We believe there is now, more than ever, an opportunity to nurture a culture of improvement across the provider sector, building on the experiences and achievements of the last year.

Miriam Deakin    Nurturing a culture of improvement: how trust boards can embed organisation-wide improvement, NHS Providers (2021)

Establishing effective leadership for improvement


  • The challenge of complexity in healthcare (BMJ, 2001): a five-minute read outlining how healthcare is best considered a complex adaptive system and what this means for altering our understanding of how change happens.
  • Why healthcare leadership should embrace quality improvement (BMJ, 2020): a five-minute read which succinctly explains the changes in leadership mindset to make quality improvement a core tenet of how healthcare organisations are run, to ensure safe, high quality, and responsive services for patients, and the opportunities this provides.
  • How do hospital boards govern for quality improvement? A mixed method study of 15 organisations in England (BMJ Quality and Safety, 2017): although focused on hospitals, this ten-minute read offers useful insight into the characteristics of boards with a more mature approach to governing for improvement including: explicitly prioritising QI, balancing short-term (external) priorities with long-term (internal) investment in QI, using data for QI, not just quality assurance, engaging staff and patients in QI, and encouraging a culture of continuous improvement. These characteristics appeared to be particularly enabled and facilitated by board-level clinical leaders.
  • From super-hero to super-connector, changing the leadership culture in the NHS (Royal College of Physicians, Future Healthcare Journal, 2019): a five-minute thought leadership article that challenges us to reimagine the role of leader, making use of emotional intelligence and relational skills alongside technical skills to improve.
  • Transformational change in health and care – reports from the field (The King’s Fund, 2018): both a summary (seven-minute read) and longer report which brings together stories of transformational change drawing on the collective experiences and reflections of four sites that have been recognised as successful transformation initiatives, including lessons on the need for transformational leadership.
  • Michael West on compassionate and inclusive leadership (King’s Fund, 2019): a seven-minute video explaining the connections between compassionate and collective leadership, the impact this has on a team, their decision making ability and innovation, as well as outlining the key leadership behaviours.
  • Leadership for continuous improvement in healthcare during the time of COVID-19 (Clinical Radiology Online, 2020): a ten-minute read article focusing on lessons from Royal United Hospitals Bath NHS Foundation Trust radiology department but relevant to leaders generally.
  • Making the case for quality improvement – lessons for NHS boards and leaders (The Health Foundation and The King’s Fund, 2017): a 25-minute read outlining ten lessons for leaders, as a starting point for those seeking to embed quality improvement in their work.
  • Leading large-scale change – a practical guide (NHS England, Sustainable Improvement and Horizons teams, 2017): a more detailed read to help those involved in seeking to achieve transformational change in complex health and care environments.
  • The practice of system leadership – being comfortable with chaos (King’s Fund, 2015): this 80 page report draws on the experiences of 10 senior leaders to look in depth at the skills needed to be a system leader.


Creating governance arrangements and processes to identify quality issues that require investigation and improvement

  • CQC brief guide: assessing quality improvement in a healthcare providers (June 2020): a three-minute read briefing guide for inspection teams which provides insights into how judgements are made into the maturity level of a provider’s approach to quality improvement.
  • How do NHS hospital boards govern for improvement? (National Institute for Health Research, 2017): a mapping of characteristics of boards with higher levels of QI maturity, part of a wider study into how boards govern for QI. This two page findings summary also relates to QUASER, a research-based guide for senior hospital leaders to develop and implement QI strategies.
  • What every board member needs to know about improvement and quality assurance (Good Governance Institute and Perfect Ward, 2021): exploring the current, rare opportunity to recast quality governance within organisations afforded by the pandemic, this 40-minute read outlines some of the key concepts of quality assurance and improvement, key questions for board members, and best practice examples and tools to translate theory into practice. It also provides a maturity matrix to support organisations to self-assess whether they are appropriately applying the key principles.
  • Patient Safety Incident Response Framework – introductory version (NHS England and NHS Improvement, 2020): The PSIRF is a key part of the NHS Patient Safety Strategy published in July 2019. It supports the strategy’s aim to help the NHS to improve its understanding of safety by drawing insight from patient safety incidents. In testing phase currently, please note, the final version of the PSIRF and significantly updated associated tools are anticipated in Spring 2022. Until instructed to change to the PSIRF by NHS England and NHS Improvement, non-early adopter organisations must continue to use the existing Serious Incident Framework (2015).
  • Seven features of safety in maternity units (BMJ Quality and Safety, 2020): a 15-minute read outlining the findings of a study which aimed to characterise features of safety in maternity units, and to generate a plain language framework that could be used to guide learning and improvement.
  • Managing adverse events with Susanna Stanford and Sarah Seddon: a 30-minute film with a positive message about managing adverse events in healthcare. Drawing together the patient and clinician perspectives, they discuss how clinicians and other healthcare professionals can prepare for the inevitability of things going wrong, and how both patients and clinicians need the same things in the aftermath of adverse events.
  • A thematic analysis of the Healthcare Safety Investigation Branch’s first 22 national investigations (HSIB, 2021): this outlines the most commonly identified patient safety themes and recommendations for a systematic approach to managing safety nationally, which offers insight into areas of improvement useful at a local level.


Adopting a consistent, aligned and systematic approach to improving quality

  • The hard work of healthcare transformation (New England Journal of Medicine, 2016): by Dr Richard Bohmer, New Zealand-trained doctor and a management academic, this five-minute read outlines the importance of aligning frontline improvement with organisation-wide objectives, and how to support improvement work at senior levels.
  • How organisations contribute to improving the quality of healthcare (BMJ, 2019): a five-minute article bringing together research to explain why an organisation-wide approach is beneficial and the role of leaders.
  • How to move beyond quality improvement projects (BMJ, 2020, login required): a five-minute read which outlines the importance of using quality improvement alongside quality planning, quality assurance, and quality control to create a single, consistent management system that represents a holistic approach to managing quality.
  • A shared commitment to quality (National Quality Board, 2021): a five-minute read which provides a nationally-agreed definition of quality and a vision for how quality can be effectively delivered through ICSs, outlining responsibilities for all levels including providers. It also outlines the three core quality ‘functions’ of quality improvement, planning and control as described in the Juran Trilogy, a quality management model.
  • Quality improvement at times of crisis (BMJ, 2021): in this 10-minute read, Dr Amar Shah, chief quality officer at East London NHS Foundation Trust, and Penny Pereira, Q initiative director and others, outline the lessons from COVID-19 for improving healthcare.
  • Overcoming challenges to improving quality (The Health Foundation, 2012): an outline of the 10 key challenges to improving quality, identified through a review of 14 quality improvement evaluation programmes.
  • Quality management systems: building the conditions for effective change (Q, 2021): a 100-minute recording of a webinar on quality management systems hosted by the Q Community, exploring the link between QI, quality planning and quality control.