In order to determine the infrastructure investment appraisal, causal relationships between healthcare intervention delivery and output; health outcomes and health gain and public health and welfare have to be empirically established. Benefits should encompass economic, social and socio-economic parameters. Quantifiable benefits such as economic returns are easier to measure, but non-traded impacts such as population health and welfare are more difficult to monetise. Social Return on Investment (SROI) enables valuing these components and several techniques (such as Willingness to Pay, Revealed Preference Technique or Stated Preference Technique) can be used to achieve this.
SROI analysis is a method for understanding the environmental and social value being created by an organisation in addition to the financial value generated; the aim is not simply to maximise the financial return but to generate a broader set of “blended returns” – economic, social, and environmental (Carleton Centre for Community Innovation, 2008). SROI is a framework for measuring and accounting for a much broader concept of value; it seeks to reduce inequality and environmental degradation and improve wellbeing by incorporating social, environmental and economic costs and benefits (The SROI Network, 2009). An SROI analysis can take many different forms. It can encompass the social value generated by an entire organisation, or focus on just one specific aspect of the organisation’s work.
There is no single way to conduct a SROI analysis and methods differ in complexity and their application to specific cases. We envisage SROI being used at different scales within healthcare infrastructure planning; ranging from levels of decision making (approval, decisions, consultation, information) to levels of planning (feasibility and outline business case development / decision-to-design, Full business case / decision to construct , building design (RIBA C, D, E, F), construction, operation, refurbishment / modification); and for different healthcare settings (Acute hospitals, community hospitals, emergency departments, walk in centres, polyclinics, regional reconfigurations, GP practices). The following equation is based on the research undertaken by the Roberts Enterprise Development Fund (The Roberts Enterprise Development Fund, 2001).
SROI can be used to ‘forecast’ social value generated if activities/service reconfigurations meet their intended outcomes and can be very beneficial at the planning stage to ensure investment can maximise its impact. SROI can be evaluative to be ‘retrospective’, based on actual outcomes of the project.