Clinical Systems Improvement

Clinical Systems Improvement (CSI) can be described as evidence-based operations management for healthcare. This term is used to describe a body of knowledge adapted from systems engineering, psychology and other disciplines to improve clinical processes at the heart of service delivery. It encompasses quality improvement tools and methods adapted to healthcare from disciplines such as Theory of Constraints, Lean Thinking and Six Sigma.

The Service Transformation team is working in collaboration with the Leadership and Learning teams in the NHS Institute to increase the capabilities of NHS organisations in Clinical Systems Improvement.

How can it help?

By increasing the CSI capability of the NHS we will support organisations in their efforts to improve health outcomes, reduce delays and remove waste through targeting activities which add no value to patient care. This will significantly contribute to lowering NHS costs and increasing productivity. Patients will benefit from receiving better care, with fewer delays and improved reliability.

The NHS Institute is supporting the establishment of a National Centre for Clinical Systems Improvement based at Warwick University. This will contribute to increasing the CSI capability in the NHS. New knowledge and products will also be produced to support NHS staff in accelerating CSI within their organisations.

A snapshot of current practice

The NHS Institute commissioned researchers at Warwick University to evaluate the capability of NHS organisations in quality improvement. This important study has discovered that improvement capability in acute trusts is patchy, with some organisations having highly developed capability which is applied in many parts of the organisation, while others have very limited improvement skills and capacity. The picture in PCTs is rather worse with only limited improvement capability in most.

The findings highlight the importance of developing improvement skills and capacity in organisations so as to deliver the quality improvements expected by commissioners, clinicians, patients and the public. The NHS Institute has a leading role in helping to develop that capability by designing training in CSI. This will be incorporated into training for clinicians and managers. The full document can be downloaded here:

CSI_Snapshot_Warwick_2006.pdf Clinical Systems Improvement in NHS Hospital Trusts and their PCTs - a snapshot of current practice 2006 (277.58 KB)

Developing the centre for CSI

The NHS Insititute spearheaded an initiative at the Univery of Warwick to develop a new centre for clinical systems improvement. This centre is a collaborative made up of many NHS and educational organisations. The focus of activity for the centre is research and delivery of conferences, and consultation on all aspects of systems improvement. For details of training and other events please check or email

Cost and quality in the NHS

The NHS Institute is working on the application of lean in healthcare for more information see our article on lean thinking.

Helen Bevan has written an article entitled 'On Cost and Quality in the NHS' for the Health Service Journal.