Performance Improvement in the Public Sector
Medway NHS Foundation Trust is a large organisation that had been experiencing performance challenges, leading to it being in and out of special measures in recent years.
The Trust decided to take decisive action, through a performance programme called Patient First – and appointed KPMG as its implementation and delivery partner.
Since 2022, a team from KPMG has been leveraging the firm’s established expertise in NHS transformation to help bring about remarkable change. This has involved creating clear ‘Breakthrough Objectives’ with sharp alignment and focus in the Trust’s strategy and how it is cascaded to frontline teams. It has been also about hearts and minds, supporting and enabling change rather than directing it. This means instilling a sense of purpose, motivation and energy at every level through the organisation – a ‘Board to ward’ strategy.
Throughout, the KPMG team has paid significant attention to strong programme management complimented with coaching and support at all levels, and this started with the leadership team.
KPMG worked with the executive team around the leadership behaviours that support improvement – concepts like how to lead with humility, how to use scientific thinking, how to work as a team. These principles also flow down to the middle and frontline layers. A sign of how well and pervasively these behaviours have been embedded in the Trust is that they are now reflected in recruitment criteria when advertising new positions – recognising how important it is to sustain the culture and values that have been created.
Then, working closely with staff at every relevant level and bringing deep technical skills to bear, KPMG has provided tools, techniques and a standardised approach to identifying and tracking improvement, giving staff clarity about what they need to do, every day. KPMG has supported them in analysing what the current problems are in target areas, using a data-led approach and root cause analysis. By focusing on the handful of top contributors to those problems, constantly tracking progress to unblock them, amazing leaps can be made. It is not unusual to see 40% gains in a matter of weeks. Staff at Medway have become highly enthused and developed an appetite to go further and achieve more. The innovative introduction of ‘Breaking the Cycle’ weeks, when a specific issue became the overriding centre of attention for change, further accelerated progress.
Results have improved across many key areas:
- Award-winning cardiac arrest calls approach, reducing them from five to just one a month
- Ambulance handovers improved to the best in the region
- 24% improvement in number of pre-noon discharges
- In-patient recommend rate of nearly 95%, increased from below 70% in July 2022
- Over £1 million of annual savings achieved through a review of medicines policy and procedures
With KPMG’s support, the Trust has made changes that are not quick fixes, but fundamental shifts at the heart of what they do – saving lives and driving real improvements on the ground.
View the KPMG profile in the MCA Members Directory.