King’s College Hospital: People‑Led Productivity Cuts Outpatient DNAs by 25%

How frontline-led action learning, psychological safety and practical tools from the Modern Productive Series helped King’s College Hospital deliver 3,000 more outpatient appointments a month without extra staff.  

The situation 

King’s College Hospital NHS Foundation Trust was struggling with one of its most persistent operational and equity challenges: high Did Not Attend (DNA) rates in outpatients. DNAs were wasting clinical time, delaying care, inflating waiting lists and creating unnecessary rebooking work for both patients and staff. In September 2024, KCH had the 8th highest DNA rate in England, sitting at the worst end of Quartile 4 in Model Hospital. The gap between the most and least deprived patients was particularly stark, signalling that services were not equally accessible. 

The solution 

On joining the Modern Productive Series, KCH identified DNAs as a people-led productivity challenge, not just a technical problem. Using the Connecting Conversations approach – a key element of the Modern Productive Series toolkit - surfaced that low morale and a steep power gradient between senior leaders and Band 6–8b staff were blocking improvement. The Trust responded by combining A3 problem-solving with a new Transformation Action Learning Set (TAL) approach aligned to the 12 attributes of productive leadership. 

• At macro level, KCH used A3 to define the Trust-wide DNA problem, using quantitative data and staff insight. 

• At meso level, they held collaborative conversations with general managers and Band 6–8b leaders to agree Care Group DNA ambitions and surface local frustrations. 

• At micro level, they launched Apprenticeship and Transformation Action Learning Sets, giving frontline leaders skills, protected time and psychological safety to test changes in their own services. 

  
  

This approach deliberately pushed agency and decision-making closer to the point of care, while senior leaders focused on removing obstacles and amplifying learning. 

“The power of the Modern Productive Series is it invites leaders to do something different, and it invites frontline teams to have a sense of control – those two things together are a superstar combination.”

- Barbara Cramond, Director of Transformation 

The impact 

Within 12 months to September 2025, KCH achieved a 25% reduction in DNA rate, from 11.3% to 8.5%, doubling the pace of improvement compared to the previous year. The Trust moved from being one of the worst performers nationally to “best in class” in South East London and from the 8th highest to the 33rd highest DNA rate in England. Reduced DNAs released capacity for around 3,000 more new outpatient attendances per month without extra staffing, supporting 100% delivery of the 2025/26 outpatient operational plan and a 4% productivity challenge. 

Implied productivity gains were significant: a 7% reduction in wasted slots and a 21% reduction in avoidable missed outpatient appointments across major specialties. Flow improved across pathways, contributing to a 16.4% increase in completed pathways (24,530 additional completions), a 15% reduction in the total waiting list, and record RTT performance with 80.3% of patients seen within 18 weeks for a first outpatient appointment. Staff reported higher morale, clearer roles, more confidence in tackling inequalities and a renewed sense of purpose linked to visible, local impact. 

“By supporting teams to gain ownership, reliable data and protected time to innovate we have observed increased participation in improvement activities, higher morale and enhanced confidence in addressing health inequalities.”

- Barbara Cramond, Director of Transformation 

What next – advice for others 

Start with people, not process: use connecting conversations to understand what really matters to staff and patients in relation to DNAs and access. 

Flatten the power gradient: create spaces where Band 6–8b leaders and frontline teams can speak openly, shape the problem statement and co-design solutions. 

Combine socio and technical: pair structured problem-solving (e.g. A3, data from Model Hospital) with action learning sets that build psychological safety, reflection and peer support. 

Protect time for improvement: make it explicit that testing changes is part of the day job, not an add‑on. 

Keep equity in view: track DNA improvements by deprivation and use freed-up admin time to reach digitally disadvantaged groups. 

For organisations earlier in their journey, a practical first step is to pilot a small Transformation Action Learning Set around one outpatient pathway with a high DNA rate, then spread what works. 

Find out more 

• Link to Connecting Conversations page.