The strategic case for improvement

The NHS faces an almost unprecedented array of challenges, but extra capital investment and the promised extra staff in key professions alone will not be enough to deliver the breadth and depth of change needed. 

Improvement approaches and methods are part of the solution to address the many delivery and transformation challenges health care faces.

The briefing will help organisational, system and national leaders navigate the complex landscape of improvement activity. It describes the broad types of improvement approaches seen in NHS systems today, the limitations of the current improvement landscape and what needs to happen to achieve effective large-scale deployment. 

• Improvement approaches, often with impressive results, have been in common use in some health care settings for more than 20 years.
• Yet improvement is far from being embedded into the core strategy and operations of every health care organisation or system-wide partnership of organisations. The briefing examines why this is still the case. It argues that embedding improvement approaches across all health care settings is now vital, and describes what needs to happen to shift improvement from the margins to the mainstream of health care.
• Improvement approaches will be essential to tackling the biggest delivery and transformation challenges that health care faces. These include the need to make greater use of technology and tackle waiting times and winter pressures. They provide a systematic, collaborative and inclusive approach capable of delivering sustained improvement at scale.

• Create consensus about the role of improvement in driving sustained change across health care. While policy commitments, for example through NHS Impact [ref] NHS England. NHS IMPACT (Improving Patient Care Together). [/​ref] in England, is an important foundation, the consensus needed relies on broad ownership and therefore deep engagement at local, regional and national level.
• Recognise and encourage the mediating role of local leaders. Unlock the potential of improvement by ensuring that local leaders have the opportunity to strengthen and deploy their strategic and political skills and build their experience of overseeing diverse improvement portfolios.
• Create an improvement-centred vision for the NHS and other care services. Improvement needs to be an integral part of every major national, system and organisation-level initiative that has a bearing on health care performance.
• Build improvement ecosystems. Connecting, supporting and empowering people to use improvement approaches and methods. 
• Ensure that improvement is properly resourced. High-performing improvement-led NHS trusts provide the space for leaders, managers and improvement teams to implement and sustain improvement in parallel to their day-to-day business. 

The Health Foundation have a companion guide to the briefing with detailed examples of specific improvement interventions and the benefits they can deliver.