Transformation Services

SYSTEM 21 was founded 30 years ago and has considerable experience in subtle change management programmes involving large complex organisations full of people. We use lean management methods, capacity modelling techniques and in particular, full and careful engagement with the people in the organisation. This open approach is particularly successful in the NHS where the workforce is represented or is very cautious about change they regard as threatening to their future or to the care of their patients.

We see People as the most important part of a Project.

Engagement with staff is the only way to ensure the smooth implementation of a change in working methods, planning systems and processes, prior to proper Consultation with all staff involved, Trust management also share this vision as the most important element of delivering the strategic and cost saving objectives of the Trust, without upsetting its workforce.  SYSTEM 21's methodology can deliver all of these objectives without needing redundancies.

Our specialisation is the implementation of lean methodologies and improved operational efficiency in any organisation employing a lot of people and our past clients included Vodafone, Corus, British Airways, the Scottish Office, large Pharmaceutical companies and in recent years, the NHS Trusts.   Our methods involve engagement with members of staff at all levels in making sustained, recurring change that will generate performance benefits and deliver cost reduction in the form of real financial savings. We have delivered significant returns on investment in the NHS and our three most recent projects achieved annual recurring savings of £12.7m, £4.8m and £3.2m respectively, without any reduction, only improvement, in service delivery.

Our Transformation Services involve all of the following on most projects :

    Engagement with staff and management

    Integration of individual and group behaviour change

    Systems, process and procedure changes to improve service levels and the Patient Experience

    Revised structure and accountability - Organisation and Infrastructure

    Training in new managerial responsibilities and to promote Accountability

    Improved operational performance - measured improvements against agreed historic base levels

    Significant savings and revised departmental budget proposals, fully integrated with Finance Budgets

    Business and Operational Modelling to enable future trend analysis and cost allocation

    Increase in levels of customer service ( Patient Experience) without any reduction in front line service provision

    New Reporting Indicators linked with proper Accountability for performance, with KPIs

SYSTEM 21 provides :

    People resource, scalable to the appropriate size for the project

    The skills and experience

    Project management expertise

    Independent engagement with staff throughout the organisation

    Training of Champions and Trainers


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 SYSTEM21 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. 

No redundancies were required to generate these savings

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.


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SYSTEM 21 is a registered Trade Mark

SYSTEM 21 is ISO 9001 Accredited (British Standards Institute)

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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

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