Great expectations: how to prove ‘return on investment’ in the complex world of healthcare education and training

Great expectations: how to prove ‘return on investment’ in the complex world of healthcare education and training

By Stuart Lowry, Service Development Director, NHS Professionals Academy

Training is a way of life in healthcare. It’s an essential requirement for many roles, ensures professionals remain up to date with the latest practice, and diversifies skills through continuing professional development. It can also grow networks, build confidence and nurture creative thinking, all of which support safe patient care.

However, its central place doesn’t make it immune from financial scrutiny or searching questions such as: ‘What is the return? How does it support strategic and patient safety agendas? Is it really worth the time and expense?’ 

As public bodies, NHS Trusts, Integrated Care Systems, and Integrated Care Boards must, of course, justify their spending - education and training included. This is nothing new, but the economic downturn means the pressure to demonstrate value for money and the so-called return on investment (ROI) is even higher.

Proving ROI on education and training can be complex, especially in the public sector when profit isn’t as relevant, so let’s take a closer look at it.

Classic ROI

The well-known Jack Phillips ROI model is a measurement benchmark. It hinges on gathering data before, during, and after the training, plus the analysis of process and productivity gains and increased profits. Using a formula, a ‘value’ is then put on the training by comparing the outcomes with the costs – including training development, delivery, labor, and participants’ time.

The obvious issue here for NHS-based training is that profit isn’t in the mix. Savings could replace profit under the model, but really the emphasis is all on process and productivity. It leads us to ask: is there another way we can quantify training ROI in the NHS?

Return on expectation

One answer is to redefine ROI as ROE – ‘return on expectation’. This increases the scope of what is deemed ‘valuable’ and recognises that not everything can be measured in pounds. The ‘expectation’ could come from a range of people; the person being trained, their patients, supervisor or employer, or a combination. 

For this model to work, the expectations should be clearly defined. To do this, we have to work backwards, starting not from the training but from the outcomes of the training. 

The outcomes can be for both individuals and their employers and deliver benefits such as improved qualifications, skills, competencies, and patient safety. Some may relate to service reconfiguration, to deliver a more cost-effective service. Outcomes around engagement and well-being may also be helpful, to support quality and retention in the post-pandemic climate.

Train to task

Outcomes could centre on specific tasks a provider or system needs to train people for to address local needs and skill gaps. We saw a striking example of this ‘train to task’ model during the pandemic’s crisis phase when NHS Professionals rapidly stood up thousands of people who were then trained at pace to deliver COVID-19 vaccinations. Another good example comes from Derbyshire ICS, which now has eight new learning disability nurses (with more in the pipeline) thanks to a ‘train to task’ collaboration between the community and acute Trusts and Derby University

With defined outcomes, we can then identify training courses and content to match these, so the whole approach is outcome-led from the start. Too often, training courses are content-led. That means a lot of course time and investment can be wasted because there is a disconnect between the training and specific outcomes, such as organisational and role development. 

The training itself should also be flexible to suit different levels of experience, and adaptive to different learning styles and time constraints by using classroom and digital settings. A hybrid of both is also helpful.

Proving the ‘return’

Defining expectations through outcomes makes the process less generic and more anchored in specific metrics. It helps to set clear learning objectives and training pathways based not on content the educator thinks is important, but on deliverables that can be measured or indicated.

To prove a ‘return’, it’s essential to implement outcome-led training once it has been agreed upon. It’s also key to gather concrete examples of improvements and positive changes – the outcomes - in the months and perhaps years that follow.

This leads to more focused and reliable quantitative and qualitative data and completes the expectations-based model. Measurement is also hugely valuable in learning lessons and feeding into future initiatives and course design. This ensures training is always responsive to outcomes. It helps us to answer the key question: what is an acceptable level of success? 

Sustainable training


Our expectations and outcomes from training should be largely centred around people – the patients receiving care and the staff providing it. Both should experience measurable benefits. But there is also the system: it should also benefit.  

Evidencing the system- or organisation-wide value of education and training, alongside the people value, will make the case for further investment much easier. This, in turn, will make high-quality education and training more sustainable and help it continue to be a positive way of life for healthcare professionals, no matter what the economic landscape looks like.