Learning and improving across systems

The practice of improvement is increasingly recognised as a key part of the solution to the unprecedented challenges faced by today’s health and care services. 

This was demonstrated by the launch of NHS IMPACT [ref]NHS England. NHS IMPACT (Improving Patient Care Together). [/​ref], NHS England’s single shared improvement approach, in April 2023. 

The need to build improvement skills across health and care systems, such as Integrated Care Boards, and to scale improvement has never been greater. But system-level improvement is complex, involving several organisations, many people, a variety of patient pathways and a mix of challenges. 

In June 2023, the Q community, NHS Confederation and the Health Foundation launched a partnership to support health and care systems to boost their improvement capabilities.

In 2024 we hosted a peer learning programme for system leaders. Our nine-month programme brought together leaders across 38 integrated care systems, NHS trusts and health boards, local authorities and voluntary organisations across England, Scotland, Wales and Northern Ireland. We used a mix of tools, expert talks and peer discussions centred around personal inquiry questions to support leaders’ professional development and create new connections across systems. 

The partnership aimed to:

• develop learning and improvement approaches needed to meet system goals
• galvanise local improvement ideas and expertise, helping leaders connect from the board to the ​‘frontline’ of delivering change
• pool evidence and experience to understand and make progress on priority topics together
• share and scale what we’re learning across systems.

Our work together has been grounded in a learning framework. It supports leaders to recognise, navigate and holistically plan improvement to improve health and care across systems. This tool also helps work through what NHS IMPACT means in practice.

Through the partnership, we wanted to boost support for people leading improvement work at a system level.  Outputs from our partnership included:

• Practical tools and connections to support implementation in practice, such as our principles for supporting peer learning across systems.
• A report by Professor Sir Chris Ham [ref] Professor Sir Chris Ham. Improving health and care at scale: learning from the experience of systems. 2023 [/​ref] with eight case studies of systems, their approaches to improvement and the results so far.
• A podcast, Leading Improvement in Health and Care, co-hosted by Penny Pereira and Matthew Taylor.

Our partnership led us to develop System Improvement Support, a tailored service for health and care leaders and their teams to help them transform services and achieve sustainable improvement. It is delivered by Q and The NHS Alliance.