Service improvement: an introduction

Service improvement and transformation is best approached in a structured way.


This includes understanding the challenge, analysis, creativity and prototyping (testing to learn) techniques that that allow teams to develop innovative solutions. It’s an approach that uses your understanding of the needs of your patients, the wider population and your organisational and service requirements, to deliver the best care.

Firstly, you must understand what improvement is and what transformation is. Improvement is about making things (eg processes, systems, ways of working, behaviour, location) better. Transformation is about changing their form, appearance, or structure.

Three phases of service improvement

The patient experience is always central to this approach. There are three phases in the approach and three themes/activities that you need to consider.

The three phases are:

  1. Discover and understand
  2. Generate and develop ideas
  3. Implementation

Within each phase there are three things to consider:

  • Stakeholder management: if you know who your stakeholders are then you will be able to identify and raise potential issues and challenges more easily. Remember that patients, carers and staff are key stakeholders in any change and improvement work.
  • Measurement and evaluation: monitoring your project ensures you know the difference you have made or are making.
  • Sustainability: will you be able to maintain the improvements you are making?

You can apply this approach across a range of projects. These might be small improvements or larger organisational or system transformations. The framework will help you to develop innovative solutions to the challenges faced in delivering health and care.

There are a range of different tools and models to use for improving and transforming services. It’s always a good idea to check if your organisation has a particular model or approach. The local approach should include all the elements described within this framework.

Top tips

  • Push yourself out of your comfort zone: think differently and be creative
  • Test out new ideas early: fail often and learn to develop innovative solutions
  • If you are unsure about what to do, remember that someone will have been there before, so talk to them
  • Take responsibility for what you achieve
  • Have fun: being creative and innovative should be enjoyable!

    Further information

    • NHS Institute for Innovation and Improvement Service Improvement handbook: 75 tools and technique for service improvement which have been used in health and care.
    • NHS Institute for Innovation and Improvement Improvement Leaders Guides: 15 guides covering the themes of General Improvement Skills, Process and Systems Thinking and Personal and Organisational Development. They provide practical advice on service improvement in health and care.
    • The Health Foundation Quality improvement made simple: an overview of approaches to health care quality improvement.
    • NHS England Leading Large Scale Change: a guide to help all those seeking and leading transformational change in complex health and social care environments.
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