Business Case Flashcards
What are the main steps of a NHS business case?
- Provide contextual background information
- State your proposed solution
- Explain how your solution is solves the problem
- Describe the key benefits of the solution
- Confirm acceptability across departments
- provide contextual background information
What key points need to be made?
background of current situation/ problem
- population we are serving - e.g East of England Pathology
- how many test we currently perform
- facts about disease e.g respiratory virus morbidity/ mortality/ incidence
- information about experiences of other hospitals in network who have done similar things
- if it would breach any NHS mandatory targets
- if it would breach any Trust targets e.g PRIDE - excellence
Example:
The virology lab needs modern HDV testing, due to failure to identify patients with HDV infection, and better meet national requirement of screening all patients with HBV. The following business case will summarise our assessment of how this need can be met, and the financial and resource implications of doing so.
- State your proposed solution/ options appraisal
What key points need to be made
Outline the solution
Outline the benefits
Outline the costs
Identify alternative solutions, and why you have chosen your solution
List alternative options:
- do nothing
- negotiatenew contract with supplier for current testing
- reduce current testing to only key patients e.g haem
- outsource to other labs in network
- reference lab
Example:
Our solution is to bring HDV testing in house. This would improve turnaround time, and help us meet national guideline of testing every HBV patient. This would save £x amount per year. This is cheaper than the alternative solution of outsourcing testing
- Explain how your solution does the job
What key points need to be made
Sate how the solution works
In house HDV testing allows us to ensure all our HBV patients are tested, in line with national recommendations. It also reduces costs, and improves our turnaround time for results.
List alternative options:
- do nothing
- reference lab
Explain how you have reviewed evidence and previous examples. Example - other trust implemented similar plan, and saved x amount of money. This tests shows 40% increase in patient outcomes
- Describe the key benefits of your solution
What key points need to be made
Similar to number 2, where we outlined the solution. Except in this case we go in to more detail
Our solution allows us to control the workflow of HBV results, which ensures 100% patients will get a HDV test. It also improves turnaround time, and reduces costs. It saves £x per year versus our current solution
List financial breakdown and savings with solution - cost effectiveness
- fixed costs e.g IT, admin, staff, equipment
- variable costs - maintenance, training, consumables
Also list risks of your solution - e.g increased workload in our department
- Confirm acceptability across departments
What key points need to be made
must ensure all key stakeholders have been informed about the proposed change. Ensure have range of departmental heads on board to strengthen your proposal.
Our hepatology service welcome the improved testing service. The laboratory staff can accommodate, without adding extra workload. They are agreeable to improving our HBV workflow SOP.
Key stakeholders:
Laboratory
Finance department
IT department
Specialities - Haem/ ED/ ITU
- Conclusion and recommendation
What key points need to be made
Needs to summarise your whole proposal
NNUH PRIDE values
What are these?
How do they help with business case applciation?
People-focused
Respect
Integrity
Dedication
Excellence
Can explain how your business meets these values. Example - testing will deliver excellence, and help us treat patients better
After summaring whole business case, how will you prove that your project is effective?
Evaluation with audit, quality control and feedback from staff/ stakeholders
When thinking about costs for new technologies, what costs need to be considered?
quality - external/ internal/ accredidation
staff
training
environment - physical space
reagents/ consumables
waste disposal
integration with IT system
TAT
overall cost per test
When considering a new technology, who might important stakeholders be?
Laboratory staff
end users
IT
finance
How does PPV affect the utility of testing?
If a disease has a high prevalence e.g covid, then a positive test is almost certainly a true positive - high PPV
However in summer, there is low prevalence of covid. So a positive test is less likely to be true
it is better to avoid tests with a low PPV, especially those that are affected by variable prevalence
Essay question
Write a business case to your laboratory manager to propose using nucleic acid detection to replace virus isolation for diagnosis of respiratory virus.
- Provide contextual background information
problems with current service - e.g turn around time, cost, staffing requirements, PRIDE values, public health respiratory virus burden - State your proposed solution
Describe new test
Include details about cost, physical space, staffing, training - Explain how your solution is solves the problem
Explain how it solves the problem - Describe the key benefits of the solution
Benefits e.g faster turn around time, higher sensitivity, more automation, higher throughput, IPC, discharge patients, antimicrobial stewardship - Confirm acceptability across departments
describe acceptability by key stake holders. e.g respiratory team happy for new diagnostics
Discuss how you would provide HIV testing services (excluding CD4 testing) for a teaching hospital that has a cohort of about 1,000 HIV infected patients as well as emergency, antenatal and occupational health services.
State how these meet specifications given in current UK guidance.
- Who is responsible for HIV testing services?
commissioning sexual health and HIV services (that is, contraception and reproductive health services, GUM services, HIV testing or treatment services and abortion services), is shared between local authorities (LAs), Clinical Commissioning Groups (CCGs) and NHS England
NHS England sets out a single operating model for commissioning. This ensures consistent standards nationally, in order to improve equity and outcomes. How things are done locally needs flexibility, and the other providers help with the delivery of this.
NHS England also has responsibility for commissioning all the antiretroviral drugs listed in BNF
Local authority - comprehensive sexual health service, STI testing, HIV prevention
NHS England - HIV treatment and care
Discuss how you would provide HIV testing services (excluding CD4 testing) for a teaching hospital that has a cohort of about 1,000 HIV infected patients as well as emergency, antenatal and occupational health services.
State how these meet specifications given in current UK guidance.
- What are the goals and responsibilities for a HIV service
reduction in new HIV and other sexually transmitted infections (STIs)
reduction in late diagnosis of HIV infection
promoting good sexual health, prevention and self-management
effective treatment of illness
HIV and AIDS Reporting System - HARS. To improve collection data and to support surveillance
To answer the question - cannot just perform HIV testing solely. Have to provide full sexual health services, and access to treatment
