In a nonprofit or public-sector case, the objective may be better access, improved learning, fewer missed appointments or a safer community. Revenue and cost still matter, but they do not define success on their own.
Start with the change the organisation is trying to achieve, for whom and by when. Then trace what has to happen for people to receive that benefit. This gives the case a clear structure without forcing it into a commercial market-entry template.
I would listen especially closely to the difference between activity and results. Running more sessions can be useful, but the recommendation must explain how those sessions improve the outcome.
Turn the mission into a decision
Suppose a district immunisation programme wants to improve completion of the visits specified in its programme. The case tells you that many families attend the first visit but miss the follow-up.
Clarify the eligible group, the completion window, the current rate and the target. Confirm whether the decision concerns funding additional access support, redesigning delivery or choosing where to focus an existing team.
For this exercise, assume a fully observed cohort of 2,000 eligible children and an objective of increasing programme completion from 60% to 80%. That means moving from 1,200 to 1,600 completions, a gap of 400.
Completion is the service measure supplied by the case. It should not be presented as a direct calculation of illnesses prevented. The causal link to the wider health outcome requires separate evidence; here the decision is how to improve access to and completion of the existing programme.
Define the population, place and intended result. Those boundaries determine which improvements count towards the public-service objective.
Trace the beneficiary's journey
For this programme, the journey includes knowing about the service, being able to attend, completing the first visit and returning for the required follow-up.
Find where the largest meaningful gap occurs. Then ask what causes it. A lack of information, inconvenient hours, transport costs, service cancellations and an unsatisfactory previous experience call for different responses.
Investigate practical access barriers before interpreting missed visits as a lack of motivation. Find out what people experience when they try to use the service.
In an interview, turn that into a targeted request: “Can we compare first-visit and follow-up completion by district, then look at the reasons families give for missing the second visit?” That is more useful than asking for every stakeholder's view before locating the problem.
Use the denominator that answers the question
Assume the cohort is split evenly between an urban and a remote district:
| District | Eligible children | First visit completed | Full programme completed |
|---|---|---|---|
| Urban | 1,000 | 900 | 800 |
| Remote | 1,000 | 900 | 400 |
| Total | 2,000 | 1,800 | 1,200 |
Both districts have 90% first-visit uptake. Full completion is 80% in the urban district and 40% in the remote district. The overall programme reaches 60% of the eligible cohort.
Among those who started, completion is about 89% urban and 44% remote. Across both districts, 1,200 of 1,800 starters complete, or about 67%.
These are all valid calculations, but they answer different questions. Reporting 67% as population coverage would omit the 200 children who never attended the first visit. The table directs attention to the remote follow-up gap without losing sight of those initial non-attenders.
Quick Case Math Drill
A council funds a jobs programme for long-term unemployed residents. Its goal is lasting work: still employed six months after starting a job.
- Annual programme cost
- £240,000
| Programme stage | Residents |
|---|---|
| Enrolled | 800 |
| Started a job | 400 |
| In work six months later | 300 |
What did the programme cost per outcome the council is funding?
Match the intervention to the barrier
Suppose interviews and service records indicate that remote families face an expensive journey for the follow-up and that some scheduled sessions are cancelled. Many already know when they are expected to return.
More advertising would not address the main barrier in that finding. Compare options such as transport support, more accessible service locations or a more reliable schedule, with reminders playing a supporting role where forgetting is also a problem.
Check the programme's ability to deliver the proposed change. Extra demand is not helpful if staffing or supplies are unavailable when families arrive. The operations framework can help trace those administrative constraints.
Engage the people affected in testing the explanation. A convenient time for the delivery team may be incompatible with caregivers' work or travel. Their experience is evidence about how the service functions, not simply a communications task after the design is finished.
Compare additional completions at a realistic cost
Suppose the case estimates that reminders would cost £20,000 and generate 100 additional completions. Transport and access support would cost £60,000 and generate 300. Each is initially estimated at £200 per additional completion.
If some of the same families benefit from both, the combination might generate 350 additional completions rather than 400. At £80,000, that is about £229 per additional completion.
The combined plan would take completion to 1,550 out of 2,000, or 77.5%. It improves the programme but falls 50 completions short of the 80% target.
State that gap. Do not present two individually attractive proposals as a complete solution before checking their overlap and combined effect.
Compare those outcomes with what would happen under the existing service. Some families may complete later without the new support. The Green Book's appraisal principles distinguish additional outcomes from those that would occur anyway. In a case, make the baseline explicit before calculating cost per additional result.
Keep access obligations beside the average
An intervention that reaches easy-to-serve families cheaply may leave the largest access gap unchanged. If the programme has an obligation to serve remote communities, that belongs in the decision criteria from the start.
Show who benefits and who remains excluded. Compare outcomes by district and relevant access needs, rather than relying only on the improved average. Explain the trade-off if one option costs more per completion but reaches people no other proposal serves.
You do not need to pretend that every social objective can be reduced to a single monetary score. Present the quantitative comparison, the access requirement and the judgment the decision-maker must make.
Quick Business Judgment Drill
A health board is splitting next year's dental budget. Islanders have no local clinic, and the board must legally serve them.
- Budget
- £100,000
- Island minimum
- 300 check-ups a year
| Option | Cost per check-up | Reaches |
|---|---|---|
| Town evening sessions | £50 | Town residents |
| Mobile boat clinic | £200 | Islanders |
Which budget allocation should the health board recommend this year?
Make delivery and learning part of the recommendation
For this case, prioritise a targeted response to the remote follow-up barrier, confirm delivery capacity and test the assumptions behind the additional completions. Keep an explicit plan for the initial non-attenders and the remaining gap to target.
Track whether the intervention was delivered as intended as well as whether completion improved. A transport programme that never operated reliably has not tested the underlying proposition fairly. A reliably delivered programme that does not change attendance calls for a different diagnosis.
Set a review point, identify who owns the decision and establish the recurring funding required. A grant that funds a temporary access service may leave the same barrier in place when it ends.
For a different public-service setting, try University Enrollment Decline. Define the university's outcome and constraints before choosing a fix. When several interventions compete for the same budget, continue with the resource-allocation framework.
Structure drill
Would your case structure convince an MBB interviewer?
University Enrollment Decline
Apply the service-funnel logic to university enrolment. This drill weighs academic quality and net tuition, so define its outcome before choosing a fix. Present your approach to Casey, Case Room’s AI interviewer, then review feedback on your structure and starting point.
Frequently asked questions
Defining success and the decision
How is a nonprofit or public-sector case different from a commercial one?
Success is defined by an outcome, such as better access, improved learning or fewer missed appointments, rather than by profit. Revenue and cost still matter, but they do not define success on their own. Start with the change the organisation wants to achieve, for whom and by when, then trace what must happen for people to benefit.
What should I clarify before analysing a public programme?
Clarify the eligible group, the completion window, the current rate and the target. Then confirm what is actually being decided: funding additional access support, redesigning delivery or choosing where to focus an existing team. In the immunisation example, knowing that many families attend the first visit but miss the follow-up already narrows the problem.
How do I find where a programme is losing people?
Trace the beneficiary's journey step by step and look for the largest meaningful gap. For the immunisation programme, that means knowing about the service, being able to attend, completing the first visit and returning for the follow-up. Once you find the gap, ask what causes it before proposing any solution.
Diagnosing the problem with data
Which denominator should I use for completion rates?
Use the one that answers your question. Measured against eligible children, the urban district completes 800 of 1,000 and the remote district 400 of 1,000. Since both complete 900 first visits, measuring against first-visit completers shows the problem sits at the follow-up: the remote district loses 500 children after attending once, against 100 in the urban district.
Why shouldn't I assume families who miss visits simply don't prioritise them?
Because different causes call for different responses, and practical access barriers should be investigated first. A lack of information, inconvenient hours, transport costs, service cancellations and a poor previous experience all produce missed visits. Treating them as a question of families' intentions risks funding the wrong fix while the real obstacle stays in place.
Would an awareness or advertising campaign improve follow-up attendance?
Not if families already know when to return. In the example, interviews and service records show remote families face an expensive journey and some sessions are cancelled. Advertising would miss that barrier. Transport support, more accessible locations or a more reliable schedule fit the evidence better, with reminders playing a supporting role.
Choosing, costing and delivering interventions
How do I compare the cost-effectiveness of interventions?
Compare cost per additional completion, not total spend. Reminders cost £20,000 for 100 extra completions; transport and access support cost £60,000 for 300. Both initially work out at £200 per additional completion. The cheaper option overall is not automatically better value, and the larger option may reach more of the families the programme most needs.
Can I add up the impact of two interventions run together?
Not if they reach some of the same families. Separately, reminders and transport support add 100 and 300 completions, but combined they might generate 350 rather than 400. At £80,000, that is about £229 per additional completion, so the combined plan costs more per result than either option alone.
Should I always choose the option with the lowest cost per outcome?
No, if the programme has an obligation to serve hard-to-reach groups. A cheap intervention may reach easy-to-serve families and leave the largest access gap unchanged. Put access obligations in the decision criteria from the start, show who benefits and who remains excluded by district, and explain the trade-off if a fairer option costs more.
What should a public-sector recommendation include beyond the chosen option?
It should cover delivery and learning. In the example, prioritise a targeted response to the remote follow-up barrier, confirm delivery capacity and test the assumptions behind the projected additional completions. Also keep an explicit plan for families who never attended the first visit and for whatever gap to the target remains.
How would I know whether the intervention actually worked?
Track whether it was delivered as intended as well as whether completion improved. If completion stays flat, you need to know why. A transport programme that never operated reliably has not fairly tested the idea that transport support raises follow-up attendance, so judging it on outcomes alone could wrongly discard a sound approach.