Our work in Healthcare is targeted at more effective planning and communications methods to the benefit of the patient. We use the exact same disciplines that we use when looking for opportunity in Business and Industry.

Better planning and improved communication translates as fewer cancellations and better use of fixed resource. Examples of the improvements and areas where we have delivered significant savings and performance improvement are as follows. This is not a definitive list and there are probably hundreds of opportunities that present differently in each location.

All Hospital departments would benefit from a review of the operation from time to time. Systems and processes become "stale" over time and an excellent indicator of where this has happened is where a department has come to rely on "individuals" who have become key members of staff. Of course, there are always exceptional individuals in every organisation and these are the same people who will maximise the benefit of a SYSTEM 21 Project programme. However, when "things stop happening" because somebody of off work ill, or on holiday, this is when the communication process has become dependant on individual input and has therefore become "personalised".

Another good example is the over use of "spreadsheets". No problem with spreadsheets, but when a department takes in data from another area, and progresses the information through their own spreadsheets, before it comes out at the other end, it really is time to look at the whole process to improve total operational efficiency.

Our Analysis review of Diagnostics is usually able to identify numerous potential improvements to processes, working practices, capacity planning issues and service delivery improvements. We then work out the potential savings possible from a short Project that would involve clinicians and staff in a jointly implemented change programme that will deliver the full potential..

SYSTEM 21 is able to transform the working of departments and organisations so they are better integrated and are more efficient communicators. The following is s list of benefits that illustrate what SYSTEM 21 can deliver in Diagnostic Services.


    Improved scheduling and planning
    Better ability to deal with ‘urgent cases’
    Reduced turnaround times
    Improved batch size processing
    Improved purchasing protocols and cost


    Improved machine utilisation
    Improved capacity planning
    Increased throughput of patients
    Improved maintenance - planned and preventive - leading to more available uptime
    Reduced ‘in-service’ downtime due to maintenance
    More efficient booking systems
    Reduced waiting list times
    Improved productivity of staff and therefore better demonstrated performance
    Improved patient care levels (reduced waiting and preparation time)
    Shorter reporting times and better KPIs


The Analysis team completed a study of Radiology equipment utilisation involving 10 units and over several weeks of data to average out peaks and troughs.  The resulting “net” utilisation was on average under 60% but with peaks well in excess of this figure. A revised scheduling method based on capacity planning around labour resources showed that the equipment utilisation could be improved by at least 30% on average, with some units able to deliver a 50% increase without any additional labour hours.

A secondary study on “communication of the results” of the Radiography function was able to demonstrate several breakdowns in the communication process to doctors, consultants and the patient.  The increase in utilisation of the equipment in the study was valued at over £2.5million per annum with a unit cost reduction per patient of 11%.

Our specialisation is the full implementation programme rather than just a “expensive report” on what to do.



The Diagnostic Imaging department had been identified as having a variety of problems. In particular, the new MRI scanner had failed to generate the volumes on which the financial case for purchasing the machine were based. The manager of the department felt that “the department was beyond her control” which resulted in her asking for assistance in the form of additional staff. The Chief Executive deferred the decision on additional staff until an analysis of the area was completed. 

The analysis showed a wide variation in the service levels in the department, the process of transferring patients to and from the area was chaotic and the patient waiting times could be anything up to 2 hours for scheduled appointments. As a result of their inability to schedule appointments effectively, radiographers were having to work long hours which resulted in poor morale and escalating overtime payments. (Population 39)

Objectives (12 calendar weeks)

      To achieve the MRI volume targets as projected during the analysis.

      To support the existing manager through training and counselling.

      To achieve a significant attitude and behaviour change in the radiography staff.

      To schedule appointments effectively and install a system of monitoring the department’s performance against Patient Service Level Indicators.

MRI Department

The department had recently installed the most advanced machine in the country but was operating at 70% of the potential volume outlined in the original financial forecasts. The inefficiencies in the patients handling process resulted in unacceptable waiting times, during the analysis stage 30% of scheduled appointments were more than 30 minutes late. Many patients had to wait for over 2 hours. There were also problems in high risk areas such as paediatrics where specially trained anaesthetists were required and the screening of patients prior to scanning was haphazard. The reporting of scans was slow, with a 2-3 days turnaround period compared with same day reporting of results at a local private hospital. Most of the problems in area were attributed to the radiography staff.

Our approach was to closely analyse the patient handling process, the key to solving the problems was in the communication between the clerical team responsible for scheduling appointments and the radiographers. This process analysis demonstrated that the underlying problems rested with the clerical staff not the radiographers as had previously been thought.

MRI scans were categorised according to the type of machine set-up required, appropriate appointment times were allocated to each type of scan and a colour coded booking system was devised which specified the times each scan could be booked. By booking like with like and specifying when complex cases could be carried out, more scans could be booked each week and the volume targets were exceeded during the course of the project.

Strict guidelines on the screening of patients were introduced and the clerical staff were trained in the correct screening procedures. Specific categories of patients i.e. inpatients, HIV, MRSA and emergency cases were given specific timeslots and communication with the wards re patient transfers was improved.

Measurable performance indicators were introduced to enable the Chief Executive and the Chief Radiographer to monitor patient waiting times, MRI scan volumes and patient categories on a weekly basis.  A report on the reasons why patients were delayed was produced which allowed the Chief Radiographer to eliminate the reasons why delays occurred. This satisfied the Chief Executive’s need for management information and gave the Chief Radiographer the tools to manage the department more effectively.

General Appointments

A colour coded booking system and booking protocol was devised for all areas of the department based on the appropriate time for each procedure and patient type. A reporting system was installed to record patient service levels, patient type and procedure volumes.

During the course of the project it was noted that the staff/floor area ratio of the administration area was breaking current Health & Safety legislation. This would invalidate any insurance claims made in respect of employees injured at work and expose the hospital to financial risk and bad publicity should a claim arise. The floor area was increased during the course of the project to comply with current legislation.

The Chief Radiographer was coached to enable her to reduce the abuse of the scheduling system which had been a feature of the department e.g. doctors sending patients with incomplete clinical information or at short notice.

Project Results

  1. As a result of the programme the MRI scanner began exceeding the volume targets originally set.
  2. The demand for MRI scans increased due to an improvement in the turnaround times of reports:  80% were reported on the same day compared with an initial turnaround time of 2-3 days.
  3. By categorising patient types they were able to run a Saturday list for medical legal cases where payments have been made in advance, and therefore accounts staff are not required.
  4. The consultants recognised their impact on patient delays and have scheduled their times to better suit the department
  5. Training in key areas such as the MRI scan has been extended.
  6. Patient delays have been greatly reduced e.g. the MRI delays were reduced from 30% of patients to 7% during the course of the project.
  7. The Chief Radiographer has the skills and confidence to manage the department and introduce change.
  8. The Chief Executive has confidence in the Chief Radiographer’s managerial ability and substantial revenue improvements.




The hospital, (with 5 operating theatres and 3 Cath labs), was performing poorly with respect to reference costs being well above national average.  management explained their feeling that there was a lack of accurate management information available to the Directorate on a weekly / monthly basis regarding the operational performance of theatres and cath labs, therefore the Directorate were unable to evaluate where and how improvements could be made to proactively improve the reference costs.

Study Findings

Following a three week study, working with the local management team we identified a number of areas which if addressed would substantially improve reference costs.

Key Findings of study


Theatre utilisation during study (observations) and over a 9 month period (statistical analysis) was in the region of 67% - 77%., although the reported utilisation was 95%. ( Only measured from "knife to skin, into recovery") The level of nursing support varied per theatre patient hour from, 3 nurses per patient hour, to 9 nurses per theatre patient hour, therefore delivering an inconsistent service to both surgeon and patient.  This also highlighted poor resource planning. 

Cath Labs:

Cath Lab utilisation during the study (observations) and over a 9 month period (statistical analysis) was in the region of 59%.  Albeit that the labs had the look and feel of a busy area there was a lot of downtime during patient turnover and this combined with poor patient pre-op preparation led to a frustrated staff and many patient cancellations

Project Objectives and Elements (16 calendar weeks)

  • Theatres
    • To design and implement a Bookable Theatre Schedule (BTS) around individual surgeon requirements

      To design and implement support services resource roster (nursing, ODP, perfusionists, portering, Anaesthetists) to support the new BTS

      To design and implement a management information system and reporting structure that delivered timely and accurate information to the Directorate on a weekly basis.

      To reduce the support pay costs by 20%

      To improve theatre utilisation to 80%.

      Increase activity by 5%.

  • Cath Labs
    • To design and implement a planning system to support individual cardiologists

      To design and implement support services resource roster (nursing, radiographers, technicians, porters) to support the new BTS

      To design and implement a management information system and reporting structure that delivered timely and accurate information to the Directorate on a weekly basis.

      To reduce late starts

      To improve utilisation to 85%.

Project Results - Theatres

In consultation with the surgical team, the scheduled theatre time was reduced by 18%.  This was achieved by designing individual BTS’s per surgeon and developing and implementing a surgeon specific planning tool with the consultants’ secretaries and the scheduling department.  The net effect of this reduction was a pro-rata saving on support pay costs.  A management information system was also introduced which now provides accurate timely information on all operational indicators for the directorate weekly meeting.  Theatre utilisation has increased by 15% to 90%, but measured accurately. (not as "knife to skin" / into recovery)

Results - Cath Labs

A weekly multidisciplinary team meeting was introduced.  Chaired by a cardiologist this team has used the management information system developed and implemented during the programme to address issues such as late starts, pre- op preparation, patient flow and resourcing.  The database planning system introduced provides the team with planned session by session utilisation and allows this team to proactively drive the lab utilisation on a session by session basis.  The net outcome has been an increase in Lab utilisation to 88%.

CONTACT US for more information or email to info@system21.co.uk


SYSTEM 21 is a registered Trade Mark

SYSTEM 21 is ISO 9001 Accredited (British Standards Institute)

All text and examples are copyright SYSTEM 21 and may not be copied or reproduced without prior written permission .

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

Contact Us

To contact us please fill out a general enquiry on the Contact page, phone or email or text as below.

Address: 270 Castle Street, Dudley DY1 1LQ, UK
Telephone: +44 (0) 1384 456 760
FAX: +44 (0) 1384 456 348
text: +44 (0) 7767 297 661