This can be Board, executive or senior leader level.

So that change is not ‘done-to’ people, but ‘done with’. Effective and sustainable change always involves:

• staff (the people who do the work and want to improve it)
• stakeholders (people in organisations, systems, and other partners, that are affected by the work done and want to share in its improvement)
• people with lived experience. We describe co-production as “a way of working that involves people who use health and care services, carers and communities in equal partnership; and which engages groups of people at the earliest stages of service design, development and evaluation”.

A structured, systemic and measurable approach for a whole organisation to link goals to strategy to action, in the long, mid and short-term; as follows:

• Develop goals derived the organisations vision, mission and purpose, develop strategy from those goals, and prioritise actions.
• Describe the method by which activity at all levels (leadership, management, and delivery) is aligned with goals, how progress and performance is measured, and how to course-correct to maintain progress, i.e. should have plan, do, study, act at its heart at all levels.

Safe, effective, positive experience (responsive and personalised; caring), well-led, sustainably-resourced and equitable care, in service of better health outcomes

Teaching of a coherent and structured improvement approach that develops knowledge of the principles, method(s), and tools, and how to apply these in practice as an individual, and within teams; to note: NHS IMPACT encourages the use of any established improvement methodology.

Effective learning comes from knowledge applied, ideally frequently, to ‘close the learning loop’.

Improvement training should be available at various levels from basic through to advanced, using a ‘dosing’ approach.

An improvement specialist is responsible for leading the deployment of an improvement strategy, for training others and for providing technical expertise and coaching support for improvement. They have received training in an improvement methodology and have delivered multiple improvements over time.

This means people who deliver quality improvement training, and facilitate quality improvement sessions, and follow-up with coaching support.

An improvement method is the core part of an improvement methodology – it encourages and enables a structured trial-and-error style testing by all.

It is a defined and consistent set of actions that are repeated continuously in a cycle in order to (i) effect process change and deepen knowledge about it that can be shared (ii) practice the method to gain expertise in it, and (iii) become skilled enough in the method to teach and coach others.

An improvement methodology is a systemic, structured and consistent approach to think about, develop, and manage change that is focused on producing process improvements within the domains of; delivery, quality, resource use, and people-related factors, and across all levels of an organisation and/or system.

All improvement methodologies should have an improvement method and teamwork at their heart.

Improvement is usually:

• focused on continuous improvement which is the ongoing, long-term improvement to processes, products and services. This can involve incremental improvements over time or breakthrough improvements made all at once. The goal is to make periodic beneficial changes.
• about having learning at its core
• more iterative and experimental
• based on teamwork, in that it’s the people who do the work that can improve the work, and are full of ideas
• done in collaboration; improvement can bring joy to work and taps into the intrinsic motivation of individuals and teams to make things better for people
• develops a positive, collaborative and inclusive culture focused on the patient.