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Improving Improvement

A toolkit for Engineering Better Care

 

Make the Case

The case describes the set of facts or arguments in support of improving a system and delivering a particular solution(s) to a problem within the system.

Contents

 

Introduction

The need to Make the Case is the fifth of the seven strands in the improvement model. It underlines the importance of making the case for change for the system to be improved, following understanding the system, defining the problem, developing the solution and collecting the evidence. As a result, it is expected that such a case will be developed in the early stages of the improvement process and revised, as appropriate, as the process develops.

Purpose

Making the Case is critical to systems improvement: predicting the benefits to stakeholders of the proposed change; estimating the resources required and cost associated with the proposed change; and making a credible and ultimately successful care for changing and improving the system.

Activities

The process of making the case may include a wide range of activities including, but not limited to: Demonstrate Future Improvement, Predict Stakeholder Benefits, Calculate Resources Required, Estimate Time Required and Present Case for Change.

Tools

The practice of making the case may draw on a wide range of tools including, but not limited to: PEST(LE) Analysis, SWOT Analysis, Stakeholder Analysis, The Five Ws and two Hs and Wardley Map.

Getting Started

Making the case is critical to the successful delivery of an improvement project. It is particularly important to make the care at the beginning of the improvement process and to refine the description as necessary during the remainder of the process.

The Understand, Design, Deliver and Sustain stages of an improvement process were previously described within the Introduction section, where each stage will likely comprise a preliminary activity, followed by a number of stage activities.

For the Make the Case strand of the Understand phase, the preliminary activity is entitled Draft the Pitch. For the Design, Delivery and Sustain stages, the initial case should be further developed into a full case for the benefits to be delivered by the proposed solution(s).

Draft the Pitch

This preliminary activity encourages people to create a simple description of the problem, the process that will solve it, and the benefits that might be achieved and compile the most compelling case to deliver the proposed solution(s) for improving the system.

Worksheets: Improvement Questions, Improvement Stakeholders, Improvement Strands Canvas, Improvement Plan

Top tips:

  • Describe and quantify the scale of the challenge
  • Outline the plan for improving the system
  • Quantify the likely benefits for patients and stakeholders

Following on from this preliminary activity, the remaining stage activities are: Demonstrate Future Improvement, Predict Stakeholder Benefits, Calculate Resources Required, Estimate Time Required and Present Case For Change. Each of these are now described in turn, together with the tools that may be used to support them.

Activities

Demonstrate Future Improvement

The demonstration of most likely behaviour and corresponding improvement to be delivered by the modified system

Purpose: to demonstrate the feasibility of improvement to be delivered by the proposed solutions

Inputs: Define Requirements, Synthesise Evidence, Predict Stakeholder Benefits, Calculate Resources Required, Estimate Time Required

Tools: tbd

Outputs: a demonstration of the future improvement of the modified system

Top tips:

  • Describe the likely future behaviour of the system
  • Estimate the level of future behaviour of the system
  • Compare the predicted performance against the desired performance

Predict Stakeholder Benefits

The prediction of most likely behaviour and corresponding benefits to be delivered by the modified system

Purpose: to predict the stakeholder benefits expected by delivering the proposed improvement

Inputs: Define Requirements, Develop Concepts, Synthesise Evidence, Demonstrate Future Improvement, Calculate Resources Required, Estimate Time Required

Tools: tbd

Cards: Service Stakeholders

Outputs: a prediction of the stakeholder benefits of the modified system

Top tips:

  • Estimate the value of meeting the individual stakeholder needs
  • Estimate the value of meeting the system requirements
  • Predict the benefit of delivering improvement

Calculate Resources Required

The calculation of the resources most likely to be required to develop and deliver the modified system

Purpose: to calculate the resources required to develop and deliver the proposed improvement

Inputs: Define Requirements, Develop Concepts, Synthesise Evidence, Demonstrate Future Improvement, Predict Stakeholder Benefits, Estimate Time Required

Tools: tbd

Outputs: a calculation of the resources required to deliver the modified system

Top tips:

  • Estimate the effort required to meet the system requirements
  • Estimate the cost required to meet the system requirements
  • Calculate the resources required to deliver improvement

Estimate Time Required

The estimation of the time most likely to be required to develop and deliver the modified system

Purpose: to estimate the time required to develop and deliver the proposed improvement

Inputs: Define Requirements, Develop Concepts, Synthesise Evidence, Demonstrate Future Improvement, Predict Stakeholder Benefits, Calculate Resources Required

Tools: tbd

Outputs: a calculation of the time required to deliver the modified system

Top tips:

  • Estimate the effort required to meet the system requirements
  • Estimate the time required to meet the system requirements
  • Calculate the time required to deliver improvement

Present Case for Change

The drafting of a case for change, reflecting the system requirements, predicted system performance and likely benefits

Purpose: to present a comprehensive case for change, balancing stakeholder benefits against costs of delivery

Inputs: Define Requirements, Develop Concepts, Synthesise Evidence, Demonstrate Future Improvement, Predict Stakeholder Benefits, Calculate Resources Required, Estimate Time Required, Agree Aim Statement

Tools: PEST(LE) Analysis, SWOT Analysis, Stakeholder Analysis, The Five Ws and Two Hs, Wardley Diagram

Outputs: a comprehensive case for change and delivery of the modified system

Top tips:

  • Describe the routes to and priorities for enabling improvement
  • Identify the support required to deliver demonstrable improvement
  • Build a compelling case for the benefits and timeliness of the work

Tools

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