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How to make a solid business case

Doucette, Jeffrey N., DNP, RN, NEA-BC, FAAN, FACHE

doi: 10.1097/01.NUMA.0000552741.64201.43
Department: Leadership Q&A

Senior Vice President and CNO, Thomas Jefferson University Hospitals, Philadelphia, Pa.

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Q I have an idea to expand the services offered on my unit, which will help improve revenue, satisfaction, and patient flow, but I don't know how to get it in front of the right people for approval. What advice do you have on how to get started?

Creating a solid business case is a great starting point. Imagine you're the final decision-maker who has the authority to approve your idea. What type of information would you need to know to make an informed decision? I like to think about a business plan in three parts: a strong narrative, a detailed budget plan spanning at least 1 operational year, and a summary presentation that can be used to generate support.

To begin, write a detailed narrative that clearly presents the focus of your idea. Throughout your narrative, cite credible sources from both internal organizational data and the professional literature. These references should support your position that the new idea is needed and underpinned by the data you provide. Next, include a description of the new services, as well as an organizational gap analysis demonstrating the need for them. It's always best to ensure that the items you identify in the gap analysis are supported by and aligned with the strategic plan, mission, vision, and values of your organization. Clearly identifying this alignment is key to receiving the support you need to get your idea approved.

Next, you must present a clear needs analysis. Typically, the needs analysis includes a summary of the capital budget needs, the ongoing operational dollars required to implement and sustain your idea, a detailed staffing plan, a realistic forecasting of volumes and/or revenue, and what type of support is needed from other organizational services. In addition to addressing these key areas in the narrative, you'll also want to include them in your budget plan.

Any good business case identifies several key financial metrics. Your narrative should include a cost-benefit analysis in which you discuss both the risks of not implementing the idea and the risks associated with the idea, and clearly outline the benefits that will be realized if your idea is accepted and implemented. The stronger your case in terms of financial modeling, volume predictions, and reducing pain points in your organization, the more likely you are to receive approval. Provide a plan for getting your idea up and running, as well as a projected date for when your idea will break even. A key financial calculation to include in your written narrative, the break-even analysis is supported by your proposed budget.

For your budget proposal, I generally recommend submitting a budget that spans at least 1 fiscal year. Some organizations require plans for multiple years; however, 1 year should be the minimum. The budget spreadsheet must contain all the required elements of an operating budget, including, but not limited to, revenue; expenses, such as supplies, interdepartmental support, and labor; and staffing measures, such as hours per patient day, if your idea involves direct patient care. If your idea isn't supported by measures of staffing effectiveness, you should consider other appropriate measures, such as productivity or hours per unit of service.

Finally, you have to sell your idea in a way that makes sense. Not everyone is going to want to or have the time to read your detailed narrative and budget plan, so you must create a compelling presentation to summarize your idea that includes all the relevant background, data, and decision points. Limit this presentation to the smallest number of slides possible to underscore the need for your idea. Imagine you're presenting this to the board of directors for approval. What critical information do they need to provide support? Your presentation should include a summary of the budget proposal, provide the relevant facts and financial analysis in a succinct manner, and convey your proposal's overall strategic objectives.

The best chance of getting your idea approved is a solid plan presented in a meaningful way. Creating a compelling case, supported by data and aligned with your organization's goals, is sure to take your concept from idea to reality.

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