It’s natural for healthcare educators to have an implicit appreciation of the benefits of their educational services. After all, it’s logical to assume that a more knowledgeable and highly skilled workforce can provide better patient care.
Yet health administrators don’t always understand or appreciate how a training program can result in improved care, and ultimately reduced costs.
As Girdler (2009) says, proving that continuing education leads to better patient outcomes is something that many educators struggle with. Yet, in times of financial constraints, it becomes more important than ever for healthcare educators to know how to demonstrate the value of their services (Garrison and Beverage 2018).
It’s so important to know how to prove to human resources (HR) managers and finance directors that the time and resources dedicated to educational activities are worth the impact they have on clinical outcomes (Opperman et al. 2016).
Demonstrating the Value of Education to Purchasers
Traditionally educators haven’t had to justify the value of their work. But, as Cervero (2018) points out, whilst huge financial resources are put into general education there is much less investment in continuing professional development (CPD).
Yet this final and longest phase of a health professional’s career is typically underfunded, leaving many educators wondering how best to secure the financial support needed for ongoing training. It raises the question: can the value of CPD be measured and quantified in a way that makes a convincing business case for investment? (Cervero 2018).
Continuing professional development for healthcare professionals is an important strategic instrument for improving health. In the UK for example, the Department of Health (Brown et al. 2002) helpfully identifies CPD as providing the following key benefits:
- It provides a practical way of maintaining standards of care
- Contributes to the improved health of the nation
- Helps to recruit, motivate, and retain high-quality staff
Yet to demonstrate the value of participating in CPD, economic proof is often needed, especially when resources for health care are scarce, and money spent on CPD could otherwise be used for direct patient care.
So, what can educators do to present a convincing business case and free up funding for ongoing educational needs?
Creating a Compelling Business Case
Although Wise et al. (2018) suggest that it’s best to use a team-based approach when building a business case, it’s also possible for individual educators to put together a compelling case for educational funding.
As Karahanna (2018) explains, the purpose of a business case is to provide the basis for making a decision as to whether to move forward with a specific project. Buzachero et al. (2013) also point out that creating a business case helps position the project for success by aligning its intended outcomes with organisational needs. This business alignment is essential if the investment in a project is to reap a return.
5 Essential Components of a Business Case
Whilst there are numerous templates that can be used to build a business case, Karahanna (2018) suggests that there are five essential components that should always be present:
The problem description explains why there is a need for financial investment. It asks the question ‘what is the problem, and why does it need to be solved’? This part of the business proposal must be both compelling and convincing and describe a real problem that a training course can help to solve.
This section of the business proposal outlines the scope of the project and describes how the problem will be addressed. It may also require a needs assessment to justify expenditure.
Outlining the business benefits of a training event is one of the most important stages of the proposal. For example, reduced costs, or improved quality of care. To be considered worthwhile however, business objectives also need to be stated in a way that is both specific and verifiable as well as associated with a time frame.
Costs associated with the training program should be quantified if possible and include both developmental and operating costs. Both tangible and intangible costs should be considered at this stage.
Risk Assessment and Feasibility
The final component of a business case is designed to answer the questions, ‘can we proceed with this project’, and ‘if so, should we?’
Financial Assessments and Return on Investment
Not every training project can be justified from a purely financial standpoint, but in the view of Karahanna (2018) the intangible, or non-financial benefits may still be sufficiently compelling to move forward and grant funding anyway.
In general terms though, once the problem and potential solutions have been described, and the benefits, costs, and risks of the project have all been identified, the return on investment (ROI) can then be calculated.
Return on investment
is commonly used as a measure of performance that evaluates the efficiency and quality of an investment, measuring the return relative to the cost. It’s used as a tool to guide decision making and prove the worth of the investment. As Girdler (2018) points out it’s an important concept for educators to grasp when applying for funding.
Calculating the Return on Investment
Many healthcare educators are challenged by the question "What is the return on investment for a given professional development activity"?
Calculating the return on investment isn’t normally a task that educators consider part of their role but as competition for funding increases, many trainers are now having to embrace these skills to secure their training budgets. These are important skills to have because knowing how to calculate the financial impact of educational interventions can change the perspective of finance directors, helping them to appreciate the wider picture. Benefits can be highlighted not just in terms of patient care but for the organisation as a whole.
As Garrison and Beverage (2018) suggest, calculating the ROI is the most commonly accepted way to quantify the value that professional development brings to the organisation. As Opperman et al. (2018) say, whilst practitioners routinely measure the impact of educational interventions on clinical care, they seldom consider the financial impact of the same educational events, suggesting that more consistent measuring and reporting of the financial and clinical impact of continuing professional development is needed.
That said, consistent and standardised methods of calculating the ROI of educational activities is hard to find in the literature.
As Brown et al. (2002) points out, whilst the literature on the effectiveness of CPD continues to expand, educational effectiveness is not necessarily a sufficient criterion for implementation. In other words, for scarce resources to be devoted to education, the relative cost-effectiveness of different educational interventions needs to be established, allowing finance departments to select those offering the most value for money.
Brown et al. (2002) also go on to suggest that cost-effectiveness analysis in research is rare. This, they suggest, is due to:
- Limited training for researchers in presenting a business case for funding;
- Antipathy towards economic analysis that might constrain training programs and policies;
- Lack of significant results in studies of educational effectiveness; and
- The quality of such research is also often poor.
Ultimately, it is perhaps true to say that the very nature of continuing education is changing and that not all education needs to be live and not all staff need to be trained on every topic (Garrison and Beverage 2018).
With the growing presence of online classrooms, on-demand learning and mobile technologies, the challenge remains to decrease the cost of education yet still maintain its effectiveness.
- Buzachero, V., Phillips,J., Pulliam Phillips, P. and Phillips, Z. L. (2013) Measuring ROI in Healthcare: Tools and Techniques to Measure the Impact and ROI in Healthcare Improvement Projects and Programs. [Online]. Available at: https://accessmedicine.mhmedical.com/book.aspx?bookid=2316(Accessed: 20.2.19).
- Brown, C.A., Belfield, C.R. and Field, S.J (2002) 'Cost effectiveness of continuing professional development in health care: a critical review of the evidence', The BMJ, 324:652(), pp. [Online]. Available at: https://www.bmj.com/content/324/7338/652.short(Accessed: 20.2.19).
- Cervero, R., (2018) 'Outcomes-Based, High-Value CPD from a Business Perspective', in National Academies of Sciences, Engineering, and Medicine (ed.) Exploring a Business Case for High-Value Continuing Professional Development. Washington: The National Academies Press, pp. 7-17. https://www.nap.edu/catalog/24911/exploring-a-business-case-for-high-value-continuing-professional-development (Accessed: 20.2.19
- Garrison, E., Beverage, J. (2018) 'Implementing a Process to Measure Return on Investment for Nursing Professional Development', Journal for Nurses in Professional Development, 34(1), pp. 8-11. Available at https://www.nursingcenter.com/cearticle?an=01709760-201801000-00003&Journal_ID=54029&Issue_ID=4482409 (Accessed 20.2.19)
- Girdler, M. (2018) Proving Return on Investment (ROI) in Nursing Education, Available at: https://www.ausmedcorporate.com/proving-return-on-investment-in-nursing-education/(Accessed: 20.2.19).
- Karahanna, E. (2018) 'Outcomes-Based, High-Value CPD from a Business Perspective', in National Academies of Sciences, Engineering, and Medicine (ed.) Exploring a Business Case for High-Value Continuing Professional Development. Washington: The National Academies Press, pp. 7-17. https://www.nap.edu/catalog/24911/exploring-a-business-case-for-high-value-continuing-professional-development (Accessed: 20.2.19
- Opperman, C., Liebig, D., Bowling, J. and Johnson, C.S. (2018) 'Measuring Return on Investment for Professional Development Activities', Journal for Nurses in Professional Development, 34(6), pp. 303 - 312. https://www.nap.edu/catalog/24911/exploring-a-business-case-for-high-value-continuing-professional-development (Accessed: 20.2.19
- Opperman, C., Liebig, D., Bowling, J., Johnson, C.S. and Harper, M. (2016) 'Measuring Return on Investment for Professional Development Activities: A Review of the Evidence.', Journal for Nurses in Professional Development, 32(3), pp. 122-9. [Online]. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27187826(Accessed: 20.2.19).
- Wise, H (2018) 'Outcomes-Based, High-Value CPD from a Business Perspective', in National Academies of Sciences, Engineering, and Medicine (ed.) Exploring a Business Case for High-Value Continuing Professional Development. Washington: The National Academies Press, pp. 7-17. https://www.nap.edu/catalog/24911/exploring-a-business-case-for-high-value-continuing-professional-development (Accessed: 20.2.19)