Quality improvement: the hidden NHS capability

Across health and care, there is no shortage of commitment to patient safety. What is in short supply is time, capacity and headspace. Teams are under increasing pressure as demand continues to rise, and many people feel they are working at full capacity to maintain services. In that context, quality improvement can sometimes feel like a nice-to-have – extra work layered on top of already busy roles.

However, the reality is that things are unlikely to become safer or better without deliberate action. If we want to deliver safer, more reliable care, quality improvement is not optional, it is essential.

Why quality improvement matters

Quality improvement is often talked about as something big, technical or abstract. In practice, it is a very practical way of helping people make small, focused tests of change, towards an aim of improving how care is delivered.

Those changes might look modest on their own, but together they can make a significant difference to patient safety, sustainability and the experience of both patients and staff.
At its heart, QI recognises a simple truth: the people who work in services every day usually know where things don’t work as well as they should. They see the workarounds, the delays, the duplication, and the points where patients are most at risk. What QI offers is a structured way to systematically turn that insight into improvement.

One of the biggest barriers to QI is the perception that it creates additional work. In reality, it often does the opposite. By helping teams examine how a process actually works, rather than how it looks on paper, QI can root out the steps that add little or no value, introduce risk, or simply make work harder than it needs to be.

Quality improvement is a toolkit, not a single method

Quality improvement is sometimes framed as a choice between different approaches. For example, between running Plan‑Do‑Study‑Act (PDSA) cycles or carrying out process mapping. In practice, these are not alternatives. They are complementary parts of the same toolkit.

Process mapping can help teams understand a pathway end-to-end and identify where problems arise. PDSA cycles allow those teams to test changes on a small scale, learn quickly, and adapt before rolling improvements out more widely.

Measurement for improvement cannot be overlooked. It is critical we measure as close to real time as possible, using signals in the data to identify specific causes and avoid wrongly reacting to variation from common causes.

The skill lies in knowing which tools to use when and in keeping changes proportionate to the problem being tackled.

Supporting patient safety in practice

Nowhere is the value of QI clearer than in patient safety work. Many national priorities, such as improving the recognition and escalation of deterioration, depend on reliable processes being embedded into everyday care.

For example, in some organisations implementing patient safety initiatives linked to deterioration, teams have used QI methods to pilot how patient‑reported concerns are captured and acted on within digital systems.

By testing different ways of asking questions, reviewing how information appears on screens, and observing how staff interact with the process in real time, teams have been able to refine workflows before fully embedding them. The result is something that is more usable, more consistent, and more likely to be sustained.

These kinds of improvements are rarely headline‑grabbing. But they are exactly the sort of changes that make care safer.

Health Innovation East’s Patient Safety Collaborative (PSC) is supporting the implementation of Martha’s Rule, to help reduce deterioration-associated harm. Quality improvement is central to this approach, enabling early detection of deterioration, by listening and acting on the concerns of patients, families and staff.

Balancing strategic with local

Effective quality improvement needs direction, but it also needs to be grounded in front-line reality. Strategic priorities give focus and help protect improvement work. At the same time, staff need to be supported and empowered to improve those things that are within their gift to change.

Some trusts have invested in dedicated QI teams that work alongside clinical and operational staff. They offer coaching, support measurement, and help teams apply improvement methods to real problems.

Others have created internal improvement hubs that provide expertise and continuity. These approaches help ensure that improvement does not depend on goodwill alone, and that staff are not left to struggle on their own.

Building morale and momentum

Quality improvement is not the preserve of managers or specialists. Anyone can contribute. Often the best ideas come from the people closest to the work, who understand patients’ needs and the realities of service delivery better than anyone else.

There is also a human side to quality improvement that is easy to overlook. Being able to fix something that frustrates you or puts patients at risk can be deeply motivating. Small, achievable improvements build confidence and help people reconnect with why they came into healthcare in the first place.

As one experienced improver puts it, improvement is about breaking big challenges into bite‑sized pieces. Over time, those pieces add up, and morale improves alongside outcomes.

What next?

Nationally, there is growing recognition that improvement needs to be done in a more structured, consistent way. Frameworks such as NHS IMPACT (Improving Patient Care Together) reinforce the importance of building improvement capability, leadership and culture across organisations.

Improvement will be key to making the aims of the NHS Ten Year Health Plan a reality, allowing staff the permission, support and time to test ideas, learn and adapt. Whether you are working on patient safety, pathway redesign, digital change or service efficiency, quality improvement provides a practical way forward.

How can I get involved?

If you are new to QI, start small and keep it simple. Focus on a problem that matters to you and your patients, and remember to measure. Without measurement, it is impossible to know whether a change has really made things better.

For those looking to develop their skills or get support, there are dedicated quality improvement resources and training available. In today’s NHS, quality improvement is one of the most important capabilities we have, and one we cannot afford to lose.

Contact your NHS organisation’s quality improvement team and find out what support and training they can offer.