Improvement Science - Elizabeth Bradbury

Date: 19 May 2016

Authors: Elizabeth Bradbury, Director AQuA and Nicki McNaney, AQuA Affiliate

Definition: Improvement science is a body of knowledge that describes how to improve safely and consistently (The Health Foundation, 2011).

As a quality improvement organisation, quality improvement science underpins all AQuA’s work and is focused on helping organisations and systems to develop the capability and capacity to improve care. This includes the quality, safety, experience and outcomes of care in all settings whilst achieving value for money. Because we recognise that all place-based change programmes will be highly individual and that the improvement knowledge and skills capability within each locality will vary, our approach to improvement is flexible. Some systems have committed to using lean thinking, others to the Model for Improvement or have used a blend of several techniques; our intention is not to derail the improvement that is underway by introducing large scale change and complexity theories and their associated techniques, but to demonstrate how they can complement one another.  For example, driver diagrams, simple rules and pattern mapping techniques enabled the leadership teams to make sense of the complexity of their interrelated work streams, to explore cause and effect and to align their work to a clearly defined system goal.

AQuA’s uses a three-tier model (Figure. 3) that works from micro to macro levels of the systems to illustrate the need for large scale capability building at all levels and illustrates relevant improvement approaches.



AQuA has found that there needs to be considerable experience in the application of improvement science within the system leadership team in order to operationalise the change concepts at scale and pace across a system. This requires the local leaders and programme faculty to be fluent in a wide range of improvement approaches and tools that can be deployed to enable staff at all levels to test, embed and sustain successful changes and then to manage scale and spread.

Developing capability and capacity for improvement across the system requires skills in training teams, mentorship and coaching for improvement. AQuA’s experience is that coaching moves beyond the system leadership team as transformational work gains momentum and encompasses more people.  This necessitates long term quality improvement advice and support to be available, and ideally to be embedded within the locality teams. 

Critical to any improvement initiative is the ability to gauge progress and ask whether the changes have improved the situation. Considerable time has been devoted to supporting programme teams with system measurement frameworks aligned to the three tiers in Figure 3. The ‘big dot’[1] population outcomes measures are aligned to the system level and reflect the programme aims; the service and team level measures include a mixture of shorter teams process and balancing measures aligned to primary and secondary work streams.  AQuA’s System Integration Framework Assessment (AQuA, 2012) offered teams an opportunity to reflect on the human angle of transformational change and to measure individual and team views on the strength of their relationships, the degree of collaborative working and their progress against the eight key enablers of system integration.



AQuA (2012) System Integration Framework Assessment Tool.  Manchester: AQuA.

The Health Foundation (2011) Evidence scan: Improvement Science.  London: The Health Foundation

[1] By ‘big dot’ measures we mean the indicators or overarching system measures that would indicate achievement of transformational change over time. In this case the big dot measures are related to improved population indicators.