HOW ANY ONE CAN … DESIGN AND BUILD A BUSINESS CASE

+

THEN DEVELOP IT AS A SERVICE ENHANCEMENT

Irrespective of whether the outcome is success or failure

BACKGROUND PERSONAL HISTORY

• I didn’t want to be a Head of Department• We didn’t have a plan for the Department• Plan = Seeing patients that walked in +

responding to babies born +supervising / teaching staff

• Years passed – responding to crises + emails + dictating letters

LESSONS LEARNED

• Observing problems + powerless to change• Are we all on the same journey?

• Getting the ‘birds eye’ view• Identify how you can take action = 10

step path to Business Case Enlightenment

EXISTING SERVICE ENHANCEMENT?

Examples:• Admin staff positions

[7yr]• Paediatric Diabetes Spec

[4yr]• 4 extra SCN beds [3yr]• Converting VMO to staff

specialist position [1yr]• PICS [2yr?]

Examples:• MRI under GA service

[2yr]• NEAT AT-registrar [1yr]• Paediatric Neurologist

[4yr]• Nurse Practitioner [2yr?]• MD Paed skills centre

[2yr?]• Video-based teaching

[5yr]

NEWSERVICE?

STEP 1: IDENTIFY … AREA OF CRITICAL SERVICE DEFICIENCY

STEP 2: CONSULT …. WIDELY

• Consult senior staff in department• Canvass support from partner departments

...ED / O&G / allied health• Networked services [eg: MP4 / SCHN / Perinatal

services]• DOH / NSWK&F

STEP 3: TRACKING … HISTORY OF THE PROBLEM / NEED

• How did this predicament develop?• Strategies previously tried/

exhausted• Services currently denied?• Near-misses / IIMS / M+M

references?• Risk register / complaints?

Example: MRI under GA service, 3 hrs/month

STEP 4: FORMULATE … THE PROPOSED OPTIONS

• What is the solution proposed?• ‘Definitive’ Vs ‘Interim’ or • “phase 1 - nucleus” Vs “phase 2 - extras” proposal• Write in bulleted points, ranked in order of

importance• ‘Less is more’ – try to summarise the essence of the

proposal

Example: Paediatric Integrated Care Service

STEP 5: COSTING …INCLUDING ALL DETAILS

• Partner with a business manager• Complete the financial template• Include ‘on-costs’ – superannuation / AL / office• Revenue costs Vs revenue raised / cost savings..

- clinic billings: Medicare item nos. x activity

- Procedures or bed days saved

Example: Paediatric Neurologist position 0.1FTE

STEP 6: FUNDING..

• Activity based funding• Revenue enhancement• Revenue offset• Statewide networks• Innovation funding• Building a record for ‘financial responsibility’

Example: 4 extra SCN beds

STEP 7: LOBBYING …

• Selling the idea to the divisional / managerial / finance staff• Explain efficiencies made, exhausted existing resource options• Trade-offs prepared to be made to fund additional service• Promote any innovations in models of care• Consider title / acronym which will promote the service• Align it to LHD sponsored trends [‘HITH’ / ‘ICS’ / ‘ED bypass’]

Example: Nurse Practitioner

STEP 8: STAYING THE DISTANCE…

• Promoting need for the service at council-level meetings• Offering to be the subject of a departmental review• Highlight ongoing vulnerabilities for the service• Reference any complaints / concerns from other

hospital services• Failing to meet statutory obligations or capabilities?

Example: Paediatric Diabetes service 0.2FTE

STEP 9: RECRUITING … APPOINTEES MAY SELL / KILL

SERVICE• Job description needs to be ‘punchy’ on essential

criteria• Interview Qs need to be ‘discriminating’ for

applicants• Consider appointing a 12 mth. Locum [‘try before

you buy’]• Reference checks [flexible? promote a positive

working space? willing to do extra? task-completion? high-maintenance? ability to work in stressful situations? without supervision?personality disordered? bring out the best in others?]

Example: Administrative officer positions

STEP 10: SHOWCASING …BENEFITS, ONCE SUCCESSFUL

• Promote results achieved• Celebrate milestones• Publicise dept. + hospital• Presentations at council mtgs. and hospital grand

rounds• MP4 meetings + posters at conferences

Example: NEAT – Advanced trainee registrar

SUMMARY

• ‘Drone view’ not ‘street view’• Network not craftwork• Innovate don’t stagnate• Persistence for the

distance