Business Case Flashcards

1
Q

What are the main steps of a NHS business case?

A
  1. Provide contextual background information
  2. State your proposed solution
  3. Explain how your solution is solves the problem
  4. Describe the key benefits of the solution
  5. Confirm acceptability across departments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  1. provide contextual background information

What key points need to be made?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  1. State your proposed solution/ options appraisal

What key points need to be made

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
  1. Explain how your solution does the job

What key points need to be made

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
  1. Describe the key benefits of your solution

What key points need to be made

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  1. Confirm acceptability across departments

What key points need to be made

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  1. Conclusion and recommendation

What key points need to be made

A

Needs to summarise your whole proposal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

NNUH PRIDE values

What are these?

How do they help with business case applciation?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

After summaring whole business case, how will you prove that your project is effective?

A

Evaluation with audit, quality control and feedback from staff/ stakeholders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When thinking about costs for new technologies, what costs need to be considered?

A

quality - external/ internal/ accredidation
staff
training
environment - physical space
reagents/ consumables
waste disposal
integration with IT system
TAT

overall cost per test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When considering a new technology, who might important stakeholders be?

A

Laboratory staff
end users
IT
finance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does PPV affect the utility of testing?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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.

A
  1. Provide contextual background information
    problems with current service - e.g turn around time, cost, staffing requirements, PRIDE values, public health respiratory virus burden
  2. State your proposed solution
    Describe new test
    Include details about cost, physical space, staffing, training
  3. Explain how your solution is solves the problem
    Explain how it solves the problem
  4. 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
  5. Confirm acceptability across departments
    describe acceptability by key stake holders. e.g respiratory team happy for new diagnostics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

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.

  1. Who is responsible for HIV testing services?
A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

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.

  1. What are the goals and responsibilities for a HIV service
A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

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.

  1. What diagnostic tests would you use?
A

4th generation HIV 1/2 screening Ag/Ab test with high sensitivity

4th generation HIV 1/2 confirmatory test with high specificity

HIV 1/2 differentiation test - Geenius

HIV viral load testing

Other services :
avidity testing
viral load
proviral testing
resistance testing
other STI diagnostics

17
Q

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.

  1. Overall answer the question
A

Propose business case - e.g what is the problem, how solution works, how it is funded, what tests you would use

describe who is involved in commissioning

18
Q

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.

  1. What is the name of the guidance?
A

“A Framework for Sexual Health Improvement in England 2013”

19
Q
A