15 Steps Challenge

I can tell what kind of care my daughter is going to get within 15 steps of walking on to every new ward.

This powerful statement, from a mother whose daughter needed frequent inpatient stays, inspired the development of the ’15 Steps Challenge’.

The 15 Steps Challenge focuses on seeing care through a patient or carer’s eyes, and exploring their first impressions.


The 15 steps challenge guides were previously developed and published by the NHS Institute for Innovation and Improvement. The Institute no longer exists and their functions were incorporated into NHS England. The guides have been in use by Trusts for a number of years and so we were keen to be able to ‘host’ them on our website. However, we also recognised that they needed reviewing, refreshing and bringing up to date.

The aim of the guides is to support organisations (FTs, NHS Trusts, CCGs, but also other providers) to implement the ’15 steps challenge’. This is an approach to service/quality improvement that focuses on ward (or service) ‘walkarounds’ using a ’15 steps challenge’ team that includes patients; carers; staff; and Board members, the team members consider their first impressions of the ward/service from the perspective of a service user, recording how it appears; looks; sounds; smells etc. The outcomes should inform improvement actions at a ward/service and organisational level, linking into other relevant initiatives as appropriate.

If you have queries about the 15 Steps Challenge please contact the Public Participation team by emailing england.nhs.participation@nhs.net.