The CAREFUL business case
Creating a business case for a CAREFUL programme can be difficult, because the elements of the programme provide little direct payback.
There are some direct benefits on the cost of staffing: reduced sickness, reduced staff turnover, reduced vacancies and so forth but these are marginal.
Our assertion is that investing in the development and motivation of staff and the training of leaders will provide benefits to patients ("happy staff means happy patients") and is very likely even improve patient outcomes ("well trained staff means safer staff"). See the Three Circles model for some reasoning on this.
However, neither of these will directly "pay" for the CAREFUL programme through a clear "return on investment"
Much of what is recommended by the CAREFUL programme is in some way "in hand" in most organisations: leadership development, behavioural standards ... you name it, it's probably "being done" somewhere. The programme is in many ways simply a vehicle for ensuring the persistence of these disparate elements of staff development and engagement. We sometimes refer to this as "putting a fence around" the stuff which is important but not urgent.
So, can we develop a robust business case for the CAREFUL programme?
The answer is yes. The "trick" is to ensure that the CAREFUL programme incorporates into the ACTIVE theme delivery teams that have themselves a payback and use the CAREFUL programme as a way of ensuring that these delivery teams are properly resourced and protected within a larger programme.
For instance, we may decide that "Length of Stay" is an important parameter - both for patient experience and patient safety. Any stand-alone programme to deliver improvements in length of stay may find objections among senior staff and may founder on difficulties of both implementation and the ability to persist.
By making the "length of stay" project a delivery team under the remit of the ACTIVE theme it stands, in our view, a chance of linking-up with other elements of the CAREFUL programme - those, for instance, around UNIFORMITY (process improvement) - and of persisting long enough to deliver substantial results.
The following document is a discussion document for senior leaders considering the CAREFUL programme in their organisation.