Service improvement: discover and understand

The first phase in any service improvement plan is about really understanding what is currently happening within your service. There are several ways you can do this.


You need to consider how your service is working for patients, their families and carers and staff. You also need to understand the context and wider influencing factors, as well as the local service delivery. To do this, you must look at what the drivers are for change, at national, local and policy levels.

National drivers

There is information available to support you in finding out more about the national picture and policy on the following NHS sites:

Local factors

Most organisations have websites that include information about their priorities.

In England, it’s important to understand the local commissioning priorities to be able to link your improvement and transformation work. Check out the CCG (Clinical Commissioning Group) websites, and your local Sustainability and Transformation Partnership (STP) website.

NHS Right Care provides data packs to understand the areas of priority for a local population. It’s always worth having a look at those to see how that data might support your case.

Another important source of information about local population needs and issues is the Joint Strategic Needs Assessment (JSNA). This helps district leaders understand and agree the needs of all local people. This, along with the joint health and wellbeing strategy, sets the priorities for collective action. To find out more, do a web search for JSNA and your local town/area.


There are also some great tools for understanding the wider system challenges and opportunities. A PEST(LE) analysis looks at the following factors in relation to your organisation and/or service:

  1. Political
  2. Economic
  3. Socio-cultural
  4. Technological
  5. Legal
  6. Environmental

There are many templates you can use for this tool, for example:

Is your organisation/service ready to transform care?

To find out if your organisation or team is ready, one tool that is really useful is a SWOT analysis. This will help you identify the strengths, weaknesses, opportunities, and threats related to your proposed service improvement.

You can also adapt the SWOT analysis template in the eportfolio. Instead of relating the questions to you, relate them to the team or organisation you are assessing.

Further assessments of the current situation include:

  • identifying your service’s core purpose

  • knowing the demand on your service

  • knowing your capacity to deliver

  • understanding patient flow through your service.

Find out more on matching demand and capacity

It's a good idea to involve patients and carers when you're trying to understand the current situation. There are many ways you could do this. Talking to your patients and finding out about their experiences is one way.

Another approach is experience-based design. This uses patient, carer and staff experience to design better services. The first two phases; capture and understand, really help you to grasp what is actually happening for patients, carers and staff in the service.

These tools will all help you understand where your service is currently at and help identify opportunities for improvement. You can then start to develop and generate ideas on how to go about this improvement.

Improvement leaders guides

This set of guides is produced by the NHS Institute of Innovation and Improvement and provides practical advice for use by anyone who wants to include service improvement in their work. They are applicable to all areas of health care relating to service improvement and cover three broad areas:

1. General improvement skills

  • Improvement knowledge and skills
  • Process mapping, analysis and redesign  
  • Working with groups  
  • Involving patients and carers  
  • Evaluating improvement  
  • Technology to improve service  
  • Sustainability and its relationship with spread and adoption

2. Process and systems thinking

  • Measurement for improvement  
  • Matching capacity and demand  
  • Improving flow  
  • Working in systems  

3. Personal and organisational development

  • Managing the human dimensions of change
  • Redesigning roles
  • Building and nurturing an improvement culture
  • Leading improvement
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