Thursday, 17 January 2013

Challenging Misconceptions About Business Intelligence in the NHS

Business intelligence (BI) has been recognised by many businesses as a valuable tool to reach strategic goals, increase profitability, improve customer satisfaction and ensure regulatory compliance. In the UK public sector, there has also been a broad adoption of BI to support performance management, cut operating costs and improve processes to address the need to deliver leaner public services.

However when compared to other Public organisations, the adoption of Business Intelligence technology has been relatively slow in the NHS. DSCallards have been working within the NHS for over 10 years, and have come to appreciate why this is so.  The tremendous stakes involved in healthcare naturally lead to considerable caution about changing the status quo. The practice of medicine is as much an art as a science, so many physicians are understandably reluctant to instead put their faith in recommendations generated by a database. Another reason is that there is relatively little flow of people in and out of the healthcare sector so that innovations developed in other industries take longer to be adopted.  

Finally, the data generated by the NHS is often more voluminous and complex than that generated within other public organisations. But today the unprecedented challenges faced by the NHS to improve clinical care and patient satisfaction while reducing costs are generating a new focus on process improvement. BI stands out as a technology that has been proven in many other industries to have delivered substantial improvements in quality and reductions in cost, but we often find that the benefits of BI are often misunderstood and relegated to enhancing basic operational needs and limited to isolated departments.  

In this blog I'd like to explore some of the benefits that can be realised by embracing Business Intelligence across the organisation, and hopefully give you a sense of what is possible.

So, let's imagine five levels.  Level 1 being how the organisation is using Business Intelligence as it currently perceives it and Level 5 being the delivery of 360 degrees of value to the organisation through the true use of Business Intelligence.

The first step is to understand how things are working (or not) currently


Our initial engagement with key stakeholders usually uncovers these common realities.



  1. Business Intelligence needs are focused on the enhancement of basic reporting capabilities.
  2. Executives and managers view reporting and analysis as an 'audit' activity and don't see the value of Business Intelligence derived from information.
  3. Requirements are generally represented by long standing reporting templates which have evolved from centrally mandated requirements.
  4. Operational users pull together data from various sources manually to create reports with little understanding of need.
  5. Reports are created on a quarterly or monthly basis and are of limited value.
  6. Decisions are often made without the availability of relevant and trusted information.  There is no performance management.
The organisation is at Level 1

From this starting point we can begin to structure a phased approach to delivering the true value of BI, but at a pace that will best suit the organisation's budget, as well as its ability to adopt new technology.

Level 2 - Post delivery of an intial BI project


  1. BI needs are focused on enhanced reporting and analysis capabilities, but are also moving into the implementation of basic dashboards and scorecards.  There are even some planning, budgeting and forecasting applications.
  2. Executives and management levels are now benefiting from reporting applications and there is less manual effort involved in preparing and presenting information.  Users are even able to customise some reports or analysis on a limited basis.
  3. Management information (secondary use) is not an automatic aggregation of operational data (primary use) e.g. clinical data and performance data are not intrinsically linked.  They are perceived as two different data set derived from different sources.
  4. BI becomes timelier, with reports and analysis delivered on a weekly or monthly basis.  But there is still minimal analysis capability to create actionable intelligence.

Level 3 

  1. Organisations have implemented integrated reporting where secondary use of information for BI is automatically generated from primary data with little or no manual intervention (e.g. clinical records and performance information are intrinsically linked).
  2. The organisation is moving towards balanced scorecards and streamlined key performance indicators which have been agreed across the organisation.
  3. The business drivers for information are linked directly to an organisational performance agenda.
  4. Front line staff are now users of BI and are trained in how it can benefit their role.
  5. Sources of data are more widely available and not constrained by disparate systems.  Information is now delivered when needed (at the right time) and pulled, cleansed and used according to the business needs.

Level 4

  1. Business Intelligence is used to optimise the way business processes are designed and the way people work.
  2. Analytics are automated and embedded into business processes to enable front line decision-making.  Front line users are highly skilled and have new expectations around information delivery and capabilities that allow them to be more responsive to their business environments, predict outcomes and dig deeper with analytics.
  3. There are a high percentage of real time applications which allow for immediate decision making at the front line.
  4. Managers have more confidence in the integrity of Business Intelligence and are comfortable devolving decision making responsibility to the front line.

Level 5