Programme overview futurefocusedfinance.nhs.uk bpv.futurefocusedfinance.nhs.uk

Contents Overview of Future-Focused Finance Introduction to BPV action area Value theory Overview of BPV Decision Framework Decision Steps and RAPID roles Modelling value Further resources

Future-Focused Finance FFF is about Making People Count by ensuring that everyone connected with NHS finance can influence decision-making in support of high-quality patient services Upskill the NHS finance profession Improve networks and joined-up working Identify and promote best practice

Finance Leadership Council (FLC) Bob Alexander Deputy CEO / Executive Director of Resources Paul Baumann Chief Finance Officer Shahana Khan HFMA Representative David Williams Director General Finance & Commercial Steve Clarke Director of Finance

Action areas www.futurefocusedfinance.nhs.uk futurefocusedfinance@nhs.net

New ways to model, plan and decide what gives most value Best Possible Value (BPV) Caroline Clarke Senior Responsible Officer Paul Baumann Programme Sponsor New ways to model, plan and decide what gives most value Widespread and consistent application of the new approaches to maximising value

Value equation concept Maximising value means improving outcomes or reducing resources (without compromising either) Focusing on improving outcomes is the best way to reduce costs Conceptualising value like this provides a single uniting goal and a common language for finance and clinicians to speak

example Value Measures

Overall, NHS ranks 34th percentile out of 100 Decision effectiveness Overall, NHS ranks 34th percentile out of 100 High decision effectiveness range = top quintile of decision effectiveness scores; Low = bottom quintile; Mid = all other Source: Bain decision and org effectiveness survey Jan 2013 (n=1001)

Source: Bain client diagnostic survey (n=153) Ways of making decisions Directive: Decision making authority rests exclusively with one person, who issues directives that are expected to be followed Democratic: Decisions are reached based on vote (e.g. majority rules) Dissenting views are expected to support the final decision Consensus-driven: Decisions are reached when all involved reach agreement Participative: Single-point accountability for a decision, with input taken from those with relevant knowledge and expertise Once a decision is made, all are expected to support it Source: Bain client diagnostic survey (n=153) In the NHS as a whole

Bpv Decision Framework

Decision Steps

RAPID Roles RECOMMEND INPUT DECIDE AGREE PERFORM Only one D for each decision step Locate D at the right level in the organisation Primary value lies in the business Appropriate information lies Reaction time is appropriate Best capability to integrate information, make trade-offs If D belongs to a group, clarify how it gets exercised RECOMMEND Only one R for each decision step Individual who does 80% of the work to develop the recommendation R has broad visibility and access to information for relevant inputs R has credibility with both Is and D INPUT DECIDE AGREE Can be multiple Is Assigned only to those with valuable, relevant information which could potentially change the decision Avoid I proliferation PERFORM A should be assigned sparingly Usually for extraordinary circumstances (e.g. regulatory or legal) A can veto R (D makes a final decision) May be multiple Ps May involve P as an I to help upfront planning

RAPID Roles

Value Comparison example

Value priorities example

Making a recommendation The top right quadrant is HIGH VALUE, LOW RISK – recommend these as the preferred option The bottom left quadrant is LOW VALUE, HIGH RISK – recommend rejecting these options The top left quadrant is HIGH VALUE, HIGH RISK – recommend methods to mitigate risk The bottom right quadrant is LOW VALUE, HIGH RISK – recommend methods to improve value, or combine with other options The Strategic Factors may be a deal-breaker for the decision Agreer

Bpv process 6. Managing the process BUSINESS CASE WHAT WHO HOW WHEN Framing the decision, properly defining the problem and agreeing value objectives WHAT Clearly agree upfront who will play what role in the decision WHO Installing a structured decision approach and stating what tools will be applied throughout HOW Clarifying a timeline for decision execution including key milestones and iterations WHEN (2) Framing the decision DECISION CHARTER (3) Defining value VALUE MEASURES (4) Planning the decision DECISION STEPS KEY ACTIONS DECISION TIMELINE RAPID ROLES (1) Involving the right stakeholders (5) Modelling options VALUE GENERATION OPTION PRIORITIES

builds stakeholder commitment and engagement decision roles Champion Co-ordinator Facilitator runs and administrates the process between meetings and writes up workshop output leads and facilitates workshops to support participants in completing templates builds stakeholder commitment and engagement

Example decision workshops Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Coordination Meet with the co-ordinator Understand the decision context Discuss how the framework can be best applied Plan workshops and timing Agree who to invite to which workshops Workshop 1 Introduction to value-based decision-making Overview of the BPV framework and process Collaborative completion of first WHAT templates Promote BPV community Workshop 2 Recap of previous session and review of first completed WHAT templates Collaborative completion of all WHAT and WHO templates Workshop 3 Recap of previous session and review of completed WHAT and WHO templates Collaborative completion of all HOW and WHEN templates Training Feedback discussion on the framework and process Training / advice for the Value Generation and Option Priorities elements of the framework Maintaining momentum Coordinator arranges workshops and communicates outputs between sessions

Get involved See one  Do one  Teach one You pick a decision – one that is upcoming, stuck, or went badly You get your decision stakeholders in a room together We provide a BPV Specialist to: lead the workshops help you run the process train your staff up You apply the framework (and give us a case study) Staff experiencing the process become the BPV Specialist to facilitate the next decision Contact futurefocusedfinance@nhs.net to become a demonstration site See one  Do one  Teach one