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Steps in the Improvement Journey: phases, tools and resources

The following framework can be used to structure and plan the phases of a ‘typical’ improvement project. Some common methods, tools and resources are provided for each phase to support your journey.



 Methods / Tools


1. Define the problem

Identify problems or service shortcomings.
Root Cause Analysis:
5 whys, cause and effect (Fishbone), force field analysis, affinity diagram
Process/value stream mapping
Safety culture
Understanding data
– Pareto analysis
Patient & staff experience data
Trigger tools
Topic scoping and research
Define the problem, diagnose why the problem exists and what improvement would look like.

 2. Develop a shared purpose

Form a team of enthusiasts who are resilient, passionate and committed to delivering improvements.
Leading and influencing
Human dimensions of change
Project management
Human factors
Communication and stakeholder engagement
Establish a clear aim for an improvement in patient safety/care – that aligns with organisational and quality improvement objectives.

 3. Plan the changes

Formulate, prioritise and test solutions – be clear about the benefits to patients.
Deming’s System of Profound Knowledge
• What is Systems Thinking?
• Logic Model/Driver Diagram
Model for Improvement
Six Sigma
Generating ideas and creative
Theory of Constraints
Demand and Capacity
Experience Based Co-design
Understanding variation
Designing reliable processes
Complete a Project Charter to detail proposed improvement, including investment required and potential benefits to patients.

 4. Test and measure

Test, review and re-test improvements – in order to find a solution.
Measurement for improvement
• Run charts
SPC chartsReturn on Investment (ROI)
• Evaluation of a QI project
Solution identified that demonstrates ‘change’ is an improvement in quality and safety without negative consequences.

 5. Implement, embed and sustain

Implement the improvements widely, using project management methodology and appropriate governance.
Spread and diffusion
Large-scale change


Formalised procedure in place to ensure the improvement is embedded into routine practice and sustained with governance arrangements.
Project completed.
Share learning for others to adopt (BMJ Quality?)


West of England AHSN toolkits >

< The Improvement Journey Overview