More Related Content
005
- 1. This information isconfidential 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 Getting Started: Applying the Decision Effectiveness Framework A step by step guide to making the most of the decision effectiveness framework with worked examples, blank templates and some ideas to support successful implementation June 2015
- 2. This information isconfidential 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 2150615 Decision Effectiveness ...LON Using this guide • This guide is aimed at those tasked with facilitating and supporting the decision making process. It will also be a useful reference point for all those involved in making the decision. • It explains how to apply the framework in more detail, outlining in each section: - Critical factors for success - A worked example of the stage in the process - Blank forms for completion in your decision
- 3. This information isconfidential 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 3150615 Decision Effectiveness ...LON In design and testing of the framework in the NHS we found it was helpful to run the process by having specific people acting as: • a senior champion (building stakeholder commitment) • a facilitator (running the process in meetings) and • a co-ordinator (running the process between meetings). These can be informal roles; in small decisions, one person could act as all three. How to get the most out of the Decision Effectiveness Framework
- 4. This information isconfidential 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 4150615 Decision Effectiveness ...LON • The framework is best suited to decisions made from scratch; for those mid- stream it is crucial to determine progress made at the outset • Specific aspects of the framework may require multiple iterations to lock down the final version e.g. criteria and metrics • Engagement from a balanced set of stakeholders is critical when working through the framework • Clinicians should be involved as much as possible; consistent attendance across the board allows for a more streamlined and effective process • Workshop groups should be limited to ~10-12 people maximum to facilitate engagement How to get the most out of the Decision Effectiveness Framework
- 5. This information isconfidential 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 5150615 Decision Effectiveness ...LON Contents • Decision Charter • Decision Architecture • Criteria and Metrics • RAPID • Critical Steps • 6Cs • Workplanning
- 6. This information isconfidential 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 6150615 Decision Effectiveness ...LON • As a plenary, think through the decision you are trying to make as well as the key outcomes and constraints for your decision • The context should be a brief summary of the background to the decision making process • Objectives should be considered in the context of maximising value • Constraints should outline issues that need to be addressed when making a decision Decision Charter: sample exercise instructions What Who HowWhen EXAMPLE
- 7. This information isconfidential 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 7150615 Decision Effectiveness ...LON Decision Charter: worked example Constraints Objectives Context • Value must be considered in terms of outcomes, patient experience, safety and cost and should strive to reach “best in class” • Offer services in good standard facilities • Avoid critical shortage of patients and staff • Must be acceptable to all key stakeholders including patients/public, clinical staff, financial staff • Public input must be taken into option appraisal and choice of preferred option • Must align with commissioning strategy and allocation decisions • Must consider all viable options and must not destabilise providers beyond their ability to cope • Two trusts in a rural area serve an increasingly aging population, such that demand for maternity services has dropped considerably. Currently these services are offered in 5 different locations across the area, but 3 of these would be sufficient to meet demand. The two service commissioning CCGs have decided that investment/disinvestment in infrastructure needs to be made to provide safe and sustainable maternity care. • The two CGGs now need to decide how to invest/disinvest to maximise value and the two trusts need to decide how to respond to and implement the commissioning changes. Decide how to invest/disinvest in infrastructure to provide safe and sustainable maternity care Decision What Who HowWhen EXAMPLE
- 8. This information isconfidential 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 8150615 Decision Effectiveness ...LON Constraints Objectives Context Decision What Who HowWhen Decision charter: template
- 9. This information isconfidential 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 9150615 Decision Effectiveness ...LON Agenda • Decision Charter • Decision Architecture • Criteria and Metrics • RAPID • Critical Steps • 6Cs • Workplanning
- 10. This information isconfidential 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 10150615 Decision Effectiveness ...LON • As a plenary, for the main decision you have identified consider the key sub-decisions that need to be made • Aim to have no more than 8 sub-decisions to inform the main decision • Pull out the key sub-decisions to act as milestones along the way • Sub-decisions should be written in sequential order Decision architecture: sample exercise instructions What Who HowWhen EXAMPLE
- 11. This information isconfidential 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 11150615 Decision Effectiveness ...LON Decision architecture: worked example Key sub-decisions CCGs decide commissioning configuration CCGs decide value criteria CCGs decide case for change CCGs decide service specifications to commission Trusts decide service reconfiguration to meet spec Trusts decide implementation and mobilisation plan Decide CCG and provider contract(s) 1 2 4 5 6 3 Decision: Decide how to invest/disinvest in infrastructure to provide safe and sustainable maternity care Main decision: 7 What Who HowWhen EXAMPLE
- 12. This information isconfidential 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 12150615 Decision Effectiveness ...LON Decision architecture: template Key sub-decisions 1 2 4 5 6 3 Main decision: 7 8 What Who HowWhen
- 13. This information isconfidential 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 13150615 Decision Effectiveness ...LON Agenda • Decision Charter • Decision Architecture • Criteria and Metrics • RAPID • Critical Steps • 6Cs • Workplanning
- 14. This information isconfidential 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 14150615 Decision Effectiveness ...LON • As a plenary, consider each of the components of value and identify the criteria and metrics for each • The criteria should align with the key outcomes you selected in the Decision Charter • Evidence and data for the metrics should be accessible and relevant • Highlight those metrics which you believe are the most important to assess your decision, and which you will focus on going forward Criteria and metrics: sample exercise instructions What Who HowWhen EXAMPLE
- 15. This information isconfidential 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 15150615 Decision Effectiveness ...LON Criteria and metrics: worked example Outcomes Clinical outcome • Quality of pre, during and post child delivery care • Outcome of interventions • Recovery • Volume of at risk births (e.g. premature, low weight, medical condition) • Perinatal mortality and still birth rate • Volume of births by birth type (e.g. natural, c-section, episiotomy, induced) • Medical complication rate (e.g. postpartum haemorrhage) • % of complications successfully treated • Days to discharge post-c-section / premature birth Patient experience • Accessibility to care facility • Accessibility to people within care facility • Comfort of environment • Quality of interactions • Patient choice • Average and maximum travel time to maternity ward within catchment area • Ratio of midwives and obstetricians to patients • Availability of alternative birthing facilities e.g. home birth support • % of patients able to choose where to have their baby • % of patients provided with advice on post-birth baby care Safety • Avoidance of harm to patient • Safe environment that supports delivery of care • Adequate resourcing • Rate of avoidable mortality • Rate of avoidable harm done to patient e.g. infection rate • % adherence to best practice estate maintenance protocols • % of time staffed according to best practice minimum staffing levels • Staff experience (measured as number of patients per staff per year) Resources Revenue costs • Clinician salary • Admin staff salary • System running costs • “Stranded costs” i.e. costs of unmet overhead as result of disinvestment • Staff relocation and training costs • Co-dependency expansion costs (e.g. gynaecology consultant salaries) • Operating cost per birth Capital costs • Investment in facilities / equipment • … • Upfront investment for facility expansion • Co-dependency expansion costs (e.g. additional facilities) COMPONENTS OF VALUE CRITERIA METRICS (EXAMPLES) What Who HowWhen EXAMPLE
- 16. This information isconfidential 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 16150615 Decision Effectiveness ...LON Criteria and metrics: template Outcomes Clinical outcome Patient experience Safety Resources Revenue costs Capital costs COMPONENTS OF VALUE CRITERIA METRICS What Who HowWhen
- 17. This information isconfidential 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 17150615 Decision Effectiveness ...LON Agenda • Decision Charter • Decision Architecture • Criteria and Metrics • RAPID • Critical Steps • 6Cs • Workplanning
- 18. This information isconfidential 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 18150615 Decision Effectiveness ...LON RAPID: sample exercise instructions What Who HowWhen • Split into 2 groups • Sub-decisions will be allocated evenly across groups • Allocate RAPID across stakeholders for each of your sub-decisions using coloured dots • Bear in mind best practice with regards to RAPIDs - Only one Decide - Only one Recommend - Few Agree, if at all - Only Inputs that have something valuable to add EXAMPLE
- 19. This information isconfidential 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 19150615 Decision Effectiveness ...LON DecideInput Agree Perform Recommend Rules for allocating decision roles • Only one R – 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 • A’s should be assigned sparingly • Usually for extraordinary circumstances (e.g. regulatory or legal) • A is on the R – D makes a final decision • Can be multiple Is • Assigned only to those with valuable, relevant information which could potentially change the decision • Avoid I proliferation • May be multiple Ps • May involve P as an I to help upfront planning • Only one D for each decision • Locate the 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 RAPID should reflect what will work in 90% of situations – design for the rule, not the exception
- 20. This information isconfidential 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 20150615 Decision Effectiveness ...LON Stakeholders NHSEngland Regulators LocalAuthority Overviewand scrutinyboard CCGboards Programmeboard Programmeboard chair,leadCCG rep CCGheadof finance Trustchief executiveor equivalent Trustboard Trustheadof finance Trustheadof medical Trustheadof nursing Trustservicelead Representativesof providerinterests &abilities GPs Public Politicians CCGs decide commissioning configuration (e.g. lead commissioner) R CCGs determine value criteria D A R I CCGs decide case for change I I I A D A R I A I I I I CCGs decide service specifications to commission A D A R I A I I I I I Trusts decide service reconfiguration to meet spec A A R D A A A A I I Trusts decide implementation/mobilisation plan A A A P D R A A I Decide CCG and provider contract D A R A A P P P RAPID: worked example R Recommend A Agree P Perform I Input D Decide What Who HowWhen Decision: Decide how to invest/disinvest in infrastructure to provide safe and sustainable maternity care Ensuring stakeholders understand their RAPID® role up-front will improve efficiency, reduce impasses and improve decision quality Sub- decision 1 2 3 4 5 6 7 D P P P P EXAMPLE
- 21. This information isconfidential 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 21150615 Decision Effectiveness ...LON RAPID: template R Recommend A Agree P Perform I Input D Decide What Who HowWhen Decision: Stakeholders Sub-decisions
- 22. This information isconfidential 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 22150615 Decision Effectiveness ...LON Agenda • Decision Charter • Decision Architecture • Criteria and Metrics • RAPID • Critical Steps • 6Cs • Workplanning
- 23. This information isconfidential 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 23150615 Decision Effectiveness ...LON Critical Steps: sample exercise instructions • Split into 2 groups • Think through all of key activities that are needed to proceed with each of your sub-decisions • These activities could be data gathering, analysis, meetings etc • Order the critical steps sequentially, noting any feedback loops within the process EXAMPLE What Who HowWhen
- 24. This information isconfidential 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 24150615 Decision Effectiveness ...LON Decide value criteria and metrics Decide on set of available long-term / interim options Decide on preferred long- term and / or interim options Sign off outline business case (OBC) Decide on contractual terms with UHNM/CCG UHNM CCG Sign off full business case (FBC) Decide funding go/no-go (ITFF) Decide implementation plan What Who HowWhen Critical Steps: worked example 1 2 4 5 6 7 3 Decision: What is the best mechanism to maximise the value in the growth of elective demand at MCHFT, while consistently delivering the 18-week target throughout the year for both MCHFT and UHNM? Trust Board decision / sign-off Infrastructure review/agree Define key criteria Gather clinical and expert input For each option, define: • Scope • Ringfencing • UHNM p’ship Do light touch evaluation to narrow down to sensible short list Define constraints and impact on option set Gather clinical and expert input to brainstorm long list of options Options appraisal, including e.g. incremental capacity, ROI Decide how to evaluate options based on criteria/metrics EMB review/agree Div. Board review & recommend Develop contract documents Carry out negotiations Identify preferred option Evaluate option set Consider / identify option set Respond to CCG feedback Notify CCG of impact Identify impact of proposed activity on CCG SUB-DECISION CRITICAL STEPS 1 2 3 5 6 Executive lead feedback / generate recommendation Pull docs together: • Loan app’n • Bus. Case • Monitor return Appropriate to comply with Monitor arrangements? Submit loan application to ITFF Receive feedback from Monitor Notify Monitor with bus. case N Develop risk log Allocate owners and workstreams Refine Project Plan (building on plan in business case) Set up Project Board (Task & Finish Group steps down) Define governance for project delivery 7 8 Trust Board decision / sign-off EMB review/agree Div. Board review & recommend 4 Executive lead feedback / generate recomm. Complete template Agree business case template/format 8 IfNoIfNo Y EXAMPLE
- 25. This information isconfidential 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 25150615 Decision Effectiveness ...LON What Who HowWhen Critical Steps: template 1 2 4 5 6 7 3 Decision: SUB-DECISION CRITICAL STEPS 1 2 3 5 6 7 8 4. 8
- 26. This information isconfidential 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 26150615 Decision Effectiveness ...LON Agenda • Decision Charter • Decision Architecture • Criteria and Metrics • RAPID • Critical Steps • 6Cs • Workplanning
- 27. This information isconfidential 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 27150615 Decision Effectiveness ...LON 6Cs: sample exercise instructions • Split into 2 groups • Think through all of the components necessary to make each sub- decision effectively, in particular: - Criteria: What are the key criteria to evaluate the options / make a decision? - Critical Steps: What are key activities needed to make a decision? - Choices Considered: What are the choices that need to be made? - Committees: Which groups need to be engaged to make this decision? - Communication: How will this decision be communicated to the relevant parties, and/or throughout the organisation? - Closure: How will we know that closure has taken place and how will we practically mobilise to implement this decision? • Taken as a whole, the 6Cs should provide an overall snapshot of the thinking necessary to make the overarching decision effectively EXAMPLE What Who HowWhen
- 28. This information isconfidential 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 28150615 Decision Effectiveness ...LON CCG boards Programme board chair, lead CCG rep Programme board Provider reps (provider interests and abilities) Criteria Critical Steps Choices Considered Committees • Changes should maximise value (equals outcomes over costs) - Clinical outcomes (improved antenatal/intrapartum/neonatal /postnatal health, outcome of interventions, recovery time, etc.) - Experience (accessibility, info, choice, comfort, quality interactions, etc.) - Safety (enough staff/resources, safe environment, no patient harm, etc.) - Cost (affordable to reconfigure service & disinvest in estate, etc.) • Define criteria • N/A • Programme Board: commissioning led board made up of cross stakeholder representatives - Programme Board Chair will assemble a Recommendation to take to the boards of both CCGs who will make the overall decision on value criteria - Recommendation must have Agreement from the programme board and additional Input from provider representatives as needed Communication Closure • Chair to inform CCG boards • Inform trusts of rational behind intentions to change service • Engage CMA, Overview and Scrutiny Committee, and Health and Wellbeing board • Engage key stakeholders per stakeholder map and communication strategy What Who HowWhen Sub-Decision: CCGs determine value criteria 6Cs: worked example DECISION RAPID Roles 2 3 41 2 3 4 AR ID EXAMPLE
- 29. This information isconfidential 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 29150615 Decision Effectiveness ...LON Criteria Critical Steps Choices Considered Committees Communication Closure What Who HowWhen 6Cs: template DECISION Sub-Decision: RAPID Roles AR ID 1 3 3 3 4 4 P 4
- 30. This information isconfidential 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 30150615 Decision Effectiveness ...LON Agenda • Decision Charter • Decision Architecture • Criteria and Metrics • RAPID • Critical Steps • 6Cs • Workplanning
- 31. This information isconfidential 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 31150615 Decision Effectiveness ...LON • As a plenary, think through how long it will take to complete each of the sub-decisions • Think back to the critical steps identified for each sub-decision to inform your estimation of the amount of time required • Remember that work can take place in parallel and may be iterative • Strike a balance between pace and realism, informed by past experience What Who HowWhen Workplanning: sample exercise instructions EXAMPLE
- 32. This information isconfidential 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 32150615 Decision Effectiveness ...LON What Who HowWhen Workplanning: worked example Decision: Decide how to invest/disinvest in infrastructure to provide safe and sustainable maternity care Decision Calendar Mo 1 Mo 2 Mo 3 Mo 4 Mo 5 Mo 6 Mo 7 Mo 8 Mo 9 Mo 10 Mo 11 Mo 12 CCGs decide commissioning configuration (e.g. lead commissioner) - Set up programme board, communications team, and charter CCGs determine value criteria CCGs decide case for change CCGs decide service specifications to commission - Options analysis and identify preferred option (OBC) - Public consultation (13+ weeks) - Draft final business case (FBC) Trusts decide service reconfiguration to meet spec - Create ‘case for change’ (SOC) - Options analysis and identify preferred option (OBC) - Draft final business case (FBC) Trusts decide implementation and mobilisation plan Decide CCG and provider contract Iterative process, misaligned incentives and behaviours can extend this process EXAMPLE 1 2 3 4 5 6 7
- 33. This information isconfidential 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 33150615 Decision Effectiveness ...LON What Who HowWhen Workplanning: template Decision Calendar 2015 2016 Mo 6 Mo 7 Mo 8 Mo 9 Mo 10 Mo 11 Mo 12 Mo 1 Mo 2 Mo 3 Mo 4 Mo 5 Mo 6 Mo 7 Mo 8 Mo 9 Mo 10 1 Decision: 2 3 4 5 6 7 8