Developing a framework of quality indicators for healthcare business cases: a qualitative document analysis consolidating insight from expert guidance and current practice

Background: Business cases are used to provide a structured justification in favour of investing in new projects,
services or interventions. Despite the use of business cases in determining how limited resources will be allocated
within England’s National Health Service (NHS), guidance concerning how to develop and evaluate business cases
in the context of healthcare is inconstant and of varying relevance. This study aimed to develop a new framework
of quality indicators for healthcare-related business cases by analysing the content of expert guidance documents
and a sample of NHS business cases.

Methods: Qualitative document analysis was conducted on guidance documents (n = 7) and existing NHS business
case documents (n = 18). Documents were purposefully sampled using criteria to ensure the framework reflected a
diverse spread of expert opinion, and a varied sample of example business cases from current practice. Data were
analysed using thematic and content analysis, and are presented in a visualised framework.

Results: Seven themes were identified within the qualitative document analysis (purpose, strategic priorities,
options, benefits, costs, risks and evaluation). These themes were described and presented with a framework of
quality indicators for healthcare-related business cases.

Conclusion: To our knowledge, this is the first framework of business case quality indicators designed specifically
for use in a healthcare context. The framework presented in this study has implications for how business cases are
developed and evaluated by decision makers. In the future it would be beneficial to investigate how the framework
could be used in practice as a tool for critical appraisal.