Software Process Improvement (SPI) Best Practices

Jones B, Woodhead T (2015). Building the foundations for improvement. London: The Health Foundation. Available at: (accessed on 8 September 2017).

Features of boards that are successful in driving quality improvement include:

Leis J, Shojania K (2017). ‘A primer on PDSA: executing plan–do–study–act cycles in practice, not just in name’. BMJ Quality & Safety, vol 26, no 7, pp 572–7.

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STPs and other local partnerships could also help NHS organisations to ‘act like a sector’, bringing together professionals from different services to agree standard procedures and processes to improve care (Dixon-Woods and Martin 2016). Working as a system can also be key to spreading improvements in quality. Networks to facilitate information exchange and sharing of practical insights can create a ‘learning system’, enabling improvements to be adapted and spread (; McCannon and Perla 2009).

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While the role of boards is key, responsibility for leading quality improvement also extends well beyond the most senior leaders in the NHS. Leadership for improvement must be distributed within organisations. A clear, unifying vision for improving quality should be enacted at multiple levels, with co-ordination and alignment between teams, departments and individuals (; Dixon-Woods et al 2014). The examples given above illustrate how leadership for improvement comes from all parts of an organisation (or multiple organisations), as well as from patients and service users. But the support of senior leaders in the organisations involved is important in getting a project off the ground and creating time for staff to design and test new ways of working, as shown in on dementia care in Sussex.

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The drivers of health service improvement are also multiple and overlapping; there is rarely (if ever) a single, magic bullet for improving quality. Local context is crucial in understanding the success of different quality improvement programmes (; ; Kaplan et al 2010). Interventions that ‘worked’ in one place are rarely easy to replicate in others. The Practical Obstetric Multi-Professional Training (PROMPT) programme () is a good example of this. The programme’s success in helping Southmead Hospital in Bristol to improve its perinatal outcomes and to reduce its litigation costs has encouraged other maternity units across the UK and around the world to implement it. Yet many have found it challenging to match Southmead’s impact. Embedding the type of attitudes and behaviours that have underpinned PROMPT’s success takes time and is not straightforward.

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This means that NHS leaders must make a long-term, overarching commitment to improving quality within their own organisation, and set realistic goals for improvement. Rather than searching for magic-bullet solutions, leaders should focus on developing the processes, systems and cultures to support the delivery of high-quality care on a continuous basis (Dixon-Woods and Martin 2016).