Throughout October in CLIC we are shining a spotlight on improvement – helping you learn and connect with others across health and care to make a difference.

‘Not every change is an improvement but every improvement is a change; you can’t do anything better unless you can manage to do it differently’ - Eliezer Yudkowsky.

Sometimes working in health and care can feel like constant change… and not always for the better. When improving services you need to consider what you are trying to achieve, how you will know if a change is an improvement and what changes you can make that will result in improvement.    

Measuring for improvement does not have to be complicated, can be applied to small scale changes, and can show: 

  • How well the current process is performing
  • If we have reached an aim
  • If the changes have resulted in improvement
  • If the change has been sustained

There are 7 steps to good measurement as shown in the diagram. Working through each of these systematically enables us to gather data that helps us make better decisions about how to improve our services.

Find out more about measuring for improvement in our toolkit...


Spaghetti Diagrams

Spaghetti diagrams are one of the simplest forms of data collection

They are hand or computer drawn diagrams showing the movements in a process. The movements could be information, materials/equipment or people, and drawing these out in a visual way helps us to identify where waste and inefficiencies are happening.

Repeating the spaghetti diagram after a change has been made can really help to demonstrate the improvement.

Find out more about spaghetti diagrams in our toolkit...


Plan, Do, Study, Act (PDSA) - every improvement is an experiment

PDSA (sometimes known as PDCA) is a key tool in any improvement work, and provides a framework for developing, testing and implementing change. It can be used to test out any planned improvement or change in the way we work on a small scale, in small steps.

A fundamental part of the PDSA cycle is gathering information and data to enable you to measure whether the change has resulted in an improvement.

Multiple and simultaneous PDSA cycles may be used when the planned change is complex or if further improvements are required. 

Here's a useful video giving an overview of PDS(C)A:

Find out more about PDSA in our toolkit... 


5 Whys

When gathering data, you learn about the area you are aiming to improve and gain a greater understanding of the problem. Data can help to assess if you have a problem, but it won’t necessarily explain why the problem exists. 

The idea of using 5 whys is to simply ask why something is done as it is. To the response, another why is then asked. This continues until you drill down to a full understanding of the reason for an action or process.

Moving into 'fix-it' mode too quickly might mean dealing with symptoms but leaving the underlying problem unresolved, so you can use the 5 Whys to ensure that the cause of the problem is being addressed.

Find out more about 5 Whys in our toolkit...


OGIM (Objectives, Goals, Initiatives, Metrics)

OGIM can be used at all levels of an organisation, giving structure to developing an annual plan that is linked and aligned to the organisation's vision and strategies. It is visual and simple to understand.

A particularly important part of an OGIM is the 'metrics', or your data/measurement. Displaying this for the whole team to see allow you to keep check on your progress, and ultimately keep the work on track.

Find out more about 5 Whys in our toolkit...


Improvement Story: Beech C Improvement Wall

After attending our Leading Sustainable Change Programme, Julie McColm (Beech C Ward Manager, Cumberland Infirmary, North Cumbria Integrated Care NHS Foundation Trust), created an Improvement Wall in order to improve both patient care and her team's audit results. A great example of visual control!

If you would like to know more about the work Julie and her team have been doing, please contact: