Finance: The Business Case Is a Living

¶ … Finance:

The business case is a living document that drives program activity in light of the changes in the business' external environment and lessons from the program scope. These factors are used in preparing the business case to ensure that the program is and will continue to be viable, desirable, and achievable. Therefore, the main goal of the business case is to direct program activity towards the ultimate realization of the vision and to provide mechanisms from periodic evaluation of several aspects of the program. These evaluations provide information on whether the program should progress to the next stage, be suspended until further review is carried out, or be terminated. This implies that the development of the business case is an important practice in promoting the success and effectiveness of the business. It's a process that should not be taken lightly but accorded the necessary consideration and attention it deserves. This article focuses on examining the strengths and weaknesses of three business cases based on the business case framework provided by Gamble and other learning sessions.

MAFIA Project Consortium's Business Case:

The first business case of the three reports was prepared by MAFIA Project Consortium regarding restructuring of health services in Borlein region. The report seeks to provide NSW Government with the opportunity for designing a new and all-rounded approach for planning the Borlein District Health Services ("Re-structure of Health Services," 2013). The proposals for restructuring health services in this region are based on changes to external factors as a result of emerging trends. These emerging trends include population trends, morbidity attributes, technological advancements, social-economic conditions, and political factors. Through the reform proposals, the business case seeks to lessen waiting times, enhance bed use, improve access to health services, enhance community services, cater for population and tourism growth, and enhance healthcare reputation. As a proposal for reform of Borlein's health services, the business case has some advantages (strengths) and some disadvantages (weaknesses).

Some of the major strengths of this business case include the fact that it begins with a statement of the purpose of the change and is followed by the other sections in the basic structure of the business case. These sections that have been included are the value of the investment, blueprint of the future, financial analysis, and issues and decisions to be considered by the Review Board. Secondly, the author's of the report have not only identified the potential benefits of reforms in Borlein District Health Services but also evaluated the two feasible alternatives that would probably realize the identified potential benefits. They examine each of the alternatives from a Cost and Benefit Analysis perspective before choosing the most appropriate option to be implemented. Third, the authors provide a projection of a timeline with which their health services objectives will be achieved. Therefore, the implementation of this proposal would be governed by a specific timeline for the realization of the health services objectives, which provides measures for periodic evaluation.

However, this business case has some weaknesses that hinder its effectiveness in realization of the project's goals. While the business case provides an estimated period of time for the reform of healthcare service in Borlein region, it does not consist of a benefit distribution matrix. Even though the authors provide the Benefits Map detailing the attractiveness of the proposed alternative and the extent it provides the results to achieve benefits, their matrix does not include the benefits and dis-benefits of the option to individual stakeholders. Generally, the Benefits Map is designed based on business impact and value type (Aldershot, 2006, p.204). The value type includes the definite, expected, logical and intangible value while business impact incorporates the speculative, strategic, key operational, and support effect. These authors have failed to examine the business impact and value type of their recommended option. Moreover, the consideration of the value of investment does not clearly state the Return on the Investment (ROI) and the Net Present Value of the process.

FAB Group's Business Case:

The second business case on improving healthcare services in Borlein region is prepared by FAB project management, which is a consultancy focusing on project management of health infrastructure and service delivery in New South Wales. Similar to the first business case, this proposal begins with a purpose statement in which it seeks to outline a mechanism for the redevelopment of the region's healthcare infrastructure. Through this process, the FAB project management team seeks to determine a clear case for change for identifying a proposed solution to achieve the emerging healthcare challenges in Borlein region.

This business case is associated with some strengths and weaknesses in its attempts to develop a clear framework for enhance Borlein's health outcomes and offer greater ability for meeting the demand and challenges in healthcare. One of the strengths of this business case is that it begins with an overview of the need for strategic planning and reforms in Borlein local health district. The authors of this report have not only evaluated the current state of healthcare services in the area but also developed a case for change. The case for change is based on Borlein's demographics and the major challenges that limit the effective delivery of healthcare. During this process, the authors have found that the region is experiencing several emerging challenges in attempts to support the growing demand for healthcare services ("Borlein Region Health Service Upgrade," 2013).

Secondly, the business case seeks to address the issues identified in the case for change as the basis for developing the proposal for improved healthcare services. This implies that the authors' work in recommending the enhancement of health services and meeting the demands of these services is based on important aspects and trends in Borlein's healthcare system. Actually, the proposal for improved healthcare services is based on an understanding of the region's population growth, urbanization, aging population, demand for hospital bed, bed occupancy rates, the operating costs of healthcare organizations, and drug and alcohol abuse.

One the contrary, this business case does not include an Investment Assessment Matrix despite using a cost and benefit analysis approach in developing the solutions. The authors failed to determine the value type and business impact of the proposed solutions in contributing to improved healthcare services in Borlein region. Secondly, the FAB project management team failed to describe issues for consideration and decision by the Review Board. Therefore, this business case does not present fundamental questions for the Review Board to examine during the program life cycle. Third, the proposal does not provide the constraints or assumptions that were used to govern the process of identifying the best approach to address the need for a re-structure of Borlein's health services. It is relatively unclear about the assumptions and constraints that were used in developing the options for improving healthcare services.

The CHAND Group's Business Case:

The final report submitted at the workshop is the business case prepared by The CHAND Group to contribute to enhance healthcare services in Borlein region. This business case is prepared in response to the recent report on the need to re-structure the distribution and level of available healthcare services in Borlein area. After exploring several options, the authors recommended a three-point approach to specifically deal with the gaps surrounding population growth, changing demographics and the need for extra support services in Borlein ("Project Appraisal & Finance," 2013). As a proposal to the Regional Health Board, the report has been created to cover projection of health needs until 2020.

Similar to the proposal by FAB Project Management team, one of the strengths of CHAND Group's business case is that it begins with an outline of the case for change. The authors commence their initiative to identify a suitable option for improved healthcare services by outlining the evidence driving the need for reform of Borlein's health services. The CHAND Group has not only used the factors presented in the recent District report on Health Services but they have also examined other factors that could drive the need for a re-structure. In addition to identification of these drivers, they have proceeded to provide a description, category, strength, and evidence of each of these factors. Secondly, this business case includes a comprehensive analysis of the constraints that provided boundaries for developing options. These constraints were identified based on the consideration of internal and external factors as well as assumptions for developing the report.

However, this proposal does not provide clear considerations and decisions to be examined by the Review Board during the implementation of the proposal. This implies that it would be relatively difficult for the Review Board to refine the project as content develops during the program life cycle. In essence, the board would have difficulties in developing comprehensive approaches that would enhance the effectiveness of the recommendation.

Relative Merits and Deficiencies of the Proposals:

The recent District report on Health Services in the Borlein Region highlighted the need to re-structure the level of healthcare services and their distribution across the region. The report was based on several gaps identified in the distribution and level of health services i.e. population growth, changing demographics, and need for support services. This report provided the basis for development of a new and comprehensive approach towards planning of health services in the District. The approach for planning of Borlein District Health Services should be geared towards the realization of three major objectives. These objectives include the presentation of a report for future allocation and enhancement of health services based on application of Project Management disciplines and Business Case Framework (Smith, n.d.). These objectives provide the basis for evaluating the relative merits and deficiencies of the recommendations.

Mafia project consortium recommends providing adequate healthcare services through reallocation of Human Resource and building facilities. This process would involve downgrading or upgrading the acute health service level based on the projected rate of population growth in the region while enhancing the existing levels of emergency service across fishing, tourism, and forestry industries. The merits of this proposal include the fact that it would contribute to satisfactory changes in the population while enhancing healthcare services. Secondly, this project is less costly since it involves reallocation of current human resource and building facilities in attempts to achieve the health service improvement objective.

However, this proposal would not be effective in meeting improving health services in the region since it does not incorporate a holistic approach towards the achievement of this objective. For instance, improvement of emergency service level is recommended for three major industries, which does not include other key aspects of emergencies such as natural disasters. Secondly, it does not provide practical steps in addressing gaps in population growth, changing demographics, and need for extra support services.

FAB project management team proposes a complete upgrade of the Borlein Region Health Services to promote the delivery of an enhanced and higher quality of health services. The team considers this recommendation as the most probable to provide the optimum results due to the changing needs of the population and changes in the administration of healthcare. The upgrade process would include constructing a new level-5 hospital in Oldorando and level-4 hospital in Ottassol. Secondly, the total upgrade includes the transformation of the decommission hospitals to aged care or conversion of existing hospitals. The FAB project management team recommended this proposal because of its advantages over the alternative option in achieving the goals of the project.

This proposal has several merits or advantages including the fact that it will adequately meet the long-term health needs of Borlein District and its provision of numerous employment opportunities. Moreover, the proposal will contribute to reduced length of hospital stay, enhance patient experience, and lessens demand for acute bed-days. The other merit of the recommendation is that the infrastructure upgrade will provide the needed health system that goes beyond 2020. In essence, the upgrade will result in improved efficiency, services, and employment opportunities. Nonetheless, the project is associated with some deficiencies such as its costs because of the specific processes needed for the upgrade. Actually, the estimated capital cost for implementation of this proposal is $230 million, which presents numerous risks on the specific method of funding. Since its execution requires huge amounts of money, it results in challenges on how to secure funding for the project.

The CHAND Group proposes a three-point approach for addressing challenges around population growth, demographic changes, and need for extra support services as part of a re-structure for health services in Borlein region. This proposal involves increasing aged care and community health services, increasing bed numbers in Ottassol Hospital, and re-purposing Matrassyl Hospital. This would involve constructing a new wing for Ottassol Hospital to meet the need for additional beds while maintaining Matrassyl Hospital's Emergency services, though the other services are transferred to the developed new wing. Moreover, it would entail building new aged care facilities in Matrassyl and Oldorando.

Based on cost and benefit analysis, the merits of this proposal is attributed to its critical success factors. These include reduced waiting time, enhanced access to health services, improved bed use, address population growth, and meet the needs of aged care. This implies that the recommendation would provide a holistic approach for restructuring Borlein District Health Services. Secondly, the project is effective in meeting the long-term health needs of the population through to 2020 and beyond. The deficiency of this project is that it's would cost a huge amount of money to implement i.e. $4, 711, 404.49. The CHAND Group estimated this cost using a bottom-up approach in cost and benefit analysis and high level feasibility.

The Most Suitable Proposal:

The main reason for the development of the business case is to respond to a report by Borlein District Health Services report on the need for a re-structure of the level and distribution of health services within the region. This implies that the most effective proposal should provide the New South Wales Government with the opportunity to create a new and comprehensive approach for planning healthcare services in the region. In essence, the most appropriate proposal would be based on a decision framework or criteria that consider the specific targets presented in the need for re-structure report.