Case Studies NHS, Industry, Retail, Transformation etc

SYSTEM 21 has hundreds of reference letter from projects over decades of work with clients all over the World. In this section we have published some case studies that illustrate our ability to deliver perfomance benefits and sustainable financial savings in a number of diverse organisations. Here we have included case studies from Business and Industry along with those from the NHS and Government departments, as examples of the behaviour change and unique success we are capable of in any environment that involves working with people.

The Case Studies are listed in no particular order and we will change them from time to time to provide examples of our work in a huge range of organisations and businesses. We suggest that you bookmark the site and check back for updates we will make with additional Case Studies that will be published here in the future.

CASE STUDY - COMMUNITY HEALTH - TRANSFORMATION and PRODUCTIVITY in COMMUNITY TRUSTS

Introduction: The Provider arm of a large Primary Care Trust aimed to set up a Care in the Community programme prior to separation from Commissioning.  They needed to demonstrate that they were providing high quality, value for money Services, along with an increase in Patient Facing Time as one of the objectives. The other objective was to simultaneously achieve bottom line cost savings & increase capacity in Community Health.

Project:  An 8 calendar month programme was agreed to cover all key Community Services activities.  Through better planning and measurement, they could clearly evidence the care that they provided in terms of quantity & quality. The scope Services were as follows :

  • District Nursing
  • Palliative Care
  • Health Visiting
  • School Nursing
  • Paediatric SALT / OT/ Physiotherapy
  • Adult SALT / OT / Physiotherapy
  • Podiatry
  • Dietetics
  • Diabetic Eye Screening

Deliverables :  SYSTEM 21 managed and facilitated the Project Implementation Teams (PITs) for each of the Services, consisting of a representative cross section of clinical staff in terms of both Banding & locality. SYSTEM 21 guided these teams to define their Service in terms of what they were set up to deliver and how. This included creating a Mission Statement that was rolled out to all staff, Core Service Capacity Planning Models (with Financial Measurement), Patient Pathway Planning with Care Timelines and describing the activities they perform in a way that could be reported as measured performance improvement in the Reporting System installed. 

Special care was taken to ensure the activities were defined in a manner that would not be open to interpretation when recording whilst providing meaningful Patient & Management Information.

Once these activities were agreed, the Band of staff required, Clinical Rationale, Evidence Base, Operational Standards, Planned Outcomes & Quality KPIs were added to complete the Service Description. This provided the Trust with a powerful model that could be applied to the current caseload to understand existing demand by clinician, team and Service. When applied to historical data it could be used to predict levels of new referrals (and corresponding demand) or analysed by experienced clinicians to establish if the Service was delivering the appropriate level of care to the expected standard.

The Capacity Planning and modelling system was designed so that it would provide “what if” planning capabilities, allowing the management team to adjust patient care profiles to see the projected impact on staff capacity and future requirements for different Band levels specialisation.  It was also possible to break down the model into demographic areas, providing the ability to determine an appropriate amount of Care, and the skills required, in each “micro” Community area.

After the project started it soon became apparent that variations in clinical practice, or indeed Services provided were far greater than realised by management. There was variation between localities (former PCTs) where processes had not been fully aligned but also between teams due to differences in GP expectation, capacity and perception. By applying the agreed Capacity Planning Model to each area, these variations were minimised.

In order to understand each Service’s capacity, SYSTEM 21 guided the PIT groups to analyse their working day in terms of value added & non value added activities. Clinicians then agreed the optimum proportion of their time that should be spent with patients (Face to Face Percentage) by Band for each service, allowing for the other value added activities that they perform.

We then installed a weekly review process for each Service, with its own Reporting System, to generate performance reports by individual, team & Service. Managers and Team Leaders were aligned to this process, with clear and agreed roles & responsibilities. This enabled the Trust to match capacity with demand, at once identifying spare capacity and creating a more equitable workload for staff & more equitable Service for Patients.

Benefits:  Agreed savings of £5.2 million across all Services based on identified spare capacity. Of these savings, £1.1 M was realised as bottom line savings in the first year whilst the remainder was reinvested to increase capacity in Community Care. This included the development of a Case Management Service from existing resources. Patient Facing Time was reported to have increased by over 11% due to the productivity improvement from using more robust planning and scheduling systems.

The net ROI was in excess of 3:1 on bottom line cash out savings and greater than 13:1 on agreed savings based on spare capacity being taken up as increased Service Delivery.

CASE STUDY - SIGNIFICANT SAVINGS DELIVERY IN ACUTE NHS FOUNDATION TRUST HOSPITAL

Introduction: A large Foundation Trust Hospital had identified savings in line with QIPP targets but was finding it difficult to translate these savings into real cost reduction.  Additionally the waiting times in A&E / ED department were still too long.  Elective Surgery was suffering from too many cancellations and it had also proved difficult to reduce length of stay due to a combination of factors such as late TTO provision, surgical planning and diagnostics. They also needed to demonstrate that they were providing high quality, value for money Services, along with an increase in operational performance relating to the Patient Experience.  The other objective was to simultaneously achieve bottom line cost savings without redundancies or any reduction in the provision of service quality.

Project:  A “modular” 12 calendar month programme was agreed to cover all Hospital Service activities. Each department had individual targets and a list of deliverables and was provided with an allocation of resource from SYSTEM 21 to manage the implementation programme. The scope breakdown was as follows :

  • Elective Surgery Planning
  • Theatre Utilisation
  • Length of Stay Reduction
  • Ward Capacity management and new staff rosters
  • Outpatient Clinic Capacity Planning and new staff rosters
  • Diagnostics, Capacity and productivity
  • Specialist Nursing
  • A&C including medical Secretaries
  • Facilities and Estates
  • Improved integration of all medical areas

Deliverables :  SYSTEM 21 managed and facilitated the Project Implementation Teams (PITs) for each of the Departments, consisting of a representative cross section of clinical staff in terms of both banding & departmental responsibility. SYSTEM 21 guided these teams to define their Service in terms of what they were set up to deliver and how. This included creating a Mission Statement that was rolled out to all staff, Core Service Capacity Planning Models (with Financial Measurement), Patient Pathway Planning with Care Timelines and describing the activities they perform in a way that could be reported as measured performance improvement in the Reporting System installed. 

Special care was taken to ensure the activities were defined in a manner that would not be open to interpretation when recording whilst providing meaningful Patient & Management Information.

Once these activities were agreed, the Band of staff required, Clinical Rationale, Evidence Base, Operational Standards, Planned Outcomes & Quality KPIs were added to complete the Service Description. This provided the Trust with a powerful model that could be applied to the current caseload to understand existing demand by clinician, team and Service. When applied to historical data it could be used to predict levels of new “profiles”  (and corresponding demand) or analysed by experienced clinicians to establish if the Service was delivering the appropriate level of care to the expected standard.

The Capacity Planning and modelling system (for each specific area) was designed so that it would provide “what if” planning capabilities, allowing the management team to adjust patient care profiles to see the projected impact on staff capacity and future requirements for different Band levels specialisation. For example, the planning models used real contractual data for surgical list planning and developed “templates” to enable like for like reporting of performance.

Detailed rosters and capacity planning methods were installed in all clinical departments and new staff roster patterns were agreed in wards, theatres and outpatient clinics and in A&E, where the waiting times were significantly reduced.  At that stage of the project, each department was able to see its measured performance against the optimised capacity plan, based on the data agreed in the early stages.  This enabled the management team to make finer adjustments to the roster patterns and to the capacity of services made available in each area, based on the typical variance against the agreed plan.

To consolidate this significant improvement in cost management, a weekly review process was installed using KPI (Key Performance Indicators).  This enabled the Trust to match capacity with demand, at once identifying spare capacity and creating a more equitable workload for staff & more equitable Service for Patients.

Benefits:  Agreed QIPP savings of £12.7 million across all Services based on identified and agreed cost reduction relative to planned capacity. Of these savings, £8.4 m was realised as bottom line savings in the first year whilst the remainder was planned against specific agreed actions that would take place during the rest of that financial year, using the capacity models.  The Trust was provided with a Three Year Budget Plan for savings of £40m over the full Three year Period of the projection, as all savings identified and agreed were fully recurring. 

The net ROI was in excess of 6:1 on bottom line cash out savings and greater than 20:1 on agreed savings over the full three year projection, without any redundancies.  In each area and using the capacity rata and KPI reporting, each area was able to properly demonstrate, with documented evidence, that they were providing top quality service to patients and excellent value for money.

CASE STUDY - REDUCING THE DEMAND FOR INCREASED RESOURCE COST

"Everything is always urgent". So said all the Engineers in a Maintenance Company

When we asked the engineers when would be the worst time for an "emergency" job they had no difficulty in telling us straight away.

"Certain evenings, Friday night and weekends, etc."

We got the diary out and blocked out all these times and then asked when the next most inconvenient times would be. They blocked these out too. We then suggested that any times in days "outside these times" would be good to do the "predictable" routine maintenance jobs. Well, yes, they all agreed.

This was trialled and the result was that the perceived "overload" of urgent jobs did not exist at all when the routine maintenance was scheduled outside the busiest, worst times to receive an urgent call. Up to then there had been a constant perception of "understaffing" in the department and that more maintenance staff were needed. At times the manager had been quite specific about which skills were lacking if the service level was not to suffer even more ! This "perception" disappeared after the rescheduling exercise and after a few weeks there appeared to be much more free time to do all the jobs required.

The backlog of maintenance jobs outstanding fell by 50% within weeks, boosted by praise from internal customers in various departments. Response time to urgent calls reduced dramatically because the team was by then waiting for calls, rather than out on other jobs. After 4 months planned maintenance was expanded with additions to the list to fill the appropriate slots and response times for urgent call became almost immediate with an increasing number of first visit fixes not requiring a second call.

That was all the simple part, explained here because it was so simple. Where SYSTEM 21 make the difference is in the approach with staff. Our methodology and specific explanation of the " objective" imparted to staff was the key to the success of the project. Initial suspicion that this exercise would lead to job losses was gradually dismantled and staff participated fully in the process.

Our role was as independent advisors to succeed with radical change despite the suspicion that all management wanted to do was "make people do more for less." This kind of suspicion threatens the success of many internal initiatives but the SYSTEM 21 methodology has been perfected over many years to empathise with staff concerns and deliver the results with their support.

SYSTEM 21 combines professionalism and independence in an unique methodology that has delivered 100 % success for our clients in very complex change programmes. We apply this skill differently and uniquely to each situation we encounter. Using our expertise enables our client to move forward with new and challenging ideas that we are able to implement in any area in any organisation

SYSTEM 21 provides an expertise that is rumoured to be unique.

CASE STUDY - BAKERY

Situation

Following the takeover of another Bakery operation, the two companies were to be integrated to deliver overhead savings as soon as possible after acquisition.  The SYSTEM 21 analysis identified the process and operational changes that would be required to deliver a full integration.

Our role

To plan and implement the appropriate integration of the two businesses and to set up new procedures and KPI’s to measure operational effectiveness. Also, to implement the restructure of any parts that were duplicated by the newly enlarged business and to determine the roles and accountability of the staff in the new structure that would be agreed.

Outcome

Full integration between the two companies was completed within the original timescale, including a consolidation of KPI reporting and Financial accounting as a single centralised function. Centralisation of administration overheads was also delivered on schedule and some of the workforce was relocated (8%) to achieve the overall merger.  Savings were significant at £2.23m.

 

CASE STUDY - FISH CANNING PLANT

Situation

A large product range had led to longer set ups and more stoppages in production. Every time the product changed there was a clean down and a reallocation of staff to different functions, whilst some staff were left waiting to start the next production run. Costs were spiralling in order to meet production targets. This UK business required integrated capacity planning systems to balance manufacturing cost against budgets and a rationalisation of some of its product range relative to volume and margin analysis.

Our role

To deliver significant cost reduction, without any loss of the workforce and to correct the imbalance that was causing massive cost over-runs.

Outcome

The SYSTEM 21 Project delivered significant savings in year one with a further improvement in production efficiency and workforce behaviour. Products that contributed low profitability relative to volume were redesigned in collaboration with the customers and longer runs were achieved through the combination of product batching and better planning techniques. Production was also “capacity balanced” to optimise labour resource, machine utilisation and raw materials yield. The savings were 20% above the original target at £1.2m

 

CASE STUDY - CHOCOLATE MANUFACTURER AND RETAILER

Situation

Major International confectionery producer where margins had been squeezed beyond acceptable limits. Production planning and scheduling was identified as the key to increasing profit and to prevent further margin erosion..

Our Role

To develop KPI’s and controls to increase weekly % production performance relative to % cost allocation. The SYSTEM 21 Project led to the development of detailed capacity planning and production scheduling that increased productivity by 20%. The capacity models were made significantly more effective as a result of improved statistically based forecasting techniques that were developed by SYSTEM 21 as part of the Project.

Outcome

There were huge increases in productivity and a reduction in labour cost relative to  booked value of goods produced. No redundancies were required to generate the higher than target savings level of £ 3.6m

 

CASE STUDY - TELECOM SUPPLY CHAIN

Working on behalf of one of the largest investment banks in the world, SYSTEM 21 was engaged to turn around a loss making global business in the telecoms industry with a 45% family share holding.  The Business Review identified FOUR times more profitability potential than the management team themselves projected and the resulting project achieved this target IN FULL with a delivered ratio of savings to fees in excess of 9 to 1.

CASE STUDY - RETAIL PRODUCTIVITY 1

In a retail group of leisure clubs and restaurants the labour cost was slashed by 18% relative to turnover, in addition to improved customer service and less customer waiting time at peak periods due to the optimisation model. The return on project fee was 13:1 in Year One

CASE STUDY - BANK REPOSSESSION TURNAROUND

A major investment bank engaged SYSTEM 21 to increase the market capital value of a well known Retail group prior to a trade sale. The value was increased by £ 300m in 10 months following a programme of cost reduction and profit restructure.

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Services Overview

Professional change management and transformation services, including full implementation of all recommendations. SYSTEM 21 has an enviable track record of 100% successsful projects.

  • - Profit improvement with full implementation
  • - Busioness diagnostics and transformation
  • - Change Project Management

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