What is a 'Benefits Realisation'?

In the summer I asked some questions at our local council Health Overview and Scrutiny Committee about how would the public know that the planned reconfiguration of services at our two local hospitals would benefit patients and what were the baseline measures for the specific services being changed.

The answer I got from the PCT was "in relation to the Better Healthcare in Buckinghamshire programme, a benefits realisation performance dashboard was being developed".

At the time this went straight over my head and all I could think about was that they had not answered my question on baseline measures.  I have described my effort to get the information in a previous blog (Like getting blood from a stone).

Recently there was a twitter discussion (#NHSchange) on measurement for improvement and someone used the phrase 'benefits realisation' in a tweet.  I complained about the use of jargon but was challenged to find some alternative wording.

I had to think a bit but did come up with some suggestions for a patient friendly version.

"Is my experience as a patient better now than it was before the change/redesign/reconfiguration?"

"Is my outcome (better health, less pain, ability to work, feel better) improved as a result of the change in service provision?"

I also did a bit of research and even went back to a PCT paper on benefits realisation.  In the document it said "Better Healthcare in Buckinghamshire will begin the development of a business case from which the benefits realisation plan can be further developed". However I could find no trace of such a plan in the public domain.

The paper also said that it was important to set current baseline against which to measure benefits.  This is, of course, what I was asking about in my question to the scrutiny committee. But it did not appear to have been done.  Luckily I have a meeting with the Trust to discuss this issue in a few days and I can use this information in my discussions with them.  I will report on what happens at the meeting.

As part of my research I googled 'benefits realisation' and first up was the NHS Institute for Innovation and Improvement's (NHSIII) website where they have a paper on the topic. It is interesting and worth a read. http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/benefits_realisation.html

In their view a benefits realisation is

"a tool to make sure you actually get the intended benefits originally planned for your project". 

I like that! Clear and concise.

Further on it says

"A benefits realisation should be a fundamental part of any improvement project running from the projects beginning to the end and beyond".

Now that confirms my view that you need to know the baseline so you can measure the effects of the change you are implementing. It seems so obvious.

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So if you are running an improvement programme and you want to know if it has worked I suggest you read the NHSIII paper and make sure you have a benefits realisation framework established at the beginning of the project.

Why?

Why have I called my blog "A stone in the shoe"?

You know what it feels like when you have a stone in your shoe? Every step you take it irritates, you can feel it, it niggles! You try to wriggle your foot and hope it moves to somewhere else in your shoe.  Then you try kicking your feet in an attempt to move it.

Finally you have to stop, take off the shoe and give it a good shake .

Even then once you put the shoe back on you find the bit of grit is stilll there.  Or is it another piece?

Off with the shoe
Off with the sock
shake it all about

Put them all on again and suddenly you are comfortable.  Walking is a pleasure again.

Well.

That is what I feel I am to the local health authorities. An irritant, a stone in the shoe that just will not go away.

I want them to remember that there are patients involved in the 'businesses' that they run.

I want them to remember that they need to provide evidence that the changes they implement will benefit patients (and staff).

I want them to remember to manage change properly.

I want them to design and redesign patients pathways involving patients (and staff) early and often in the process.

I want them to build the process of implementing the new designs into the design process, not tack it on afterwards.

I just want them to do things properly.

So I ask questions at board meetings and Council Health Overview and Scrutiny committee meeetings.

I persist until I get an answer that members of the public can understand AND that answers the question.

Its not easy.

So I try to be that stone.  Always there.  A reminder to do things properly, in an evidence based way, using language that people can understand.