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Urgent Care Clinical Dashboard

Benefit Realisation Guide

V1.0

Contents

Introduction...................................................................................................................................3

The Benefit Guide........................................................................................................................4

Benefits Engagement and Communication..................................................................................5

Four Stage Benefits Strategy.......................................................................................................6

Stage 1: Identify the benefits........................................................................................................7

Stage 2: Plan for delivering benefits............................................................................................8

Stage 3: Deliver and Exploit the benefits.....................................................................................9

Stage 4: Evaluate the benefits...................................................................................................10

National UCCD Benefit Collection and Collation........................................................................11

Activity Plans..............................................................................................................................13

Stage 1 Activity Plan..................................................................................................................14




Toolkit and Resources...............................................................................................................23

Introduction

The benefits guide is a framework of how benefits can be well managed and realised in Clinical Dashboard implementations. Creating a benefit driven approach in Clinical Dashboard projects ensures that benefits for patients, staff and for the organisation are maximised, while helping to achieve local health priorities.

This guide provides:

A simple four stage approach to managing the benefits of Clinical Dashboards

Benefit resources and toolkit

Further signposting to NHS benefits & change best practice

The strategy is based on the Department of Health Informatics Directorate’s four stage benefit approach which has been developed in conjunction with the Capital Investment Branch, with input from work by the OGC and Criminal Justice IT.

The Benefit Guide

The information within this guide is designed to be flexible, enabling local Clinical Dashboard Projects to tailor their use of the guide dependent upon their needs. Benefits are locally derived, locally driven and locally realised, therefore, this guide simply lays the foundations to enable your project to design your strategy as necessary. The guide contains resources that identify benefits and metrics of Urgent Care Clinical Dashboards, but these should be viewed as a starter, a minimum, rather than a defined list.

The guide is formed by four distinct chapters:

•________•________•________•________

www.

Four Stage Benefits Strategy

Activity Plans

Toolkit & Resources

External Resources

Four Stage Benefit Model: Identifies areas of benefit management that teams implementing UCCD should consider, proposes potential outputs and offers tools that could help ensure consistent benefit management.

Activity Plans: Adds greater detail to each stage of the strategy, simply ‘click’ to view as and when it is appropriate depending on your local needs.

Toolkit & Resources: A library of tools that can help good benefit management

External Resources: Links to best practice websites and health informatics portals.

Use the guide as a menu, pick what you want from each section, and use the materials within it as appropriate for your local implementation.

Benefits Engagement and Communication

Benefits should be part of the entire team approach and not placed in a benefits and change silo. The diagram below shows how a team approach can be used to garner benefits from many different sources.

The extension of benefit responsibility to the wider team results in a greater set of stakeholders contributing to the possible benefits of the Urgent Care Clinical Dashboard. This has the potential to increase the identified benefits and maximises the potential service improvement opportunities. There is also a need to ensure there is a clear plan for reporting benefit progress utilising resources like the benefit progress template (click here), reporting via project meetings, as well as any other visible and available communication channels.

Once the final benefit data has been collected and analysed, there needs to be a clear path to communicating benefits to local stakeholders, appropriate national teams and other organisations implementing the Urgent Care Clinical Dashboard. The following communication channels can be used:

Case Studies/ Local Internal news items Engagement with local UCCD project teams Engagement with appropriate regional bodies e.g. SHAs Engagement with National Teams e.g. DH QIPP Workstream Update Benefit Realisation Report with benefits realised and disseminate

However, the communication of benefits should be not be limited to these channels and instead be locally tailored as appropriate.

Four Stage Benefits Strategy

Creating a benefits driven approach to Clinical Dashboard projects can be a key enabler to success; ensuring dashboards are implemented to positively support local health needs and programmes of work. The benefits strategy provides areas of focus in UCCD projects to stimulate benefit management best practice, which is further supported by tools and resources that focus on a four stage model. The model ensures benefits are developed and managed effectively, the stages to this model are:

Benefits should be the driver to implementing an Urgent Care Clinical Dashboards; it is being implemented on the basis that it brings benefit to patients, clinicians and the wider NHS, therefore, there must be evidence of realisation of planned and unexpected benefits post deployment.

The four stage model helps benefit management regardless of project maturity or progress as it encompasses tools and advice based on need. The strategy focuses on putting benefits at the heart of the project so all stakeholders are adequately informed and contributing to the process of discovering and realising benefits.

The following four pages of the guide detail an overview of each stage of the strategy and includes links to further information, tools and external links.

1. Identify the benefits

2. Plan for delivering the

benefits

3. Deliver and exploit the benefits

4. Evaluate the benefits

Stage 0 Feasibility Stage 1 Initiate Stage 2 Scoping

Stage 3 Develop

Stage 4 Prepare and support Go

live

Stage 5 Support and Project Close

Project Stages

Identification

Stage 1: Identify the benefits

This stage helps identify the potential benefits that will be enabled by the introduction of the Urgent Care Clinical Dashboards.

Organisations should consider at this point:

What the UC Clinical Dashboard will support in terms of key strategic objectives What service improvement need or programme of work will it support? What opportunities the UCCD will enable? Identifying the vision of what the UCCD will support and how it will improve

existing process Engaging with a wide range of stakeholder to consider the opportunities of an

UCCD

The outputs of this work should be:

Confirmation of the vision the UC Clinical Dashboard will support Identification of key opportunities/benefits Benefit map; benefits mapped to show how they support objectives/programmes

of work Identification of who will be responsible for benefit management. Development of a benefit register/log

Tools:

Stage 1 Activities Check List (click here) UCCD Benefit Registers from previous deployments UCCD Business Cases UCCD Benefit Register Example (click here) Benefit Register (click here) Benefits Informatics Zone four stage model:

http://nww.connectingforhealth.nhs.uk/biz/cycle/stage1

Top Tip!

Try not to word your ideas as formal benefits at this stage, look at them as opportunities you can realise and changes you can make. Be all encompassing, taking ideas from all your stakeholders. Think about how you want to use the dashboard and the difference it can make to your local health community, then add them to your benefit register!



Stage 3 Develop


live


Project Stages

Plan

Stage 2: Plan for delivering benefits

This stage helps develop a plan for realisation and monitoring of benefits, identifying appropriate metrics and ensuring effective owners.


Are all the initial benefits/opportunities identified at stage 1 still achievable and realisable? Are there new unexpected benefits/disbenefits?

Who will monitor and own benefit measurement? What changes will need to happen to realise benefits? What communication is needed to ensure all stakeholders understand the plan

for realisation? What metrics will be used to measure benefits? Have you identified any disbenefits?


A Benefit Realisation Plan inc. benefits, owners, metrics & timescales Defined change activities for realising benefits Updated Benefits Register Established governance of who ensures benefit realisation Prioritisation of benefits if required Baseline your benefits as planned Develop a communication plan.

Tools:

Stage 2 Activities Check List (click here) UCCD Benefit Registers from previous deployments UCCD Realisation Plan (click here) UCCD Example Benefit Register (click here) UCCD Communication Plan Benefits Informatics Zone four stage model:


Top Tip!

Getting benefit owners as early as possible is really important when it comes to measuring. Engage early so owners and measurers understand their role and what is required, they may have valuable feedback and learning!



Stage 3 Develop


live


Project Stages

Deliver & Exploit

Stage 3: Deliver and Exploit the benefits

Turn plans into reality and deliver the benefits. Support the delivery of change and the Clinical Dashboard Implementation through the monitoring and realisation of benefits. This is where planning leads to actual measurement, so ensuring progress and maintaining the plan is extremely important.


Pre go live, are you baselining your benefits as planned? Post go live, are you measuring benefits as planned? Are you reviewing benefit realisation progress at your project meeting? Are you now capturing lessons learned? Are you reviewing the benefit strategy; confirming benefits are being delivered,

capturing unexpected benefits and disbenefits? Are you collating evidence of benefits already realised? How are you mitigating expected or unexpected disbenefits?


An updated Benefit Realisation Plan including unexpected benefits & disbenefits A plan for mitigating unexpected disbenefits added to the realisation plan An updated Lessons Learned Log Benefit Progress Reports Updated Benefit Register including unexpected benefits and disbenefits Initial case studies as appropriate

Tools:

Stage 3 Activities Check List (click here) Lessons learned Template (click here) Benefit progress template (click here) Benefits Informatics Zone four stage model:


Top Tip!

Use a really simple benefit progress report to see how your benefit base lining and measuring is going. Simply give a RAG status to each benefit with a brief point of issues and mitigation if required. It gives great visibility to the team and provides assurance.



Stage 3 Develop


live


Project Stages

Evaluate

Stage 4: Evaluate the benefits

Evaluation is conducted for a number of reasons, and the approach may vary accordingly. The main reasons for evaluation are:

to be accountable to assess achievement against plan to plan to optimise further to celebrate success


Has all the business change been undertaken to realise benefits? Has all the benefit data been collected, collated, assured? Have you collected all your lessons learned? Lessons learned event? How are you going to report your benefits and change? How are you helping other implementations?


Benefit status overview report An action plan or optimisation plan to optimise new or unexpected benefits, this

can be added to your benefits realisation plan Updated benefit register Lessons Learned gathering, an event or all team meeting Publish your updated Benefit Realisation Plan (inc benefit realised and

evidence) benefits trackers and case studies on SharePoint and other areas Linking in with other implementing sites to share learning

Tools:

Stage 4 Activities Check List (click here) Benefits case study template (click here) Benefits Informatics Zone four stage model:


Top Tip!

Don’t be afraid to share your successes, good or bad! Other clinical dashboard projects can learn from your mistakes but just as importantly build on your successes and benefits! Use case studies, share via SharePoint and develop good links with dashboard local projects


National UCCD Benefit Collection and Collation

While benefits are locally driven and locally realised, the learning and knowledge from local realisation is extremely important for other implementing sites and to develop a national evidence base regarding the UCCD. National Collection and Collation of benefits ensures:

local benefits can be used as a benchmark for new implementations local benefits may be innovative and show new ways of working local benefits give new implementations a head start without having to ‘re-invent

the wheel’ national collation of benefits from sites help identify a ‘national case’ for UCCDs

identifying patient led and efficiency benefits collation of benefits helps to support annual benefit review or progress

statements

Therefore, it is important that realised benefits are detailed in updated benefit realisation plans along with evidence or supporting information such as benefit trackers, benefit case studies are prepared (as well as any other appropriate media) and these materials are uploaded appropriately to the UCCD SharePoint site. This enables all implementing organisations to see the benefits realised, and gives rise to national collation by the DH QIPP National Team.

The flow diagram below identifies the steps to National Collection and Collation:

The steps highlighted not only enable other organisation to help implement and plan their benefit realisation, it also allows for the national team to coordinate benefits and collate benefits across the NHS.

National Collation of Benefits will:

help innovation enabled by the UCCD to thrive across the NHS support the case for change enabled by the UCCD evidence a national case for the UCCD supported by quantitative and qualitative

benefits support any future national benefit statements

Supporting national collection and collation of benefits is vital, therefore, uploading of initial and updated Benefit Realisation Plans and supporting evidence (as well as any other documents you wish to share!) is a simple step which helps develop national cases and local innovation.

1. Define Benefits

2. Create Realisatio

n Plan

4. Realise Benefits

& Evidence

3. Upload Plan to

SharePoint

5. Upload Updated Plan to

SharePoint

Activity Plans

The following pages contain detailed activity checklists that can be used to support the four stage benefit model. These are designed as a reference tool for areas of knowledge that require further reading.

They can be used as a pick and mix menu or be read in their entirety. It is a local decision on their use and whether they are appropriate for your UCCD project.

Stage 1 Activity Plan

Stage 1 Activities

Agree, define and prioritise objectives

Define the hierarchy of objectives and priorities from national, regional, and local policy and plans. Align informatics investment with these objectives. Use these to prioritise, and provide a timeframe (longer term vs yearly planning round).Make sure the Objectives are SMART – meaningful and tangible at local level, but still providing a challenge. Use Benefits Network Dependency Mapping (Value Chain Analysis) techniques, working initially with a long list of Objectives. Prioritise these for example by stakeholder consensus; by any known constraints; by feasibility of achievement.

Stakeholder analysis The core project/programme team, business change and benefits leads, sponsor of the project/programme, should conduct an initial stakeholder analysis. Consider views such as:- who is a beneficiary- who has power to influence- who can make things happen.

Stakeholder engagement

Consult with stakeholders; engage with them for example through a benefits workshop with the aim of agreeing shared objectives, and to identify benefits. This is important to ensuring that they are committed to delivery, to achieving the benefits, in Stage 3. This should include project/ programme teams. Engage with the Executive team to ensure SRO buy in and commitment. Often Non-Execs have an interest and have something to contribute, and may be useful allies.Include patients in the consultation. They add a valuable perspective, and can be a useful and willing resource.

Identify Benefits There are a number of equally valid approaches to identifying the benefits that the investment can deliver. The use of a combination of approaches provides a rich picture. Many techniques are common to Service Improvement, in that the aim is to find opportunities for positive change.

Process / Pathway analysis

Process or patient pathway analysis will help understand what business changes are needed to deliver identified benefits. Consider the role of information and informatics in each process step

Well known to service improvement and change agents

Opportunistic, optimising

Use a SWOT analysis to identify opportunities for benefits. SWOT = Strengths, Weaknesses, Opportunities, Threats. The analysis could be of an organisation, service, or even a product or existing implementation. The analysis should identify opportunities for change and improvement, and the team can then consider how informatics can help, and what the consequent benefits would be.

Existing benefits registers

Useful to look at existing ideas on potential benefits. Ideally these are from reports of actual benefits achieved in other programmes or organisations.

Review lessons from past

Ensure lessons from previous projects/programmes are learned and adopted.

Review any action plans from previous Stage 4 reviews

Use case studies for real examples and checking lessons learned, and for inspiration.Contact the organisations involved, they are usually happy to answer questions and provide more information.

Profile Benefits Defining the detail of the benefits you have identified can start in Stage 1, though much of the information will be part of the Stage 2, Planning.

Start a benefits opportunity log or register

This is the collation of all relevant benefits identified to date. Gather all the benefits information, including long list and discarded benefit ideas, material from case studies, and use these to create a local/regional or national benefits register, in accordance with the Benefits Strategy.Consider this as an opportunity log, to balance the traditional project risk log, and update it regularly. Having an evidence base to refer to in the subsequent stages is helpful, and necessary for Stage 4 Review.


Stage 2 Activities

Establish governance & benefit owners

This happens at two levels:

- Benefits should have defined owners. These are the people who have the most vested interest in making the benefit happen. They may not have the organisational role or position to effect the change, so this authority will have to be provided to them.

- The organisation’s Executive team and Board (maybe at LHC level) as well as the programme Board, should have benefits on its routine agenda. The Executive and Board need to recognise these informatics programmes represent an investment into the future of the business, and may be business critical.

If for any reason the Executive team were not engaged in Stage 1, they do need to be engaged now. Their key role is to - enable due governance, including authority for benefit owners to do what they need to do. This will help smooth delivery in Stage 3- sign up to the BR plan and the benefit profiles

Stakeholder engagement

- Use existing groups, meetings, forums where possible, as means of engaging and communicating with people.

- Project / programme teams can include ‘benefits’ in any existing meetings as a regular or occasional agenda item

- Additional resources: consider colleagues in for example public health, human resources, Deaneries, PALS, and the non-executive members of the Board, and how they can be involved. They may have expertise in for example: analysis, population demographics, skills in engaging with patients or specific groups of staff, knowledge of the business.

Prioritise benefits If you have a long list of benefits from Stage 1, or further benefits being identified with the supplier, and through planning for example, this long list needs to be prioritised into a set that is manageable. Prioritisation approaches include:

- balanced scorecard. Include benefits for all stakeholder points of view, to provide buy in. Balanced scorecard usually includes the four dimensions: Patients – Staff – Clinical Care – Operational efficiency (££)

- benefits that are easily measurable, relevant, meaningful

- benefits that are interesting

- benefits that have committed owners.

Profile Benefits Prepare Benefit Profiles for the short list of benefits you intend to track and

measure, and which have committed owners.

Ideally do this together with the benefits owners, with input from other stakeholders to inform the profile.

The timing / phasing of when benefits might be realisable and measurable will depend on both project and change plans. This should be used to review business case forecasts, or can inform a Full Business Case where this is still to be written (Eg, in spring 2009 the Clinical Dashboards project is conducting pilots to review benefits to inform the full business case for rollout)

Benefits realisation plan (BRP)

The BRP shows how the benefit will be realised, including any changes in working practice, and how the benefit is to be monitored and utilised. The BRP is effectively a schedule of all the benefits profiles in an easy-to-view format for a business/benefits manager. It details who does what and when – to achieve, measure and report the benefits.

It should link to, or include monitoring, measurement and reporting plans for the benefits

Baselining should be scheduled and ideally completed before the change intervention.

Targets should be agreed in the BRP. Contextual and utilisation information will be needed, to indicate when benefits are likely to start being realised, and at what rate.

The BRP process needs to include the review of the opportunity log, as well as the risk log.

Measurement Planning

Detailed plan about how a benefit is to be measured, how often, where the information will come from, how it will be analysed, aggregated and reported. This should include the tools to be used, eg survey, extract report specifications, template spreadsheets

The measurement plan needs to take account of the phasing of benefits, when and what rate they will start to kick in, and whether they are one-off or recurring.

Baselines and targets

Baselining is the key activity now. Use the benefit profiles as a way of recording these into your benefits realisation plan. Set targets for achieving benefits, including phasing.

Contextualise Consider from your LISA/ ORAM (which should have been done as part of overall informatics plan or benefits strategy), and from any supplier analysis, what contextual information might be relevant to planning benefits realisation. Consider other contextual information about the environment you operate in: For example, Is there a large mobile population such as students; is it a rural, urban setting; are there existing partnerships with Social Care or the Third Sector.

Contextual factors may be presented for example as risks, or assumptions, or factors that influence the degree of benefit to be realised, in your benefits realisation plan.

Communications / stakeholder

Prepare a communications plan for your stakeholders – feedback, PR,

management plan progress, engagement. Use existing channels where possible. Report by exception where possible. Consider

-Who you need to communicate with (and why)

-When and how often

-What content (PR, education, feedback, reports)

-Through what mechanisms (meetings, newsletters, events, Annual Statement)

Linking. Share and Cross check the BR plan with the project/ programme plan, and embed shared milestones/ review points in these

Opportunity log Update and finalise,


Stage 3 Activities

Governance Benefit owners responsible for making benefits happen, with Executive authority provided.

Executive to maintain direction and leadership.

Implementation of technical capability, training

The business change lead, benefits leads, may be involved in supporting technical implementation to provide the business direction and perspective.

Change management, people support

Provide authority for those who are delivering the change and benefits to do so.

Escalate proactively if there are any issues.

Baseline Baseline if not done before, or ensure the BRP includes schedule for when baselining needs to take place, and that this is recorded in the profile.

Joint forum Form a joint forum for progress review between benefits and project or programme teams.

Benefits tracking – is change being delivered

The original profiles and overall BR plan should be the tracking tool for the Business change manager, and the input for the change/benefit leads delivering the change/benefits.

- Confirm if benefits are being delivered, to learn, to adapt activity if needed

- Capture anecdotal benefits and disbenefits through regular checkpoint meetings with programme/project manager, clinical or other end user group or forum as set up in Stage 2 - Start to capture any unexpected benefits or disbenefits, update opportunity and risk log.- Review metrics and amend if necessary- Compile Benefits Progress Reports

Mitigate against disbenefits

- Ensure mitigation of disbenefits is being done, always engaging the user forum, and relevant benefit owners

Start lessons learned log

Review previous lessons learned and case studies; start to capture your own in a lessons learned log, or through case studies. Keep it simple and accessible.

Communications and stakeholders

Follow the communications plan;

Key stakeholders should be kept informed and (if appropriate) give you views and feedback on benefits realised, and opportunities for further benefits


Stage 4 Activities

Data gathering The implementation needs to be sufficiently mature to have some benefits realised.

The benefit profiles/ plan should provide the guide to this phasing.

Benefit owners and implementation team staff are involved in the data gathering, as maybe other informatics, audit or support staff.

Data assurance Quality checks on the data gathered should be performed, with the benefit owners, informatics support, and against baselines, business case or other forecast data.

Benefits tracking – is change being delivered

The review stage should take a detailed and structured approach to assessing the delivery of benefits. The original profiles and overall BR plan should be the tracking tool for the Business change manager.

Through review where benefits appear not to be realised, identify any further change management or deployment activity that is needed to deliver change and the benefits.

As the maturity of the deployment of informatics develops, it is important to recognise that the benefits measures that you are using to indicate progress will almost certainly need to change.

Year 2 of a change programme for example will likely afford different benefits opportunities, as the informatics is embedded further into an organisations ‘business as usual’. Modified benefits metrics (i.e. that measure a more mature deployment) will almost certainly be required as the change programme, and further investment proceeds.

Update opportunity and risk log

Capture unexpected benefits, disbenefitsReview and record any anecdotal benefits and disbenefits captured during implementation. If relevant, incorporate these into a benefits action plan. Address disbenefits appropriately, always engaging the user forum, and relevant benefit ownersReport explicitly on any disbenefits, and recommend mitigation

Learn lessons and maintain log

Review previous lessons learned logged during implementation;

Document lessons learned from benefits reports, and from any deep-dive benefit reviews;

Write a lessons learned report – this could be a management report style document, or a training document for example.

Incorporate into benefits action plan.

Review metrics, and optimise

As implementation matures or new phases of implementation take place, review

benefits metrics for their relevance.

In the realisation plan and profiles, the phasing of the benefits should have been clearly identified. Benefits later in the implementation and operation phase should be reviewed for their relevance and validity in light of the experience from the initial implementation phase.

This is an opportunity to optimise the investment and benefits, based on the initial experience.

Through review where benefits appear not to be realised, identify any further change management or deployment activity that is needed to deliver change and the benefits – usually this should go to Stage 4 as input to overall review based action plan, but it may be more appropriate to initiate a change control through the project /programme manager or change team.

Reporting A benefits status report is a compilation of the accumulated information on benefits, including results from the routine reporting of benefits and benefits progress reports, any specific benefit reviews that may be conducted, lessons learned and the opportunity and risk logs.

Reporting effort, like benefits monitoring and measurement, should be commensurate with the need for it and impact it will have. This should not become an industry. Reporting can have many purposes, for example:

- Motivational reports, to celebrate success to date, or to engage with stakeholders

- Feedback on overall benefits realisation to benefits owners, implementation teams

- Reports to inform action planning

- Accountability, at local or national level, for which the report will need to compare with, as a minimum,

- original investment objectives

- original business case

- project/ programme plan and actual implementation scope & timescales

- benefits realisation plan.

Such reports should make the context clear, and any assumptions or factors which have affected the original plan, either positively or negatively.

Reporting mechanisms

Consider different ways of reporting:

- routine part of programme or Board agenda

- report by exception

- report from time to time at existing, routine meetings of relevant forums who may have an interest

- public reports – eg local news, newsletters, posters

Review metrics, and optimise

As implementation matures, review benefits metrics for their relevance,

In the realisation plan and profiles, the phasing of the benefits should have been clearly identified. Benefits later in the implementation and operation phase should be reviewed for their relevance and validity in light of the experience from the initial implementation phase.

This is an opportunity to optimise the investment and benefits, based on the initial experience.

Communications Key stakeholders should be kept informed and depending on their role, they

-provide input or expertise,

-assure ,

- approve benefits reports,

and recommend actions arising.

Benefits Action Plan All of the above potentially feeds into a benefits action plan or an updated benefits realisation plan which will need to be agreed. It could involve

- recommending changing scope, pace or nature of implementation, including closure, if negative information about possible achievement of benefits is found

- focusing on benefits not achieved, or new benefits to optimise

- changing which benefits are to be measured, or the metrics used to measure

- engaging new stakeholders

- specific communications

Toolkit and Resources

The following embedded tools have been signposted within the four stage benefit guide. They are examples of the tools that can be used. They can be amended and evolved to suit your local UCCD implementation.

Description FileUCCD Realisation Plan

Benefits Case Study Template

Benefit Progress Template

Lessons Learned Template

UCCD Example Benefit Tracke/Register

UCCD Benefit Register (Blank)

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