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If there is one lesson to be learnt, I suggest that it is that people must always come before numbers. It is the individual experiences that lie behind statistics and benchmarks and action plans that really matter, and that is what must never be forgotten when policies are being made and implemented.

‘The customer is king’

2

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Qualifier or differentiator

?

3

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Qualifier or differentiator

?

4

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Transforming for QIPP

1. Establishing a sense of urgency

2. Forming a powerful guiding coalition

3. Creating a vision

4.Communicating the vision

5.Empowering others to act on the vision

6. Planning for and creating short-term wins

7.Consolidating improvements and producing still

more change

8.Institutionalising new approachesJohn Kotter (1995)

QIPP

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National Health Service Act, 1946Part I

Central Administration

1. – (1) It shall be the duty of the Minister of Health to promote the

establishment in England and Wales of a comprehensive health service

designed to secure improvement in the physical and mental health of

the people of England and Wales and the prevention, diagnosis and

treatment of illness, and for that purpose to provide or secure the

effective provision of services in accordance with the provisions of the Act

(2) The services so provided shall be free of charge, except

where any provision of this Act expressly provides for the making and

recovery of charges.

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Although I am not myself a devotee of bigness for bigness sake, I would rather be kept alive in the efficient if cold altruism of a large hospital than expire in a gush of warm sympathy in a small one

Aneurin Bevan’s speech on 30 April 1946 on the second reading of the NHS Bill

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To be the best

healthcare provider in the region

To be the best

healthcare provider by delivering excellent

services to our patients

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Joint Session of Congress

25 May 1961

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Acute

Community

General practice

Local governmen

t

Vertical v. horizontal integration

Public health

What business are you in?

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There is hardly anythingin the worldthat some mancannot make a little worsecannot make a little cheaperand the peoplewho consider price onlyare this man’s lawful prey.

John RuskinBritish poet, artist,

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Portfolio analysis

Market penetration

Market expansion

Product development

Diversification

Existing New

New

Existing

Risk

Products

Markets

Igor Ansoff (1957)

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New markets?

New services?

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Since our establishment in 1957, Deffenbaugh Industries, Inc. has maintained an unrivaled record of customer satisfaction. Our founding standards of integrity and excellent service remain the basis of our reputation. Headquartered in suburban Kansas City and operating from 8 locations in Kansas, Missouri, and Nebraska, Deffenbaugh Industries, Inc. is the largest privately-owned refuse firm in the Midwest. Each member of our more than 1900-person staff shares the company's commitment to customer service and satisfaction.

High risk diversification

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Boston Box

0.1 Low

Low

High

Market Growth

Rate

Stars

Problem children/ question

marks

Cash Cows Dogs

10.0 High

1.0

Relative Market Share (log scale)

5%

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Boston Box – Cashflow analysis

modestcashflow

(positive negative)

largenegativecashflow

large positive cashflow

modestcashflow

(positive/negative)

Stars Problem children

Cash cows Dogs

Successful product development

Internal cash flows

0.1 Low

10.0 High

1.0

Relative Market Share (log scale)

Low

High

Market Growth Rate

5%

18

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Rolls Royce RB211 and Lockheed TriStar

Highly complex engine needing lengthy development and testing to deliver guarantees on technology, thrust, weight and fuel consumption. RR insolvent 1971, privatised 1987.

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Generic Strategies

Overall Cost Leadership

Differentiation

Focus Low Cost

Focus Differentiation

Low cost positionA uniqueness

perceived by the customer

Strategic Advantage

Strategic Target

Industry-wide – Broad Scope

Particular Segment – Narrow Scope

Porter (1982)

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I’m thinking that every one of the one million parts behind and beneath me were built by the guy who put in the lowest tender

Frank Borman, commander of Apollo 8

when asked “what’s it like, lying on your back at the top of a Saturn V rocket when the engines

light up?”