In 2008 all the Universities in England who offer validated healthcare professional courses where approached by the NHS Institute and asked whether they would like to undertake ‘supported implementation’ of service improvement into their pre-registration teaching programs.

Any University who agreed became a Phase 3 Partner and was ‘buddied’ with either a Phase 1 or Phase 2 Partner, who facilitate the necessary support.  All the partners are supported by the NHS Institute.  The support takes the form of staff training, attending steering committees, attending validation boards, etc. All the Partners are invited to regular ‘events’ to meet and discuss with the NHS Institute and Partners from all three phases.

The Phase 3 Partners do not need to introduce a specific model as originally piloted as a short course.  They can pick and choose any part of any model as appropriate to the way their institution works and how their courses run, on condition they fulfill the key elements and design principles. 

The NHS Institute, with the Phase 1 and 2 Partners identified the elements that are key to achieving the introduction of improvement tools and techniques to health and social care students, to achieve the desired impact.  These elements and design principles are described below under the headings of expected, highly desirable and recommended as they were issued to the Phase 3 Partners.


  • A minimum of an equivalent to a 1 day ‘stand-alone’ introduction to improvement …
    • Called ‘improvement for better, safer health and social care’.
  •     Introduction to improvement to include:
    • Exposure to a patients/service user experience
    • Principles of process mapping
    • Model for Improvement to include PDSA (plan, do, study, act) cycles.
  • Practical application in a clinical setting …
  • Supported, if possible, by clinical facilitators/mentors 
  • Setting appropriate to the student
  • An opportunity to test out a tool (e.g.  PDSA) in practice
  • Faculty and clinical facilitator development
    • ‘Training’ faculty and clinical facilitators in the same tools and techniques that students are learning
    • Make links to other areas of expertise e.g.  leadership, management, leading change, clinical governance, safety, etc.
    • Links to University and NHS targets.

Highly desirable:

  • Inter-professional / multi-professional learning
  • In partnership with services; either NHS or Social care
  • If possible learn, work and reflect with students of other disciplines possibly about the service of other disciplines. 


  • Build in an assessment element
  • Assessments can include things like presentations, poster displays, project reports, management reports
  • Include clinical staff, fellow students and faculty.
  • Plan for sustainability
  • Engage faculty and senior management at University
  • Engage with Improvement teams and colleagues in NHS and social care. 
  • Include in revalidation with Professional Bodies
  • Steering group
  • For academic year 08/09
  • Membership: university (inc. senior management and faculty), NHS (clinical facilitators and managers) and NHS Institute and a student representative
  • Assess progress, identify issues and ways forward, celebrate success, etc.

These elements are key issues for the introduction of improvement in pre-registration education as agreed by the NHS Institute and their Phase 1 and Phase 2 Partners.  The Phase 1 and 2 Partner Universities and their NHS partners who have tested improvement in pre-registration education for multiple professionals have taken these principles into their own organizations with their faculties, students, clinical placements and developed their own ways of implementation.  These principles are now being introduced by 32 of the 93 Universities that currently offer validated pre-registration courses within England.

Phase 3 is also being externally evaluated and the NHS Institute is currently re-contacting the remaining forty universities asking whether they undertake any service improvement teaching.  All the universities will be asked whether they are interested in joining the initiative.  The NHS Institute for Innovation and Improvement hopes to support the implementation of service improvement into all pre-registration teaching programs. 

We have shown that it is possible to successfully introduce the principles of quality improvement into pre-registration for healthcare professionals.  NHS Institute aims to continue the evaluation through a longitudinal study where the students are followed up once they are registered healthcare professionals. This will tell us whether the introduction of service improvement into the pre-registration education of healthcare professionals really does mean better, safer healthcare.

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