Our approach
Mindset and cultural change is at the heart of any successful transformation and does not happen overnight.
  • Create an accurate baseline

    We invest time early on to develop an accurate realistic assessment of the organisation’s history, readiness, and capacity to change. We set a stretch target and we work hard to make it explicit - what it means for daily behaviour on the job.
  • Change management is a workstream in itself

    Change management is a transformation initiative in its own right, involving as much analysis, planning and implementation as the workstreams focused on the hard redesign of processes. It cannot be left to the occasional workshop or classroom-based session, but is fully integrated into our daily work.
  • Shifting the narrative

    We mobilise and motivate staff to embrace change. Through sharing success stories and continuous role modelling, we gradually shift the narrative and create a positive can-do attitude. We combine simultaneous challenge and support, providing a risk free environment for staff to test new ways of working proactively.
  • “Synchronous co-ordinated action”

    We take a one team approach, breaking down boundaries between different operational areas. In achieving “synchronous co-ordinated action”, we can deliver double or triple the efficiencies that can be delivered by each team alone.
  • Building capability

    Our team work alongside doctors, nurses, and operational staff to continuously transfer knowledge and build capabilities. We do this from start to end via a combination of joint working, “on the job” coaching and structured capability building sessions. Our goal is to equip our clients with the tools to continue delivering improvement long after we are gone.
  • We are the architects of the “one version of the truth” (OVT)

    A granular and accurate diagnostic is the first step towards a successful transformation. Having this OVT is crucial in creating a sense of urgency and aligning stakeholders on the root causes of poor performance. Our consultants first developed the Emergency Pathway OVT 8 years ago, and since then they have been continuously improving and refining it. Our diagnostic encompasses operational processes, team effectiveness, culture, governance, and organisational alignment, providing a comprehensive assessment across the entire system.
  • We have strong analytical expertise

    Our thorough understanding of healthcare data and of clinical operations has equipped us with the skills required to translate flawed datasets into intelligent insights. Healthcare data is far from perfect; any attempt to produce meaningful conclusions fails without proper adjustments. We have the expertise to work around the limitations of the data and generate analysis full of answers, rather than full of errors.
  • We keep our diagnostics “grounded in reality”

    We do not produce insights with analytics alone. We complement it with detailed on-the-ground observations, which in turn help guide and focus our analysis. We work closely with our client team to ground our analysis in the reality of clinical operations to avoid the pitfalls of misguided insights. It is the only way to develop “intelligent” diagnostics.
  • We focus on people

    Intelligent diagnostics do not just focus on numbers. They provide insights on people and culture. We spend time with the teams and engage in continuous discussions to understand how staff feel and think. The organisational mood is the underlying factor determining whether a transformation programme will succeed or not.
  • Listen to and empower

    Most of the time, parts of the solution already exist within the client organisation, in an incomplete form or in insolation. We actively encourage people to come forward and discuss with us what their thoughts are, what they have tried in the past, and their views on what needs to happen. We lead and facilitate workshops to develop the solutions together.
  • Focus the action and instil conviction

    These discussions typically result in a very long list of potential improvement initiatives. However, experience in transforming complex systems has taught us that less is more. Transformation programmes that involve a large number of initiatives, captured in endless “rag-rated” excels do not result in real change. They dilute focus, divert attention, and create the false perception that ‘we are doing everything we can’. We work with our clients to prioritise a few big initiatives which have the potential to instil conviction to act, and to shift performance.
  • Simple action plans & KPIs

    We develop clear action plans and agree owners, objectives, and KPIs for each of the initiatives. This provides all involved with a tangible operational target, creating the link between their daily actions and the desired outcome. Failing to make this explicit link between the overarching target and the detailed SOPs (what several people need to do daily), is the most frequent reason why transformation programmes fail; we combat this with clear connections from the start.
  • Set up for implementation

    For each of the initiatives, we set up a working group with clinical and operational leadership to own and direct the workstream. With these working groups, we refine and agree plans and milestones for delivery. We put significant amounts of energy into driving these conversations on a daily basis.
  • Involve the entire client organisation

    We embed our teams in the client organisations, working side by side with all levels from senior executives, to doctors, nurses, therapists, operational teams and admin staff. We believe for any transformation to take root in an organisation, everyone needs to live and breathe the change.
  • Hands on approach & working side by side, at all times

    What differentiates us is our “hands-on” approach towards transformation. We are on the ground, working alongside our clients 4-5 days a week. Because we know that often evenings and weekends are the most challenging times to deliver change in a hospital, we also work these shifts, on site with staff in site management, in the ED and on the wards.
  • Operational discipline

    Beyond embedding change, our objective is to create a culture of accountability and discipline. Each day, we review performance against operational KPIs to agree a set of immediate priorities and actions. We drive the agreed changes via continuous “process confirmation”, providing the challenge in real-time and holding the organisation to account.
  • Problem solving & progress reviews

    Every week, we review progress with the senior leadership team, identifying potential bottlenecks. We use both quantitative and qualitative data – our observations on the ground – to bring them closer to the detail, problem solve the obstacles that arise, and constantly tweak processes to improve efficiency.
  • Shared understanding and vision

    Real transformation and sustainable performance improvement requires involvement and support across care groups within the hospital, as well as with external local health and social partners. We invest in building a shared vision between these stakeholders, securing their buy-in to the programme.
  • Leadership led transformation

    We set up a transformation leadership group typically consisting of the executive and senior clinical leaders for each area. This group meets once a week to provide input, take decisions and steer the programme, keeping everyone moving in the same direction.
  • Alignment of executives and influencers

    For any heath organisation or system to transform culture and change behaviour, there needs to be clear and unanimous leadership by the important influencers across all teams, not just the senior executives. Throughout our transformation programme, we work with these influencers to stop and neutralise any difference in narrative. We focus on getting the influencers and the executives on the same page from day one.
  • Daily workstream engagement

    We engage workstream leaders and members in daily huddles to check-in and assess progress towards the week’s and day’s deliverables, and identify any potential problem areas for further actions, using insights from detailed operational walkthroughs and data analytics where necessary.
A strategy that cannot be implemented is not successful.

Strategy can only add value if it is realistic, can be translated into clear actions, and results in a conviction to act.
  • Top down vision

    We use a top-down approach to outline the vision and the asks for the strategy, pulling in leaders across care groups and operational teams.
  • True insight on the starting point

    Our strategy development then reviews the current care model, understanding patient needs, and identifies gaps in meeting demand. We combine this with our deep understanding of service provision in the main areas of care (Emergency, Elective, Cancer) to create an accurate baseline for the local context and provide informed, tailored solutions.
  • Bottom up approach

    We have seen centrally developed NHS policy fail in implementation because the analysis was not granular enough - it does not account for the realities of delivery. Learning from this, we combine a top-down vision with a bottom-up approach, creating a realistic approach to succeed.
  • Keeping it real

    Developing strategy fails when the basic assumptions aren’t supported by fact. For example, hundreds of strategy pieces in the NHS from 2008 – 2016 were based on the assumption that hospital activity would drop by 20 or 30%; the reality was an increase in activity of the same amount, making these strategies redundant. We are different because we have solid foundations in most areas of care in the last 10 years. We work with our clients on the ground to develop realistic assumptions about the efficiency improvement opportunities that we both believe in.
  • Have people and implementation in mind, right from the start

    Typically, long fancy strategy documents stay on the shelf. Not only because the analysis is unrealistic and the baseline inaccurate, but because they fail to communicate to staff why the change is important and what it will mean for them. We focus on the people – we communicate the implications of the strategy by clearly explaining the “from – to”, meaning that our strategy is never shelved in the first place.
We stretch our clients in terms of what is possible.

We focus on delivering a pragmatic vision, and a strategy which is grounded in reality and which comes with a “delivery roadmap”, owned and believed in by our clients.
Strategy is only as good as its actual execution.

We don’t stop once the strategy is defined and agreed but keep going to develop a detailed “delivery roadmap” for implementation.
  • Generating buy-in and consensus

    We generate buy-in to the vision and strategy from executive level down, working with multiple teams to plan for successful execution. We build trust among the organisation and beyond it to include stakeholders across the health and social care system to gain consensus and support for our roadmap.
  • Breaking it down and defining the detail

    We test the robustness of the strategy, assessing how each element can be realised, through a series of intense problem solving sessions with team leaders. This design process translates the strategy into action. The end product is a comprehensive view of what needs to be achieved from governance and mandate, to ways of working on the ground.
  • Translating vision into a clear roadmap

    Our end point is an implementable roadmap that is developed with and owned by our clients. We put together all agreed actions and changes, the respective timelines and owners, providing the detail on the what and the when – all of the tools that the client will require to keep moving forward.