To establish and sustain an effective management system requires a system and providers to have developed, or at least be developing, all the other four components.

What this looks like in practice

• Develop an explicit management system that aligns with the strategy, vision and purpose of the organisation at board level and throughout all workforce structures and functions.
• Put systems in place to identify and monitor early warning signs and quality risks with clear processes of how to respond to these.
• Set up the management system as a way of operating that enables ongoing continuous improvement of access, quality, experience, and outcomes.
• Building a management system which allowed the organisation to respond to system and national priorities more easily as the organisation has a consistent and coherent management system which is used to organise all work.
• A committed board own and use this approach to manage the everyday running of their organisation. Evidence of how things are performing is visual and clear with progress easily trackable.

Guidance and resources

Assessment and improvement

Visit our assessment and improvement pages to understand where you are on your journey to embed each of the five components of NHS IMPACT and to begin building an improvement culture.

In particular, learn more about Quality Management Systems.

Courses, workshops and events

• Improvement Academy training courses – both virtual and online, focus on helping health and care staff to improve the safety and quality of care in everyday practice.
• Learning and Improving Across Systems Peer Learning Programme – NHS Confederation – Connect with leaders across the UK navigating the opportunities and complexity of leading change through health and care systems.

Free tools and guides

• The Model Health System is a data-driven improvement tool that enables NHS health systems and trusts to benchmark quality and productivity. By identifying opportunities for improvement, the Model Health System empowers NHS teams to continuously improve care for patients.
• Patient Safety Incident Response Framework – NHS England – The Patient Safety Incident Response Framework (PSIRF) sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents for the purpose of learning and improving patient safety.
• National paediatric early warning score (PEWS) – NHS England – The National Paediatric Early Warning Score or PEWS will allow for consistency in how deterioration in children is recognised.
• Statistical process control tool – NHS England – Statistical process control (SPC) is an analytical technique that plots data over time. It helps us understand variation and in so doing guides us to take the most appropriate action.
• Embedding a Culture and System for Continuous Improvement: A Practical Guide – Aqua – Following the publication of the Delivery and Continuous Improvement Review by NHS England, Aqua have developed a practical guide to help you to achieve the recommendations by embedding a culture and system of continuous improvement.
• QSIR Guide to Driver Diagrams – AQUA – A driver diagram is a tool that can be used to help plan improvement project activities.
• The EFQM Model – EFQM – The EFQM Model is a globally recognised management framework that supports organisations in managing change and improving performance.
• A Healthcare Improvement Scotland guide for quality management.
• The Lean Transformation Framework – Lean Enterprise Institute – The Lean Transformation Framework is a proven, systematic approach to resolving problems at every level of the enterprise, from executive-level strategy to frontline operations.
• Your guide to Logic Models – The Strategy Unit – This guide has been commissioned by NHS England, to provide support on logic modelling. This guide is split into two sections – theory and practical use.
• Quality standards  – NICE – NICE quality standards set out priority areas for quality improvement in health, public health and social care.

Journal articles and research

• Strategy across a health and care system: five things I learned – Kaleidoscope Health and Care – David Jones highlights what’s needed to make health and care strategy across systems effective.
• The improvement journey – The Health Foundation – This report outlines why organisation-wide improvement in health care matters, and how to get started.
• Developing learning health systems in the UK – The Health Foundation – Priorities for Action: A Health Foundation report.
• Understanding and sustaining the health care service shifts accelerated by COVID-19 – The Health Foundation – The Health Foundation collected examples of major service shifts across the health system and then explored factors that might explain why these shifts have occurred, as well as issues that could inhibit their retention.
• Research Outputs Archive – The Healthcare Improvement Studies (THIS) Institute – Browse an expanding evidence base for the NHS about how to improve quality and safety in healthcare.

Leadership networks

Leadership networks can be found through:

• Become a model ambassador – NHS England
• Embedding Improvement in Systems – Q Community

Case studies

Further case studies to demonstrate embedding into management systems and processes:

• Improvement insight hub – NHS Confederation
• Shared learning case studies – NICE
• Improvement Science
• A deeper look into Quality Management Systems – Q Community
• NHS IMPACT takeaways – Virginia Mason Institute
• Using Toyota’s Lean method to improve the NHS Podcasts – Warwick Business School

NHS IMPACT bulletin

Subscribe to the NHS IMPACT (Improving Patient Care Together) bulletin