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

2. 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

3. 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

4. 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

5. Action areas www.futurefocusedfinance.nhs.uk

6. 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

7. 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

8. example Value Measures

9. 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)

10. 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

11. Bpv Decision Framework

12. Decision Steps

13. 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

14. RAPID Roles

15. Value Comparison example

16. Value priorities example

17. 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

18. 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

19. 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

20. 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

21. 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 to become a demonstration site
See one  Do one  Teach one