes. (1 min)

30 Summary of Benefits Management Lifecycle
Project lifecycle Benefits management lifecycle Outputs Project initiation Identify and structure benefits Benefits Dependency Network (BDN) Identify change activities required to realize the benefits Prepare benefit plan and business case Benefit profiles Change profiles Stakeholder analysis Run first benefits analysis Baseline data Delivery management Use benefit plan to inform project management, system development and change management activities Regularly review project progress against benefits analysis Updated figures Make adjustment to system capabilities, business changes or benefit definitions as required Amended templates and BDN Close Run end of project benefits analysis (formal review) Formal report to Board Business as usual Identify need for further reviews and potential for further benefits To summarise: Benefits Management offers a structured approach to defining achievable benefits and ensuring that required actions to realising them are identified and will be taken to ensure the success of the project. The Benefit management methodology was not developed to replace other programme management methodologies but to complement them. It can be used as a mean of integrating the different management approaches and maintain the focus on the purpose of the programme (why are we changing and what outcomes are we seeking to achieve) instead of the means of delivery (IM and IT systems). By moving the focus away from the IM&T implementation, benefits management encourages those involved in the project to concentrate on delivering benefits to the service, not just through technology, but through better processes, relationships and new ways of working. Benefits management also provides a basis for the evaluation of the viability of a programme or project in terms of measurable returns expected against the costs involved. It will then enable the detailed planning, management and evaluation of the realisation of each benefit. Finally, the process is designed to encourage stakeholders engagement, commitment and the sharing of collective knowledge. This will largely depends on the benefits each stakeholder perceives and hence the emphasis on the ownership of benefits. The templates provided will give you an idea of what useful documentation should be completed. You should feel free to adapt these to your own needs, taking into account the particulars of your project and what other documentation is available (e.g. if detailed change management or stakeholder analysis has been done as part of project management, there is no need to duplicate this but you may want to read through the slides to ensure every relevant aspects has been captured). (3 mins)

31 References and Further Reading
The Clinical Indicators Team has produced a presentation on statistical process control (SPC): HM Treasury’s “Green Book” provides examples of methods used to estimate the financial value of activities or resources: No Delays Scotland have devised a methodology for measuring benefits: Statistics for NHS England and Wales for benchmarking on: (cont’d)

32 References and Further Reading (cont’d)
Benchmark statistics (Scotland) are available from ISD: Quarterly and annual figures on patient safety are published by NPSA: The Department of Health publishes annual and quarterly healthcare performance statistics: Population numbers by NHS Boards – births, deaths, totals, by age, by gender – are available from GRO:

33 to ensure that maximum benefit is gained from eHealth Systems.
Congratulations on completing the benefits management programme and on all your efforts to ensure that maximum benefit is gained from eHealth Systems. Session 5 v1.2, slide 23


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