Calculating return on investment for the NHS Institute for Improvement and Innovation


OPM conducted evidence reviews that support economic modelling and return on investment calculations to support the Chief Nursing Officer’s national programme of eight high-impact actions (HIAs) by nurses and midwives that promote quality while reducing health care costs.

Nurses and midwives care passionately about improving the care they provide to their patients. Following a request from the Chief Nursing Officer, frontline staff submitted more than 600 examples of high-quality, cost-effective care that, if adopted across the NHS, would make a transformational difference and reduce costs. A large group of experienced nurses and midwives reviewed the submissions and identified eight high-impact actions. The Institute’s overarching aim was to articulate the case for behaviour change in accessible ways that were engaging and meaningful to frontline staff.

What we did

Some initial work had already been completed to understand the costs and benefits of the high-impact actions. OPM built on this, undertaking a detailed exploration of the evidence base and good practice linked to the eight high-impact actions (HIA) and to further model, quantify and monetise the potential impact if these actions were replicated throughout the NHS.

Our starting point was an economic and impact literature review for each high-impact action. We then undertook field visits to 16 case study sites (two per HIA) to gain a detailed understanding of the approach taken by clinicians, the stakeholders involved, the impact (costs and benefits), and the data available to evidence this impact before and after implementation. Drawing on the literature review and case studies, we modelled the economic benefits of nursing and midwifery actions for each case study which generated returns on investment dividends.


To maximise the impact of the work, and to allow the evidence to be made more user-friendly for planning and reviewing, we produced an online ‘opportunity estimator’ that allows NHS staff to estimate the costs and potential savings that can be made in relation to each HIA.

To support nurses and midwives to adopt and implement the high-impact actions locally, the Institute published the Essential Collection, comprising a range of materials which includes our literature review, detailed economic case studies, and online opportunity estimator. Findings from our work were reported in the Health Service Journal and eight consecutive issues of Nursing Times. NHS staff also reported that our work helped them make better decisions around resourcing quality care.