Quality Improvement (QI) and older people's health

Good practice guide
Good practices guides focus on providing information on a clinical topic.
BGS Clinical Quality Committee
Susan Went
Date Published:
21 March 2018
Last updated: 
05 December 2021

Anyone involved in the care and treatment of people in health or social care settings, will understand the importance of providing the best care possible. High quality care which is safe, equitable, efficient, effective, timely and person centred. Although much progress has been made in defining best practice, setting standards for delivery and improving the processes of care, there is still variability; there is no consistent delivery or outcomes.

Anyone involved in the care and treatment of people in health or social care settings will understand the importance of providing the best care possible - high quality care which is safe, equitable, efficient, effective, timely and person-centred.

Although much progress has been made in defining best practice, setting standards for delivery and improving the processes of care, there is still variability; there is no consistent delivery or outcomes.

Healthcare is a highly complex system, full of professional people trying to do their best, but on a daily basis clinicians, managers, support staff, and students will come across processes which do not work well. These poor processes can lead to harm, delays and waits, repeated work, frustration and complaints.

Quality Improvement (QI) goes beyond traditional management practices. It is a systematic approach that uses specific techniques to improve quality in health and care.

These methods are designed for complex systems, where the problems may not be completely understood, and the answers are not always known. They are used where change is to be made at the same time as continuation of normal work.

There are several QI methodologies. The approaches most widely used in healthcare are the 'organisational approaches'. Over the past decade these robust organisational approaches to quality improvement have spread from manufacturing, nuclear and aviation industries to healthcare. The use of these methods is about creating environments in which change and improvement can flourish, where leadership fosters a culture of innovation, and which provides the tools, techniques and training so that staff can take ownership of improving the quality of care.

Everyone who works in health or care settings understands how complex these environments are; there are numerous processes and pathways, and although most of them work well, all staff will be able to identify care processes and pathways which do not work well for staff or for patients.

Quality improvement is about enabling those who work in the health and care system to take responsibility, not just for the care which they provide but for improving the system within which they work. Organisational QI approaches provide the permission, skills and resources for staff to redesign and continually improve care to meet the changing needs of patients and communities so the care system supports delivery of the best care possible.

Over the years, several national and international organisations have developed sound reputations for championing the use of these tools and techniques in healthcare. As experience in these settings has deepened, many of the same organisations have developed freely accessible resource sites which act as repositories of their learning and sources of knowledge, learning and expertise. Most of the sites listed also provide information about national training opportunities or grants and allocations.

Some sites will focus on a single subject or a specialist area; others will target their resources for a specific level of experience. For example, Foundation level for those needing a general overview; Advanced levels of training for those who may be leading a practical improvement project or for senior staff supervising a student; up to Expert level for those contemplating a move into an Improvement role.

The following summary of sites is a starting point, it is not an exhaustive list, nor is intended to rank one source above another.

For more QI resources, you may also wish to visit the BGS QI Hub.

NHS England & NHS Improvement

NHS England and NHS Improvement lead the National Health Service (NHS) in England.

NHS England oversees the commissioning of NHS services and NHS Improvement oversees NHS Trusts, and independent providers providing NHS care, making sure that they work efficiently and that they improve service provision.

Once separate organisations, NHS Improvement and NHS England have worked together as a single organisation since 1 April 2019, to help improve care for patients and provide leadership and support to the wider NHS.

Key resources:

  • Improvement Hub
    The improvement hub brings together a wealth of improvement knowledge, information and tools from across the NHS to support the delivery of service improvement. This theme-based repository of improvement tools, ideas, case studies and resources allows teams to share projects and learn from others undertaking similar work.
  • Improvement resources
    A search tool, allowing users to drill down into all resources on the site. The data can be searched by theme, by management, by operational categories, or by specific activity.
Healthcare Improvement Scotland (HIS)

Healthcare Improvement Scotland’s (HIS) aim is 'better quality health and social care for everyone in Scotland.’

HIS deliver’s this aim through a combination of skills and experience, which brings together the national functions of Evidence, Improvement and Scrutiny in one organisation.

Key resources:

  • iHub
    The iHub is part of Healthcare Improvement Scotland and was established to support health and care staff who are delivering health and social care across Scotland to redesign and continuously improve services. It is a resource site for those involved in the practice of care.
  • Quality Improvement Zone
    The Quality Improvement Zone is a learning and resource site from the NHS Education for Scotland Quality Improvement team which provides information and resources to support people to develop their knowledge of Quality Improvement.
The Health Foundation

The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK.


Key resources:

  • Improvement projects
    The Health Foundation funds hundreds of projects around the UK that are testing ways to improve the quality of health services. Their listing has a range of categories you can search by to help you find work that The Health Foundation has funded that relates to the areas you're interested in, offering ways to get ideas and inspiration for your improvement work.
  • Publications
    The Health Foundation publications include numerous QI papers, reports and project evaluations including a useful quick guide Quality Improvement Made Simple.
The Royal College of Physicians

The Royal College of Physicians (RCP) London is the British professional membership body dedicated to improving the wider practice of medicine. RCP Quality Improvement (RCPQI) is a team within RCP which aims to bring together existing quality improvement work, as well as developing new infrastructure and approaches.


Key resources:

  • RCP Quality Improvement resource page
    This page, prepared by RCP Quality Improvement (RCPQI) provides links to external quality improvement resources and other healthcare organisations focused on quality improvement work. Most of them are separately referenced on this BGS web page.
The Academy of Medical Royal Colleges

The Academy of Medical Royal Colleges (AOMRC) is the coordinating body for the UK and Ireland’s 24 medical Royal Colleges and Faculties. The Academy ensures that patients are safely and properly cared for by setting standards for the way doctors are educated, trained and monitored throughout their careers.


Key resources:

Healthcare Quality Improvement Partnership (HQIP)

The Healthcare Quality Improvement Partnership (HQIP) was established in April 2008 to promote quality in healthcare, and in particular to increase the impact that clinical audit has on healthcare improvement. It is an independent organisation led by the Academy of Medical Royal Colleges, The Royal College of Nursing and National Voices.


Key resources:

  • HQIP resource page
    This page provides information and resources to support the use of the national clinical audit and patient outcome programme (NCAPOP) to stimulate healthcare quality improvement. It also includes Quality Improvement resources and an A-Z of clinical audit networks.
The International Society for Quality In Health Care

The International Society for Quality In Health Care (ISQua)’s mission is to inspire and drive improvement in the quality and safety of healthcare worldwide through education and knowledge sharing, external evaluation, supporting health systems and connecting people through global networks. They have a network which spans 100 countries and 5 continents. Access to resources is offered through several routes, some are open access, others as part of a defined educational programme other on a membership basis.

Key resources- ISQua offers material as part their

The Institute for Healthcare Improvement

To help you with your improvement efforts, The Institute for Healthcare Improvement offers free tools, change ideas, measures to guide improvement, IHI White Papers, audio and video, improvement stories, and more.

Key resources:

  • IHI resource page

    On this site you can learn about the Model for Improvement, forming the improvement team, setting aims, establishing measures, and selecting and testing changes. The importance of measures, and the types of measures you will need to tell a team whether the changes they are making actually lead to improvement. The types of changes to select and which ones are most likely to lead to the improvement you are trying to achieve.

    The site also hosts improvement stories and many tools which organisations have developed as part of their local improvement projects.

    IHI white papers, audio and video content is also accessible through this page.

IHI Open School

The IHI Open School brings you essential training and tools in an online, educational community to help you and your team deliver excellent, safe care. When you engage with the Open School courses and Chapters, you join more than 500,000 learners from universities, organisations, and health systems around the world in building core skills in improvement, safety, and leadership.

Key resources:

  • Teaching Resources: Tools for Training Students and Staff in QI
    ​​​​Institutional faculty and organizational leaders around the world rely on the Open School courses as an easy way to bring essential training in quality improvement and patient safety to students and staff — creating a common language around improvement and giving learners crucial skills to become leaders and agents of change in health care.

To help make it easier to provide this training, the Open School offers a Team Tracking Tool and Educator's Toolkit as part of a group subscription. Learn more about subscription options here​.

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