Monklands Hospital A&E featured in ITV Wales News (Oct 2017)

How did a busy acute hospital in Scotland improve its A&E performance so dramatically?

See below


Dramatic improvement in outcomes for unscheduled care of the elderly in Sutton Coldfield.

A team of GPs and community nurses applied the 6M Design® framework, with guidance of an experienced systems engineer, to design and deliver significant and sustained improvements in the delivery of unscheduled care in their 70+ year olds.

Download the two-page pdf summary HERE


Dramatic improvements in delivery of cancer care in South Wales.

The team of trainee HCSEs applied the 6M Design® framework to diagnose, design and deliver significant and sustained improvements in the delivery of chemotherapy.

Download the two-page pdf summary HERE


System Flow Model highlighted in Health Foundation Report (Dec 2016)

See below

6M Design®

6M Design® is a generic framework for achieving objectives by bypassing obstacles.

There are three phases: Study, Plan and Do.

About half the effort is invested in the Study phase; about a third in the Plan phase; and rest in the Do phase.

6M Design

Health Care Systems Engineering

Systems Engineering (SE) is a generic framework for specifying, designing, building, verfying and delivering systems with many interdependent parts that work in synergy to achieve and intended purpose.

SE has its roots in aerospace, and has evolved over five decades into a robust and proven approach.

SE has fit-for-purpose design as its primary objective.

SE applied in human systems is called complex adaptive systems engineering (CASE).

CASE applied in health care is called Health Care Systems Engineering (HCSE).

Whole System Simulations

A system is a set of inter-dependent parts together with the set of relationships between the parts.

This characteristic of a complex adaptive system (CAS) gives us a headache because our brains have not evolved to solve this sort of problem using either intuition or logic.

So the tool we need is one that can reliably represent the complex behaviour of a complicated system of processes - a whole system model.

And to be useful a whole system model does not need to be too detailed or too perfect - good enough is OK.

The Health Care System Flow Game

This is a whole system simulation that is presented as a fun, informative and interactive game.

To succeed a player needs to achieve a defined objective: 20% improvement in productivity and 0% increase in mortality!

It is possible - but only by developing a deep understanding of how complex adaptive systems behave.

Here is a short video that demonstrates the "butterflies-wing" effect, "catastrophic transitions", "hysteresis" and the effective, but expensive and unnecessary, strategy of throwing money and space-capacity at a queue.

The treatment of congestive heart failure is not a bigger pair of legs! The treatment of congestive hospital failure is not a bigger base of beds.

To arrange an interactive demonstration of the Save The NHS Game click here

To watch the excellent King's Fund animated description the NHS unscheduled care system click here

To read Dr Kate Silvester's letter The Christmas Crisis Yet Again click here

To read the Health Foundation Report The Challenge and Potential of Whole System Flow click here

Case Study

In February 2014, NHS Lanarkshire commissioned two health care system engineers (HCSEs) to train and coach a small team in a Lanarkshire hospital. The problem was an A&E 4-hour performance that was well below the required level, and was deteriorating. The objective for the microsystem design team was to learn how to diagnose the root causes of the low performance, and then to design and deliver an improved alternative. Their purpose was a significant and sustained reduction in A&E waiting time for all patients.

The system behaviour chart (SBC) shows the impact of using the HCSE framework and 6M Design® methodology - a significant and sustained improvement in the A&E 4-hour performance.

On 26th October 2017, ITV Wales News featured doctor Andrew Russell and manager Andrea Fyfe describing how they did it using external support to guide the improvement programme.

The HCSE trainers/coaches stepped back in August 2014, as planned, so the measured improvement is wholly the result of the diagnosis, decisions and actions of the Monklands microsystem design team. They owned it, understood it and were able to change it and maintain it.

Health Care Systems Engineering / 6M Design® Deployment

The starting point is often tension between Governance, Operations, Quality and Finance.

Governance is focused on Safety; Operations is focused on Flow; Quality is focused on patient and staff experiences; and Finance is focused on Productivity. There appears to be little common ground or common language and the result can be frustration for everyone.

The first step is build 6M Design® awareness and capability in each function in parallel.

Governance develop Safety-by-Design capability; operations develop Flow-by-Design capability; front-line services develop Quality-by-Design capability; and finance develop Productivity-by-Design capability. These four design capabilities are synergistic.

The next step is to reconnect the functions using their 6M Design® capabilities as a common language.

Then use this common ground to build confidence and trust, step-by-step, through microsystem design teams collaborating to dissolve step, stage, stream and system improvement challenges.

The outcome is an embedded Engine of Excellence that synergizes the contribution of every person and every process.

A proven path to delivering improved safety, calmer and more efficient flow, a higher quality experience for all, and a more productive and affordable health care system.

More Information ...

Browse the growing library of 6M Design® case studies at the Journal of Improvement Science

Explore how to develop individual, team and organisational capability in health care system improvement-by-design here.