Delivering whole system transformation using system thinking


Healthcare blog - Charlotte Southcott

Managing Consultant, Healthcare

As part of our healthcare blog series we are looking at systems thinking and its application in the NHS, the benefits of this approach to the NHS and how it should be implemented going forward. 

Transforming large scale complex care systems is a significant challenge and carries high risk throughout implementation; getting it wrong can ultimately impact the quality of patient care. To break the mould and deliver change in a significantly different way, organisations need to appoint system leaders who understand not only the history of the NHS and its complex landscape but also the opportunities this current transformation programme affords. These leaders need to be supported by robust structures, processes and behaviours developed by fearless and dedicated transformation teams.

In response to the Five Year Forward View and the significant financial and capacity pressures currently facing our NHS services, the sector supported the creation of 44 geographical areas each with its own Sustainable Transformation Plan (STP). More recently we have seen the introduction of 10 Integrated Care Systems (ICS) formed from the highest performing STPs in the country. 

The new ‘systems’ approach, rather than the traditional focus on process or pathway re-design, has required a significant shift in thinking for many NHS leaders. Borders, barriers and silos cannot exist in a harmonious system. We have the opportunity under the current plans to be bold and to think of our services and care as part of an integrated system. 

At this stage of the NHS journey, we aim not to answer what should change, but how to change. We believe that there are fundamental elements both physically and psychologically that are critical to enable the delivery and sustainability of large scale complex system change. It is therefore why we focus upon the how and not the why.

A new approach

For years now the NHS and social care services have faced unprecedented demand on services, staff shortages, underinvestment in funding and a shift in patient profiles. When faced with significant pressures such as these our traditional approaches will not work. Boundaries need to be broken down to allow for smooth transition across services allowing for more efficient and safer services. 

System thinking allows us to view the end-to-end process, understand where our workers are and the challenges they face. As leaders embark on the long journey to deliver integrated health and care systems, they need to be careful not to fall to the common assumptions that many hold about what is required to make change happen, which can result in the overlooking factors that can have a detrimental effect on success. 

By using this approach we are able to consider three fundamental elements to successful transformation: structure, processes and behaviours. When transforming services, it is essential we remember that when we make a change or move an element, it will have consequences on other elements of the system, whether we intend them to or not. We must design the future as a system and move our transformation into business as usual for it to be sustainable. Sustainable change will only be successful if we consider each of the three pillars in every step of our journey. 

To successfully implement newly developed strategies and agreed actions we believe an approach is needed that provides the capability to set and maintain the right direction to transform the system and more importantly the capability to place the leadership and delivery of change right at the heart of the system. 

A new approach - think bigger

So what could it look like? The delivery model will need to capture all of the critical elements of the programme and ensure nothing is left to chance or forgotten. We need a method or engine for change – a System Transformation Centre (STC). 

The STC creates one version of the truth and supports highly skilled delivery teams who encourage front line staff to deliver the change. There are a number of essential elements to be included in a STC including: 

- Communication: to engage and communicate with your stakeholders

- Analytics: to mine and analyse essential data informing decision making 

- Connecting and co-ordinating: to network and co-ordinate all workstreams and staff

- Learning: providing training and continuous learning in leadership and change management  

- Delivery: working across teams to successfully deliver and embed change

- Planning: providing business planning support and strategy alignment across business units 

- Governance: a portfolio management office ensuring the timely and correct decisions are made and recorded

Your transformation change team requires senior leadership, ownership and buy-in. In addition to this, support is needed throughout the system in a structured form to strengthen the capacity and capability of the leadership team. Fundamentally the structure must be consistent to ensure success. Strong leadership, supported by ‘disrupters’ and change agents, will create opportunities, enthusiasm for change and buy-in at all levels of your organisation. 

What next?

In summary, we believe to successfully transform the NHS and deliver system thinking change leaders need to continuously think about how to implement their strategy across organisations structure, processes and behaviours. 

To do this the right leadership needs to be in place and supported by a strong System Transformation Centre made up of the right elements. The STC will have the three pillars of structure, processes and behaviours central to all its decision making and implementation design. The NHS can no longer afford to concentrate on one of these aspects as each is essential to successful implementation and sustainable change. 

This blog has been a brief summary of our detailed ‘How to deliver sustainable transformation using systems thinking’ white paper, which you can download here.  

KM&T’s recent work in healthcare

We’ve been lucky enough to be involved in a number of different projects over the years in the healthcare sector, ranging from co-authoring ‘The Productives’ to getting our hands stuck into whole hospital transformation projects. More recently, The KM&T Healthcare team has been intimately involved in some key national projects. Some of our recent work includes: 

General Practice Improvement

The national rollout across England of the PGP Quick Start programme has produced some excellent results including releasing 189 hours of GP consultation time a year and saving on average £1,529.00 per year for General Practices. Our Quick Start team have covered the country North to South delivering in-practice sessions and leaving behind the tools to make the improvements sustainable. We feel really proud to be part of an NHS England initiative that really changes the lives of the public. One of the practices we worked with is in Wiltshire. The team here saved 210.5 hours (more than 26 full days) of nursing time and Practice Manager Charlotte says

“The experience has been great, working with mixed teams has been beneficial and we’ve tackled an issue that’s freed up lots of previously unused time for our nurses.”

You can read the full case study for the Tinkers Lane Surgery in Wiltshire here.

Also, watch the video of Charlotte talk about the Quick Start programme.


Expansion across the UK

KM&T is keen that other regions across the UK can benefit from the fast rapid improvement seen in General Practice. We’ve spent some time recently across the boarders in Scotland and Wales exhibiting at events and finding pilot sites to trial the initiative.

Health and Care whitepapers

Our CEO and strategy leader Michael Shaw have been at it again; they have released a third thought paper – How to deliver sustainable transformation using systems thinking. 

The paper can be downloaded here. 

Discussing how a systems thinking approach will help the NHS create accountable care organisations; this particular paper gives the reader clues on how to go about implementing STP’S and ACO’s. We’ll be launching the paper and giving more insight into the systems thinking approach in healthcare over the next few weeks at various exhibitions and roundtable events.

Hospital trust work 

Putting the ‘trust’ back into hospital trusts is what the KM&T Healthcare team does best. By sticking to our core principals of being a partner rather than a report writing consultant, we have forged long-lasting relationships with hospital teams around the world. Most recently we’ve stayed close to home and started working with hospitals in Birmingham and Manchester; removing waste, simplifying processes and building a culture that wants to sustain these improvements.

This is a small sample of what KM&T has been getting up to in healthcare recently and we’re very keen to see all of these develop. 

Gearing up for a productivity increase in manufacturing

Many companies have a go at making changes to their organisations and make attempts at implementing Lean methodology, but it doesn’t always work the first time. At KM&T we find the most successful companies are the ones who don’t quit if a transformation attempt fails - they persevere. Recently we worked with a UK manufacturer who had spent four years trying to implement a Lean production system but kept failing. 

Since the 1960’s this company has produced a vast array of gears in high volume for various European and Asian customers. They discovered a recent large investment in new machinery was failing to deliver the predicted overall equipment effectiveness (OEE) they had imagined and management found it difficult to monitor production through the current system. They had been trying to implement a Lean production system for a few years but hadn’t managed to implement anything sustainable. The various attempts at implementing new tools had decreased morale amongst employees and left a negative atmosphere toward any future attempt at change. 

They enlisted the help of KM&T to:

• Improve quality, cost and delivery

• Increase productivity and efficiency 

• Change the culture of the workforce 

• Create confidence in the successful implementation of Lean

Our initial observations of their company were:

• Nearly all deliveries were late and lead time had increased from 6 to 8 weeks

• Poor housekeeping and very poor reaction to breakdowns

• Operators had no clear priority list and no targets to achieve

• No work instructions were in place, so any absence led to machines being down and production stopping

• Well versed in Lean techniques but no practical experience of implementing the tools



Lean deployment: The actions KM&T made 

• Developed company strategy to achieve key objectives through policy deployments

• Reduced used floor space and improved the flow of products through the factory

• Tidied and organised work spaces to aid quicker and safer operations

• Visual status boards were introduced to show hourly production targets, work in progress and any issues which could have an impact on production

• T cards were set up so that roles were structured and key objectives achieved

• Lean overview training sessions provided to overcome misconceptions

• Problem and Countermeasure meetings were organised between work teams and support functions to address outstanding build and quality issues

The tools we implemented helped to improve the productivity of the manufacturer and improve the morale of their staff. We are always pleased to work with companies who approach transformation with an open-mind and are happy for us to dive right in and get involved. Feel free to get in touch with us if you want to learn more about the productivity improvement techniques we used. 

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