Life on Marsland on realising the benefits of IM&T

The days when a successful IM&T delivery was one that got the technology in on time and on budget are long-gone, says former NHS chief information officer Iain Marsland. Now, IM&T needs to deliver benefits to organisations, clinicians and patients. But benefits are not always easy to define and measure...

Hands up if you think benefits are important. Hands up if benefits management is included in your IM&T strategy. Hands up if you have a full time benefits manager. Ah well, as that great philosopher Meatloaf once said: “Two out of three ain’t bad.”

The days of celebrating an IM&T implementation as a success because it went live on time and within budget should be long gone. Once, we focused on technology, training and data transfers as the measures of a good deployment.

Today, IM&T is a key contributor to service improvement programmes, along with process changes and staff skills. The focus has to be on delivering a positive outcome for patients, clinicians and the organisation. For IM&T to fully contribute to planned outcomes, managing benefits is as important as delivering technology solutions.

The role of outcomes and benefits in change evaluation

Change is about doing things differently. A benefits programme should therefore help people to doing things differently and focus on the key changes that will deliver the desired outcomes.

Service improvement programmes are frequently defined by outcomes. But outcomes neither have to be well defined nor measurable. They can often be described in terms of a policy direction.

Benefits, meanwhile, encapsulate the changes needed to deliver outcomes. They relate directly to people doing things differently and are of a size that can be defined, measured and achieved.  Focusing on benefits, therefore, improves the likelihood of success. 

The daisy chain between IM&T and successful outcomes

There are two mainstream approaches to managing benefits. Where you have total freedom to define IM&T, process and people changes you can work backwards. Start the programme by defining the benefits required to achieve the outcomes. Then define the process changes needed to deliver the benefits and, finally, the IM&T and skills needed to support the process changes.

The National Programme for IT in the NHS precludes this approach as the IM&T is pre-defined. The second approach to managing benefits is more fluid and enables benefits to be defined, again around desired outcomes, but for this to be an iterative process taking account of the IM&T, people and process dimensions.

Classifying benefits for clear measurement

Whichever approach is used, the benefits must be measurable, properly defined and managed. There are four classifications of benefits:

·         Cash releasing benefits – which reduce or replace known current costs

·         Cost avoiding benefits – which delay or avoid future cost increases

·         Time saving benefits – which enable tasks to be completed more quickly, contributing to more efficient processes and working

·         Qualitative benefits – which deliver subjective improvements in working practices and outcomes; these benefits can be evaluated by survey.  

Managing benefits

The first step towards managing benefits is to describe them. A benefit is defined by its profile, which includes a detailed description of the benefit for patients, clinicians and the organisation. The benefit measure must be defined to include a target or expected value and a schedule for monitoring and evaluating the benefit. This can often extend past the implementation period.

Each benefit must have a person assigned to manage its realisation. Benefits will be dependent upon IM&T, process changes and people, each of which must be identified and held to account for their contribution. This may include suppliers and other NHS organisations.

Finally, benefit management is not free of cost and an estimate of the cost of achieving each benefit must be made. Benefits are a people thing. Benefit profiles cannot be produced in isolation by the programme team. They must be constructed, developed, owned and finally delivered by service planners, clinicians and patients. Indeed, benefits are a key component of stakeholder engagement.

It is far more productive to talk to clinicians and patients about improvements in clinical services than their expectation of new technology; especially when they are the people who will be tasked to deliver them.

The NHS is not always good at benefits. NHS Connecting for Health’s published high level benefits for clinicians and patients - Improved healthcare, new infrastructure, national systems & services and local systems & services - needs further work to link the programme to service improvements and to engage clinicians and patients in their delivery. 

Well-managed benefits are one of the most effective tools for engaging with stakeholders in a changing environment. They are also the key to delivering a successful change programme. If only someone could make them just a little more exciting and engaging for the programme team!