Publishing Thursday 29 October 2026

Build. Transform. Last.

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Build. Transform. Last. is out now.

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EFRM Consulting — Build. Transform. Last.

EFRM Consulting Ltd

Healthcare services that are built
to succeed, sustain and be capable of scale.

The home of the Build. Transform. Last. philosophy — and the practical tools, thinking and expertise to help healthcare organisations put it into practice.

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The question at the heart of everything: How can we design, deliver and evaluate healthcare services so they are more likely to succeed, sustain beneficial outcomes and be capable of scale?

What we do

Start with the book. Foundation follows in January.

Reading introduces the philosophy. Foundation demonstrates understanding. Practitioner demonstrates application.

Read the Book

Build. Transform. Last. sets out the full philosophy, eight principles and practical tools for healthcare service design and delivery. Available now in paperback, hardback and ebook.

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BTL Qualifications

BTL Foundation launches January 2027 — a formal credential for healthcare professionals who want to demonstrate their understanding of the philosophy, with Practitioner as the progression pathway.

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Work With Ruth

Consulting, advisory and speaking engagements for organisations ready to build services that last. Grounded in three decades of practice across the full arc of healthcare service design.

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Apply the EFRM™

The Evidence Future Ready Model is the organisational capability lens behind BTL — for the senior leader thinking beyond individual practice.

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The philosophy

Build. Transform. Last.

A practical philosophy organised around three interconnected stages and eight principles — addressing the full arc of a service, from first understanding the problem to sustainability and scale.

Build Understand the problem, map the pathway, establish strong foundations
Transform Design and deliver with ownership, humility and continuous learning
Last Secure the future through evidence, credibility and the ability to scale

BTL does not replace project management, implementation science, quality improvement or service design. It operates upstream of all of them — shaping the thinking that precedes method selection. Read more about the philosophy →

Build. Transform. Last. — book cover

Out now · Paperback, hardback and ebook

Build. Transform. Last.
The Book

The full BTL philosophy in print. Written for the practitioner in the room — the person who has to make things work, not just present about them. Direct, evidence-informed, and grounded in thirty years of real healthcare practice.

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Available now in paperback, hardback and ebook.

About Ruth

Dr E F Ruth Miller PhD

Pharmacist, researcher, educator and healthcare service design leader with more than three decades of experience. Creator of the BTL philosophy and the Evidence Future Ready Model.

Multi-award winner across national and international healthcare. Published researcher. Keynote speaker. The thinking behind EFRM Consulting was shaped across wards, clinics, commissioning rooms and regional policy — and from the hard-won understanding that good intentions are never enough on their own.

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2016 HSJ Award
Winner
2025 HSJ Award
Winner

Ready to build something that lasts?

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