Best Possible Value

Our mission and our approach

DRAFT
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent

Our mission is to deliver a Best Possible Value health service

Demand for health services is growing faster than funding

Situation

There is consensus that the health service must deliver better

value

Challenges

Devolved authority, cross-accountability, and conflicting

incentives produce deadlocks, inefficient processes and suboptimal results

Resolution

A new approach that moves beyond organisation structures is

needed to deliver the best possible value for patient and public

This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent

LON

03-18 - Best Possible Value we ...

Our aspiration for the Finance function is to be leaders in

delivering value
FINANCE TODAY

FINANCE TOMORROW

Focused on cost

Focused on value

Work with financial metrics

Combine the best in financial

informatics and health economics

Analyse challenges

Solve biggest challenges

Input into decisions

Leadership role as drivers of robust

decision-making based on value

This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent

LON

03-18 - Best Possible Value we ...

To deliver value we must have

effective decision-making

This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent

LON

03-18 - Best Possible Value we ...

Why focus on decisions? Organisations have become more and

more complex; a new approach is needed to ensure theyre effective

The matrix is becoming a cube

CUBE?

MATRIX

EMPOWERED
BUSINESS UNITS
COMMAND
AND CONTROL

A focus on decisions can cut

through this complexity

Source: Adapted from The Future of Work, Thomas Malone

This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent

LON

03-18 - Best Possible Value we ...

Why focus on decisions? Research shows a focus on decisions

supports outperformance on financial and people dimensions
5 YEAR AVERAGE PROFITABILITY
(RETURN ON CAPITAL EMPLOYED)

HOW LIKELY WOULD YOU BE TO

RECOMMEND YOUR ORGANISATION
AS A PLACE TO WORK?

Note: High decision effectiveness range = top quintile of decision multiplier scores; Low/Mid = all other
Source: Worldscope; Bain decision and organisation effectiveness survey
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent

LON

03-18 - Best Possible Value we ...

What makes a decision effective?

Decision effectiveness = quality, speed, yield, effort
Quality

Speed

How quickly do you

make decisions vs.
stakeholder
expectations?

Effort

How often do you

execute decisions as
intended?

Do you put the right

amount of effort into
making & executing
decisions?

Faster than

How often do you

choose the right
course of action?

Yield

Slower thanOn par with

lower is
better

Decision Effectiveness Benchmarks

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)
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent

LON

03-18 - Best Possible Value we ...

What makes a decision effective? Organisational drivers must

be aligned to support decision effectiveness

Organisational drivers

Decision
effectiveness
Critical
decisions

Performance

Quality
Speed
Yield

Tools &
technology

Effort

This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent

LON

03-18 - Best Possible Value we ...

How well do we make decisions today? NHS performs below

average on each category, particularly on speed
Quality

Speed

How quickly do you

make decisions vs.
stakeholder
expectations?

Effort

How often do you

execute decisions as
intended?

Do you put the right

amount of effort into
making & executing
decisions?

Faster than

How often do you

choose the right
course of action?

Yield

Slower thanOn par with

lower is
better

Decision Effectiveness Benchmarks

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)
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent

LON

03-18 - Best Possible Value we ...

How well do we make decisions today? The NHS performs

particularly strongly on culture but low on clarity and structure

Leadership &
behaviours

Skills &
Capabilities

Tools &
Tech

Processes &
Information

Accountability
& Structure

Context &
Alignment

1 Weak

High decision effectiveness range n=324

Low/Mid decision effectiveness range n=677
NHS n=153

Average

Strong

Context around what drives value

Communication and alignment
Clear accountability for critical decisions

Structure that enables key decisions

Effective decision processes
Right information, right form, right time
Tools and technology align with needs
People equipped with right skills & capabilities
Cohesive leadership
Winning culture and workplace behaviour

Source: Bain decision and org effectiveness database (Jan 2013) n=1001 ; NHS diagnostic (n=153)
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent

LON

03-18 - Best Possible Value we ...

10

How will the future be different? At an individual decision level

outcomes can be significantly improved if focused on value
Decision example: Decide stroke care pathway and service configuration within a hospital
NOT FOCUSED ON VALUE
Focused on service delivery
Different people in charge of different parts of pathway
Considered as an isolated unit not part of a system
Consultants not empowered to make decisions
Lack of tools / financial framework

FOCUSED ON VALUE
Focused on clinical outcomes, particularly failed
interventions for most unwell
Holistic pathway view: 16% of patients use 50% resource
Best practice, data and patient / family input considered
Consultants empowered and given the financial
framework

Stroke unit clogged

Improved clinical outcomes for healthy patients

Failed interventions

Improved experience for most unwell

Sub-optimal recovery for healthy patients due to delays

Resource reduction: 50% of beds and 24 staff

Source: Delivery Group member interview based on a decision made within a London hospital
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent

LON

03-18 - Best Possible Value we ...

11

Whats our plan for improving decision-making? Weve adapted

a proven decision-making approach to the NHS and are rolling it out
HOW FAR WEVE COME
Developed a Decision Handbook that
provides a framework and approach for
managing and making value-based
decisions
Developed a definition of value, a menu
of outcomes and example metrics to help
make an assessment

Defined a set of organisation enablers

and behaviours to equip the NHS to make
value-based decisions, based on a survey
of over 150 finance and non-finance
professionals
Prioritised a set of actions to implement
change across the NHS

WHERE NEXT
Roll-out and optimise the Decision
Handbook by working with organisations
to implement the approach on real
decisions

Train finance and non-finance

professionals across all levels on the
approach to effective decision-making and
how to use the toolkit to help

Collaborate with other Future Focused

Finance initiatives to ensure organisation
enablers are set up to support value-based
decision-making

This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent

LON

03-18 - Best Possible Value we ...

12

How to learn more or get involved?

Read the Decision Handbook introduction on the FFF website to get a taste of
whats to come and sample a few of the basic tools e.g. RAPID decision roles
framework

Read the Organisation Enablers introduction on the FFF website to discover the
characteristics of high-value healthcare organisations around the world and what the
NHS can learn from them

Tell us about your experiences of making value-based decisions on the FFF website
blog

Contact us if your organisation would like to apply the Decision Handbook to a key
decision and be part of the roll-out programme

This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent

LON

03-18 - Best Possible Value we ...

13