Best Possible Value – Diagnostic Survey Results
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
Survey/interviews: Context
PURPOSE IS TO…
• Give a high level assessment of the
health of decision-making across the NHS
• Help identify the most important issues to
tackle in striving for more effective
decisions
• Provide input into which decisions to
focus on
• Guide prioritisation of actions on specific
decisions and broader organisation
enablers
WHAT IT IS
• Reflection of personal opinions
• Drawn from a sample of finance and nonfinance people within different
organisations
• Starting point that helps focus energy and
provides a platform for discussion
WHAT IT’S NOT
• Exhaustive set of issues and opinions
• The ‘gospel truth’ on strengths and
weaknesses
• The final answer
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
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Executive Summary
• Over 150 people responded to the ‘best possible value’ survey
WIP
- 65% Finance/35% non-Finance
- Good mix of commissioning/provisions; good mix of regions
• NHS benchmarks itself below average vs. our global database on decision effectiveness
- 34th percentile* out of 100
- Particularly low in speed
• Considering the drivers of decision effectiveness, some clear strengths on which to build
- Passionate employees committed to the NHS
- Reasonable alignment around the importance of ‘best possible value’ in considering decisions
- Finance seen to have a seat at the table in key decisions related to ‘best possible value’, and the capabilities
to make a difference
• A number of areas require focus to improve ‘best possible value’ in decisions
- Lack of a clear and agreed measure of ‘value’
- Given the structural complexity of the NHS, too many people involved in decisions, with roles not entirely
clear; especially for decisions which multi-party stakeholders
- Decision processes tortuous and not sufficiently informed by the right information
- Behaviours don’t always support decisions rooted in ‘best possible value’
• Issues will need to be tackled within Finance, but also beyond
• NHS employees see a strong need for organisational change to support ‘best possible value’,
both across the NHS and within their own organisations
*Decision effectiveness scores percentiles are relative to Bain benchmark database
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
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We surveyed employees across all dimensions of the organisation,
supported by ~20 in-depth interviews
WIP
SURVEY
INTERVIEWS
• Finance Leadership Council
- Paul Baumann
- Richard Douglas
- Bob Alexander
- Stephen Hay
• Delivery group heads
- Peter Ridley
- Mark Ash
- Matthew Cripps
- Mark Mansfield
• Delivery group members
- Caroline Clarke
- Jennifer Howells
- Ed Kessler
- Ros Francke
- Tim Welch
- John Yarnold
• Additional interviewees
- Jan Fowler
- Sanjay Agrawal
- Chris Mimnagh
- Muir Grey
- Greg Fell
Source: Client 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
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NHS decision effectiveness is below average
WIP
DECISION EFFECTIVENESS GROUPS
(QUALITY X SPEED X YIELD – EFFORT)
Best/81-100th percentile
61-80th percentile
41-60th percentile
NHS:
34th percentile
21-40th percentile
Worst/1-20th percentile
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
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NHS performs below average on each category, particularly on
speed
Quality
Speed
x
“How quickly do you
make decisions vs.
stakeholder
expectations?”
-
“How often do you
execute decisions as
intended?”
Effort
“Do you put the right
amount of effort into
making & executing
decisions?”
“lower is
better”
Slower than…
On par with…
Faster than…
“How often do you
choose the right
course of action?”
Yield
x
WIP
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
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“Diagnostic on a page”
Deliver value
Aim
Key
Primary focus:
most significant
areas for
development
and/or high
ability to
change within
this project
• Organisation is clear about and aligned on importance of delivering value
• Lack of clarity on how value should be measured
Structure
Roles
Process
Tools
Data
• Complex NHS
structure means
lots of people are
included
• Clarity on
purpose of voice
e.g. clinical,
financial
• Decision framing
and criteria ok
• Have some tools
to be able to
assess value
• Data and
information not
readily available
to be fed into
decisions
People
Decision
making
• Good capabilities
to meet today’s
needs; and want
to do right thing
• Lack capabilities
for future
challenges
• Lack of clarity
on decisionmaking roles
e.g. input vs.
decide
• Lack of clarity
on roles of
various NHS
entities in multiparty decisions
• Decision-making
process within
organisations
works ok
• Decisionmaking process
across
organisations is
broken
• Lack guide on
how to apply
tools to deliver
BPV and how to
run the process
to ensure right
people
involved, inputs
captured and
data used
Secondary focus:
less significant
areas of
development and
/ or limited ability
to change within
this project (e.g.
NHS superstructure)
Behaviours
• People passionate about NHS, willing to go the extra mile
• Behaviours not consistently supportive of effective decisions
Outcome
• Speed of decision making is poor and quality, yield and effort are average
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
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Decision effectiveness is worse for the NHS as a whole; it’s seen
as better within specific organisations
Excellent: ≥High perf. avg
Strength: ≥ avg + 0.2
WIP
Concern: ≤ avg – 0.2
Note: NAs excluded; 1=Strongly disagree, 2=Disagree, 3=Agree, 4=Strongly agree; High performer = top quintile “decision effectiveness” scores
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
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Across drivers of decision effectiveness, NHS performs particularly
strongly on culture but low on clarity and structure
Leadership &
behaviours
Skills &
Capabilities
Tools &
Tech
Processes &
Information
Accountability
& Structure
Context &
Alignment
High decision effectiveness range n=324
Low/Mid decision effectiveness range n=677
NHS n=153
1 Weak
2
Average
3
Strong
WIP
4
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
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Context & alignment
Accountabilities & structures
Processes & information
Tools & technology
Skills & capabilities
Leadership & behaviours
Top scores: leadership and behaviours
WIP
Accountabilities &
Structure
Leadership &
Behaviours
Skills &
Capabilities
Scoring: 1=Strongly disagree, 2=Disagree more than agree, 3=Agree more than disagree, 4=Strongly agree
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
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Context & alignment
Accountabilities & structures
Processes & information
Tools & technology
Skills & capabilities
Leadership & behaviours
Bottom scores: accountabilities and processes
WIP
Accountabilities &
structure
Context &
alignment
Processes &
information
Scoring: 1=Strongly disagree, 2=Disagree more than agree, 3=Agree more than disagree, 4=Strongly agree
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
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Employee engagement is below average relative to benchmarks
WIP
NET PROMOTER SCORE (NPS)
CALCULATION
HOW LIKELY WOULD YOU BE TO RECOMMEND THE NHS
AS A PLACE TO WORK TO A FRIEND OR RELATIVE?
Extremely
likely
9-10
%
Promoters
7-8
minus
0-6
0-6
%
Detractors
Extremely
unlikely
Net Promoter Score (NPS)
®Net Promoter, Net Promoter system and NPS are registered trademarks of Bain & Company, Inc., Satmetrix Systems, Inc. and Fred Reichheld
Source: Bain decision and org effectiveness database Jan 2013 (n=225); 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
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Uniform belief that significant change throughout the NHS needs
to occur to support BPV
Excellent: ≥High perf. avg
Strength: ≥ avg + 0.2
WIP
Concern: ≤ avg – 0.2
Note: NAs excluded; 1=Strongly disagree, 2=Disagree, 3=Agree, 4=Strongly agree; High performer = top quintile “decision effectiveness” scores
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
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Winners align key elements
• Clarity on priorities and principles
• Communication and alignment throughout the
organisation
• Clear roles for critical decisions
• Simple, cost-effective structure that supports
value creation
Critical
decisions
Tools &
technology
• Robust decision processes linked to effective
business processes
• Key metrics and information–right place, right
time
• Efficient tools
• Technology that enables decisions
• Right people in right jobs - will & skill
• Objectives & incentives focused on performance
• Cohesive leadership team living the right
behaviors
• Winning culture, with individuals who personally
engage
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
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Context & alignment: clear need for BPV, but BPV
measurement is lacking, and non-finance is not aligned
Excellent: ≥High perf. avg
WIP
Strength: ≥ avg + 0.2
INTERVIEW QUOTES
Concern: ≤ avg – 0.2
“We need clarity on what value
means, it doesn’t currently
exist – people have their own
view”
“We lack a good narrative
around why value is important
and what it means”
“Need to get clarity and
alignment around what
objectives are, what
outcomes are desired”
Note: NAs excluded; 1=Strongly disagree, 2=Disagree, 3=Agree, 4=Strongly agree; High performer = top quintile “decision effectiveness” scores
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
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Accountability & structure: Finance understand their role
but cross-organisation decision roles are not clear
Excellent: ≥High perf. avg
WIP
Strength: ≥ avg + 0.2
INTERVIEW QUOTES
Concern: ≤ avg – 0.2
“Budget holder, initiator, clinician,
service manager are
recognised titles – but
decision roles are less well
defined”
“Within an organisation roles
and accountability are clear
or can easily be made so –
across organisations there’s
a lack of clarity”
“Finance needs to take a
leadership role as owners
and appliers of the
investment process, it needs
to have bravery to have
absolute rigour and force
robustness of decisionmaking on hard evidence”
Note: NAs excluded; 1=Strongly disagree, 2=Disagree, 3=Agree, 4=Strongly agree; High performer = top quintile “decision effectiveness” scores
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
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Processes & information: decision criteria considered clear,
but lack of info and cross-organisation processes
Excellent: ≥High perf. avg
WIP
Strength: ≥ avg + 0.2
INTERVIEW QUOTES
Concern: ≤ avg – 0.2
“The length of decision-making
is an issue – it’s taken 8 years
to decide on a new hospital
complex and a decision still
hasn’t been reached”
“We simply lack the
information to be able to
make a decision – I had 69
protocols to approve but no data
to be able to say which patient
admittances would be reduced”
“We have too many
committees with decisions
getting tied up in levels of
approval”
Note: NAs excluded; 1=Strongly disagree, 2=Disagree, 3=Agree, 4=Strongly agree; High performer = top quintile “decision effectiveness” scores
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
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Tools & technology: BPV is not consistently well supported
by existing tools and technology
Excellent: ≥High perf. avg
WIP
Strength: ≥ avg + 0.2
INTERVIEW QUOTES
Concern: ≤ avg – 0.2
Finance need the tools and the
confidence that comes with
them to be consistently
rigorous and robust in
analysis and communication”
“We have no toolkits that are
widely deployed for decision
structuring or decision
evaluation”
“We need a knowledge
management system to
share experiences for others
to learn from”
Note: NAs excluded; 1=Strongly disagree, 2=Disagree, 3=Agree, 4=Strongly agree; High performer = top quintile “decision effectiveness” scores
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
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Skills & capabilities: people are well placed to incorporate
BPV in finance, less so outside of finance
Excellent: ≥High perf. avg
WIP
Strength: ≥ avg + 0.2
INTERVIEW QUOTES
Concern: ≤ avg – 0.2
“We’re bringing in bright
people with the ability to work
in the way we need. But then
we get them in and teach them
not to use their skills”
“If finance sits in their finance
office without getting close to
where care is delivered, they
will have technical expertise
but not be able to apply it to
best value”
“Incentives and objectives
could be re-aligned; surgeons
want to operate and the service
line may be very lucrative but
50% of operations may have no
benefit – the objective should
be no useless knee surgeries”
Note: NAs excluded; 1=Strongly disagree, 2=Disagree, 3=Agree, 4=Strongly agree; High performer = top quintile “decision effectiveness” scores
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
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Leadership & culture: employees strongly engaged, culture
not a major barrier to BPV
Excellent: ≥High perf. avg
WIP
Strength: ≥ avg + 0.2
INTERVIEW QUOTES
Concern: ≤ avg – 0.2
“No one single finance person has
the ability to bring their “tribe”
with them. We need a
leadership council approach
– a ‘concordat’ between what
people perceive as senior
finance leaders”
“Our biggest issue is protecting
individual organisational
interests, instead of thinking
about value broadly across a
locality”
“No culture of making these
decisions in a value based
way”
Note: NAs excluded; 1=Strongly disagree, 2=Disagree, 3=Agree, 4=Strongly agree; High performer = top quintile “decision effectiveness” scores
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
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Desire for less directive, and more participative
decision making
TYPICAL DECISION
STYLES…
WIP
THE DECISION STYLE IS…
• 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
In your organisation in the NHS
In the NHS as a whole
Source: Client 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
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Top priority actions: Tools, information and closer partnering
between finance and clinicians
SURVEY INPUT WIP
TOP 2-3 ACTIONS: WITHIN FINANCE
“Some real tools to
help us evaluate best
value balancing
quality and finance”
“Can we have information
in a way we can
understand and is
relevant? And timely?”
TOP 2-3 ACTIONS: FOR NON-FINANCE
“Non-finance engaging finance
early in change processes
because they value their
support and input rather than
'because they have to”
“Training and tools
sponsored by finance
for other teams to use”
Source: Client 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
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