System Improvement

Understanding the inner workings of a man-made system involves Systems Thinking.

Improving how a man-made system works requires Systems Engineering.

Human systems have "hard" (processes) and "soft" (people) components.

A health care system is complex, synergistic combination of people and processes.

Systems Engineering

SE is a tried-and-tested framework for delivering fit-for-purpose systems.

SE has an international standard ISO/IEC 15288:2015.

ISO/IEC 15288 requires a domain-specific methodology to fill the framework.

Digital Twins

A DT is a virtual model of a the structure and function of system.

A DT is used to design the whole life-cycle of the system from concept to conclusion.

Creating a valid DT is a core systems engineering capability.

Sociotechnical Systems

All systems involving people are called sociotechnical systems.

Sociotechnical system design is part of systems engineering.

Sociotechnical system engineers require both social and technical skills.

Health Care Systems Engineering (HCSE)

HCSE is the application of systems engineering (SE) in the health care domain.

HCSE is a framework and methodology for improving safety, flow, quality and productivity.

HCSE is a synthesis of 'soft' and 'hard' improvement-by-design methods.

HCSE projects span all scales from microsystems to macrosystems.

HCSE uses the Agile® framework to deliver improvements in a defined time box.

6M Design®

6M Design® is an improvement-by-design methodology.

6M Design® was developed for health care.

6M Design® is a synthesis of existing methods and innovative techniques and tools.

6M Design® is learnable, applicable and teachable.

6M Design® works at all levels from one-step to whole-system.

6M Design® is HCSE-in-action.

Latest News

Load Levelling with Heijunka in Histopathology (Jul 2023)

Sharing workload evenly across available staff is both fairer and delivers a higher quality service and reduced waiting for patients with suspected cancer. This case study illustrates how a histopathology team redesigned their work scheduling using a simple heijunka board.

Click here to read ...

Improving diagnostics and CT Scanner Utilisation (Jul 2022)

Timely access to diagnostic services is an essential component of emergency, urgent, routine and surveillance pathways. Before investing in additional equipment and staff capacity it is necessary to ensure existing resources are well utilised. This case study illustrates how to do that in Radiology.

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Diagnosis, Design and Delivery in Accident and Emergency (Jan 2021)

Emergency departments must be able to deliver diagnosis and treatment with minimal waiting. This case study describes how health care systems engineering (HCSE) was used to develop a digital twin (DT) to assist with the diagnosis of the causes of queues and waits for the Triage step, and what happened when a designed intervention was validated using a one-day test of change (ODToC).

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Improving Flow in Ophthalmology (Sep 2020)

Ophthalmology is the busiest outpatient speciality in the NHS and has been hit hard by covid-19 restrictions. This podcast from the Royal College of Ophthalmologists shares how health care systems engineering (HCSE) is being applied to improving safety, flow and service quality in ophthalmology.

Click here to listen ...

Predicting COVID-19 Surge Demand (Mar 2020)

The covid-19 pandemic has caught healthcare unprepared. This case study illustrates how simple but effective demand surge prediction can be done using a spreadsheet and some health care systems engineering (HCSE) techniques and tools.

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Chaos-2-Calm in Chemotherapy (Sept 2019)

This ground-breaking case study describes how chaos was converted to calm in the Chemotherapy Day Unit at Singleton Hospital in Swansea. In one day and at no cost. Surprised?

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UHNM Hospital Awards (Jun 2019)

Emergency Department and Transformation teams at University Hospital North Midlands are recognised for their work.

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Royal College of Physicians - Future Healthcare Journal (Oct 2018)

This FHJ edition looks at systems engineering applied in health care and is packed with thought provoking articles.

Click here to read ...

“The fact that I was lucky enough to come across your programme is the only reason that I’m still working in the NHS today! You restored some sanity and purpose into my work life and for that I will always be extremely grateful. So thank you for everything, it’s been a real privilege to have been involved. CJ August 2018“

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 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

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, verifying and delivering systems with many interdependent parts that work in synergy to achieve an intended outcome.

SE has its roots in aerospace and has evolved over seven 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" or 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: for example 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.

For more informatin about the Save The NHS Game contact

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.