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Quality and Service Improvement Tools

This resource is a comprehensive collection of proven quality and service improvement tools, theories and techniques that can be applied to a wide variety of situations.

You can search the collection alphabetically for a specific tool (scroll down for this). Alternatively, you can browse groups of tools using one of the following five categories:

Stage of Project identifies tools that are relevant to implementing a service improvement project, e.g. starting out, diagnosing the cause etc.
Type of Task identifies tools associated with addressing specific tasks, e.g. mapping the process, thinking creatively etc.
Type of Approach identifies tools linked to a specific approach, e.g. Lean, Six Sigma, analytical tools etc.
Seven Ways to No Delays identifies ways to improve patient flow and design delay-free services in order to achieve better patient care.
Patient Pathways identifies tools that relate to the seven stages of the patient pathway.

To select tools by category, please choose from the menus in the five drop-down boxes below.

Mapping the whole patient journey will enable you to look for opportunities for improvement by visualising how the whole patient journey currently works and identifying points of inefficiency. The efficiency of the whole patient journey is more important than the individual team's efficiencies. An outline approach of how to look at the bigger picture. Action plans are a key component of successful project management, helping you summarise how you will achieve objectives and by when. An Affinity Diagram is a specific kind of creative thinking (brainstorming) that you can use to organise significant amounts of information into meaningful categories. It will help you to clarify and make sense of a large or complex problem. You can use the balanced scorecard to clarify your team's vision and strategy for improvement, turning them into clear objectives and measures. By focusing on benefits realisation planning, you can track whether intended benefits have been realised and sustained after the end of the change or improvement project. A bottleneck determines the pace at which a whole healthcare process can work. If you want to improve the care process, you must address the bottleneck. Stick to the tried and tested rules and techniques, and you will have an effective way of generating ideas around problems, solutions and next steps. If you have a good relationship and mutual trust between yourself and members of your team, they will be more receptive to new ways of thinking, including any improvement methods that you may want to introduce. This section from the NHS Improvement Leaders' Guide suggests how you can build trust with your colleagues. A straightforward brainstorming technique which can help you to identify and plan for obstacles. Cause and effect analysis helps you to think through the causes of a problem thoroughly, then structure and group them appropriately to help you move forward. If you want to achieve successful and lasting process changes, clinicians need to be an integral part of the procedure. This tool gives you guidance on how to ensure clinician involvement. CPaT is an approach that supports trusts in introducing systematic processes to improve waiting list management. As a result, patients will be seen in accordance with their clinical priority. If you know what level of support you need from each of your stakeholders for change, you know where to direct your energy. This tool helps you identify where that commitment needs to come from. The communication matrix is a tool to help you proactively plan communication within a project. The next phase of improving services will not be easy (the easy stuff has already been done) so we need to tap into other areas to get new ideas. Using creativity tools can help you come up with these new ideas, solutions and perspectives. The 'treat day surgery as the norm for elective surgery' High Impact Change states 'Switching to day case supports the national imperative of giving patients more choice and reducing waiting times. There are enormous benefits in adopting this approach. There is clear evidence to show that patients who have day surgery have an overall better experience, improved clinical outcomes and less risk of hospital acquired infections.' Getting to the hub of the problem of why waiting lists and backlogs form and what you can do about it. This guide introduces the basic concepts of demand and capacity. For a more comprehensive guide, see a comprehensive guide to demand and capacity. Demand management is about understanding demand. The process should focus on using planning and forecasting skills to ensure patients receive the most appropriate care in the right setting. It is not about managing the number and type of referrals. Setting a date and planning for discharge reduces length of stay and ensures patients are ready to leave hospital, thereby reducing unnecessary readmissions. A way of helping managers understand and respond to people's feelings when confronted by organisational change. In the discomfort zone, people are most likely to change and learn how to do things differently. This tool examines the causes for patient non attendance and gives guidance on what you can do to reduce the level of 'did not attends' (DNAs) at your hospital. These diagrams are a simple way to show how an overall improvement goal can be broken down into its underpinning drivers and projects. As a logic tool they allow you to communicate your improvement strategy and support the development of a measurement framework to monitor progress. Organisational change can substantially impact on employees' sense of freedom and ability to contribute. It is important therefore for managers to be aware of the factors promoting empowerment and how these can be integrated into the change process. The enhanced recovery programme shows that improvements to the quality of care can speed up a patient's recovery after surgery, whilst using up less resources. Piles of work to do later, infrequent decision making for groups of patients, batching work and lists all represent a wait in a patient journey or diagnostic pathway. Reduce these, and you will also reduce referral to treatment times and variation in waiting times. Force field analysis is a tool that helps you understand the pressures for and against change. You can use it with individuals, teams and organisations, or for any planned changes or projects. An approach to help you to think about how you can communicate the potential impact of your project to others, and the potential gains of the learning from your project. We all have different ways of thinking about and tackling challenges. By using this 'fresh eyes' approach and thinking like someone else, you will be able to come up with a solution, or a new way of getting things done. An approach to help you identify common groups of procedures, conditions or activities in healthcare by volume and similarity of procedure. This helps to prioritise efforts for improving patient flow. Understanding individual differences and the way in which individuals react to the world around them can help improve communications between staff and aid the delivery of change projects. This tool helps you prepare your response to opposition by using a group of staff to act as 'critical friends' enabling you to implement and manage change more effectively. There are several tools in the No Delays Achiever that are very helpful in assisting you getting down to the real root cause of a problem. This section provides an overview. If one person jumps the waiting list for non-clinical reasons it means everyone else behind them waits longer for treatment. 'Lean' is about getting the right things to the right place, at the right time in the right quantities, while minimising waste and being open to change. Waste is anything which doesn't add value to the patient experience and satisfaction. It can be a waste in terms of resources, services, time or work. The purpose of this tool is to identify past experiences and to start thinking about their implications for future practice. Understanding and reducing how long patients spend in a hospital will help achieve an 18 week pathway, by freeing capacity and increasing throughput. If you listen properly to your staff, you are able to understand the issues more clearly and can involve them in more constructive discussion. This tool gives you advice on how best to go about this. The 'Needs and Gets Matrix' is a way of developing understanding between departments so that they are able to work together more effectively. 'Make time to save time.' This straightforward approach shows you how to illustrate (literally draw), discuss and solve problems within your working environment. This tool contains guidance and key points for managers on preventing, containing and handling conflict. Going through change can be stressful. This guidance helps you to manage and minimise stress in your team as you implement changes. Using patient files helps you to find out what actually happens to a patient. By visualising how the whole patient journey currently works, you are able to identify inefficiency as well as opportunities for improvement. Do you want a comprehensive list of the benefits that a project has for patients and the NHS? By going through a specific set of questions in conjunction with the flowchart in this tool, you can achieve this. This overview details the range of forecasting and modelling tools that can help you to decide which service improvement changes have the potential for maximum impact on reducing delays. Pareto analysis helps you identify the changes that will yield the greatest benefits. It is particularly useful when you have to decide between many possible courses of action and resources are limited. More and more people are using the term 'patient flow'. In simple terms, flow is about uninterrupted movement, like driving steadily along the motorway without interruptions, or being stuck in a traffic jam. It is important to get written information for patients right. Miscommunication can cause delays through patients missing appointments or being unprepared for procedures. This tool describes the different ways in which you can canvas patient opinion and gain their perspective to inform any service improvement you are planning. This tool gives you an overview of performance management and the tools that you can use in conjunction with it. This tool defines the required features of any measurement strategy that you may be using, plus the next steps you should take. Plan ahead: along all stages in a patient's journey. This ensures that each step of the programme is planned for and scheduled so everyone knows what to expect and when to expect it: this helps to reduce delays. You can use plan, do, study, act (PDSA) cycles to test an idea by trialling a change and assessing its impact. Pool the work of consultants, clinicians, technicians and administrative staff where there is common and equivalent work. Pre-operative assessment (POA) and planning should inform the patient about the procedure and post operative recovery, as well as admission, discharge and post operative care at home. Mapping the detailed part of the patient journey will enable you to look for opportunities for improvement by identifying points of inefficiency. Select the best approach using this overview of the different methods of mapping processes and patient journeys. Find your bottleneck using process templates. This is a template or a picture of what happens to one patient as they go through a process, measured in time. This six-stage service improvement guide provides a framework for service improvement within the NHS. We suggest you read through the whole project guide before you undertake any actions relating to the stages. This will help you get an overall picture of what all the stages involve. Protocol based care enables NHS staff to address the key questions of what should be done, when, where and by whom at a local level. It provides an effective framework for working in multi-disciplinary teams. Provocations help you challenge a way of thinking. By starting from an outrageous idea or scenario, you are able to suspend judgement and make connections and associations more freely. A lot of our work adds value to patients: right referral, right diagnostic tests, right diagnosis, right information and communication, right advice, right treatment, right aftercare and right handover. Doing more things that add value will reduce waiting times. Cancelled operations are a waste of resources and time. They bring the additional administrative burden of rescheduling appointments or a blank theatre slot. Many Clinical pathways are ready for improvement: this tool gives practical guidance on how you can shorten and improve the patient journey, using Cholecystectomy as a example. Reliable design: ensure the right patient, receives the right care at the right time. Identify potential anxieties at individual and team level and some of your potential responses and coping strategies to reduce resistance to change. Resistance is one of the main factors impeding organisational change. This guide describes the three different levels of resistance you may encounter. All too often a good idea is blocked by resistance from key personnel. This tool helps you recognise the different levels of resistance and explains how you can overcome it. This is a simple tool, you can use it to make sure that everyone is clear about roles and responsibilities. It works well within teams, between teams, for strategic management and for project management settings. This tool calculates the return on investment (ROI) of a quality improvement initiative using the financial benefits and costs data you insert from your project. If your change project has stalled, this tool helps you to decide whether it is still a priority - and if so, how you can revive it. Role redesign is a workforce improvement tool which can help you improve patient services, tackle staff shortages and increase job satisfaction through the development of new and amended roles. By repeatedly asking the question 'why?' (use five as a rule of thumb), you can peel away the layers of an issue, just like the layers of an onion, which can lead you to the root cause of a problem. Poor communication can cause delays and waste time. Situation-Background-Assessment-Recommendation (SBAR) is a simple framework which enables staff to share clear and consistent information about a patient's condition. A simple method for the team to help understand what's included and what's not in a project. This tool helps you identify, and then break some of the thinking that maintains the status quo - preventing you from moving forward and doing things better. Six Thinking Hats® is a simple yet powerful tool created by Edward De Bono based on a principle of parallel thinking. Sort and Shine is a visual system which involves relevant staff in a sequence of steps to create and maintain an organised, clean, high performance workplace. The spaghetti diagram is a tool to help establish the optimum layout for a department or ward. Its use exposes inefficient layouts and identifies unnecessary distances between key steps. This guide outlines the importance of getting staffs perception for generating ideas for service improvement and details a number of methods for collecting the views of staff. A stakeholder analysis helps you identify and categorise the groups and individuals involved in a situation, so you can plan their involvement in a change project. If you carry out any type of measurement to help solve problems, SPC is the most practical and useful statistical tool you can use. Strategies to try out if your change or improvement project has lost momentum. Ways to reignite interest and maintain commitment. If you get to a stage in the change process where you say 'that's impossible' this tool helps you to unlock your thinking and move forward. Theory of Constraints is an approach that shows how we can manage bottlenecks and their associated constraints which limit throughput until they are removed. A straightforward way to identify delays around paperwork using 'tags' attached to organisational documents. Using this tool, a cross functional team can produce a visual map of how things operate now, identifying all the steps in a patient's pathway. It also helps the team to identify a strategy to implement change. Much artificial variation is caused by the systems we set up and our patterns of working. This tool outlines a number of approaches you can use to reduce artificial variation. It may be easy to spot variation on a run chart, but why is it a problem and what do you do about it? This guide identifies ways you can manage natural variation. It can be easy to spot variation on a run chart, but why is it a problem and what is it useful to know the source of the variation? Validation is the process of checking that people who have outpatient or inpatient appointments still require them. It is a key tool for helping you manage capacity and demand on waiting lists. This tool helps you identify what the very best system of care could look like. It encourages you to look beyond 'usual thinking' and aim for what people really wish for from the health system.

You can also access a collection of improvement tools via the Improvement Network website, (jointly sponsored by the NHS Institute). The site offers free access to a suite of improvement tools to help support the needs of managers. These are accessible to public sector managers and practitioners across health, local government and police sectors. The tools cover a range of 16 topics including communication, change management and partnership working.