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. 

The Achilles heel of Integrated care – ‘The space between’


Guest Blog Healthcare - Michael Shaw

Senior Systems Transformation Strategy Consultant

The NHS in England is a service striving to meet an ever growing, complex age and lifestyle related activity dependant population, a service built upon the hospital model, a model which hasn’t adapted to this changing demand. It is currently halfway through the most austere decade in its history, where funding has not kept pace with demand. The answer, according to the Department of Health and NHS England is the 5-year Forward View.

A plan that asks the NHS to look locally for answers; closer clinical and service integration between hospitals, community services and general practices, health and social care, and mental health. Health and social care budgets pooled and organisations expected to work together in place-based systems of care; to identify, design and deliver new models of care, using the resources currently available and to break down barriers between services and organisations for the benefit of the local population.  

It is those barriers and the space they create between organisations that could well be the Achilles heel in the delivery of such plans.

The current conversation quite rightly is about the money, but the journey has started; the money will be found (maybe not all of it), but it will be found. The problem is that money has very little to do with closing that space. The 5 years Forward View and the STP’s/ACO’s created to realise that plan are built on the foundations of collaboration between separate and in some instances opposing parts of the same system. Independent sovereign organisations, which like any entities within a system will do all they can to survive.

In listening to healthcare colleagues and reading the media you get a sense that collaboration is a given, it will just happen. Maybe that optimism stems from the public service ethos; that this is for the greater good. However, as a pragmatist, a system thinker, somebody who has worked in the public sector for the last 12 years; bringing together different parts of the same system (NHS) or different parts of different systems (NHS & Local authority) is I believe; complex, challenging and unless approached through the science of change; fraught will difficulty. I recently heard disturbing mutterings about ‘forcing’ organisations to collaborate (a bit of an oxymoron if ever I heard one)!

To achieve and sustain an operating model of integration between sovereign organisations, strong relationships; leader to leader, clinician to clinician and clinician to social worker is fundamental. A culture of collaboration, teamwork and transparency needs to be nurtured to overcome the inherent organisational and professional boundaries. Bottom up change as a result of pathway re-design, combined Capacity Management Centres and multi organisational frameworks for operating will begin to expose the differences between the top down design of each organisation and the bottom needs of the system. In working together, system leaders can co-produce and put into practice a series of overarching design principles, building blocks (both physical and more importantly psychological) which will begin to close the space between the organisations, while retaining their sovereignty

System Operating Principals

1.    Clarity (Purpose & Vision)

A shared purpose and vision of the combined system and a description of the outcome(s) required of the system and how it will add value to the patient.

2.    Strategy

A strategy that combines and aligns the objectives of all the partners/services/providers involved in delivering care to the population, this customer focused strategy should have short, medium and long-term objectives. The capacity and capability to define and align the strategy would be through a central system shared service planning function.

3.    Connectivity

 A supporting infrastructure to connect and cultivate relationships, to facilitate partnership working at all levels between all the organisations across the system.

 4.    Defined Way

A defined “way” of working that states the values of the collective partners; an alignment of values and behaviours frameworks so staff know what is expected of them in their day to day roles. This psychological co-created statement will influence and require alignment to the physical human resource systems across all system. (E.g. job descriptions, appraisal frameworks, the creation of HR shared services, etc.).

5.    Route Map

A tactical route map of delivery which phases the system component changes. System leadership, change capability, capacity and infrastructure needed to realise the plan.

6.    Leadership

  • A model of distributed leadership which permeates the whole system. For the system leaders, this involves developing and nurturing a style of leadership where;
  • All members of the system have a greater understanding of and continuous input into the development of the microsystems, mesosystems and the collective macro systems; strategy, values and goals.
  • A coaching and a facilitation model of behaviour to counter balance a pace setting style.
  • Performance facilitation is key; allowing individuals to operate within the boundaries of their defined framework or operating.  

7.    Alignment

An alignment of how the whole system approaches transformation and change. In-house disparate improvement capability and capacity needs to be brought together in a central shared service function. A right sized centre of expertise; resourced with System Engineers to support front line teams to design and redesign pathways, and microsystems.

Investing in the capability of all leaders and front-line staff in practical problem solving and quality improvement will mean that they are able and willing to identify the root cause of problems and with the support of the System Engineer will solve those problems as they arise.

Where differential organisation design models operate within the same system and especially between different systems; the flow of understanding and transference across organisational boundaries is often restricted and collaborative and partnership working can be difficult to achieve. A physical and more importantly psychological infrastructure, a system thinking and improvement science approach is needed, an approach that connects and cultivate strong relationships and facilitates collaborative working.

Click here to know more about system design and how to connect, integrate & operationalise your local system.

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