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Improving Improvement

A toolkit for Engineering Better Care


Quality, Service Improvement And Redesign

The Quality, Service Improvement and Redesign programme is the latest iteration of the NHS programme that has been delivered to staff involved in healthcare.




The Quality, Service Improvement and Redesign (QSIR) programmes are the latest iteration of a highly

successful service improvement programme that has been delivered over many years to hundreds of staff involved in healthcare. Delivered in a variety of formats to suit different levels of improvement experience, the QSIR programmes are supported by publications that guide participants in the use of tried and tested improvement tools and featured approaches and encourage reflective learning1.

The QSIR programmes suit clinical and non-clinical staff involved in service improvement within their organisation and/or system. Each cohort typically consists of people from a range of backgrounds and professions. This helps to make the programmes vibrant, with wisdom in the room from a range of perspectives, providing a rich learning environment.

The QSIR programme provides access to insights, frameworks, models, tools and techniques related to a number of key improvement issues2:

  • leading improvement
  • project management
  • measurement for improvement
  • sustainability of improvement
  • engaging and understanding others
  • creatively in improvement
  • process mapping
  • demand and capacity.

QSIR College develops candidates to a level where they are assessed and accepted as associate members of the QSIR Teaching Faculty and go on to skill up other staff in their local systems. Each successful candidate commits to deliver QSIR Practitioner to a specified number of cohorts in their organisation/system to ensure a significant number of staff are trained in quality, service improvement and redesign skills and thus are able to harness the capability necessary to deliver quality and improvement projects across their local systems.



  1. Quality, service improvement and redesign. NHS Improvement, 2017.
  2. The Handbook of quality and service improvement tools. NHS Institute for Improvement, 2010.

Getting Started

Leading Improvement

Tools, models and frameworks to help an improvement leader to create a shared vision and to manage the challenges of developing a supportive culture and engaging others in improvement (e.g. case for change, mind-set changes, and aligning improvement and vision).

Project Management

Tools, models and frameworks to support the preferred project management approach, from the initiation to the completion of a project (e.g. qualitative data, six stage approach for project management, SMART goals, project charters, and model for improvement including PDSA cycles).

Measurement for Improvement

Topics, tools and techniques to help organisations, teams and individuals understand the importance of measurement for improvement (e.g. the perils of RAG ratings, understanding variation, defining your aim, driver diagrams, run charts/ SPC charts, and investment for improvement).

Sustainability of Improvement

Tools and techniques to identify strengths and weaknesses within implementation plans and predict the likelihood of sustainability for improvement initiatives (e.g. sustainability frustrations, factors affecting sustainability, and applying the NHS Sustainability Model).

Engaging and Understanding Others

Tools and techniques to identify, understand and engage with key stakeholders for service improvement initiatives (e.g. stakeholder identification and communication, engaging clinicians, involving patients, human dimensions of change, and working with resistance).

Creatively in Improvement

Tools and techniques to assist with the generation of new solutions and perspectives to an issue, problem or improvement opportunity (e.g. mental valleys, creative techniques to explore problems, observation, idea generation, harvesting ideas, and testing new ideas).

Process Mapping

Tools and techniques to create a visual picture of how the pathway currently works within a team and across functional and organisational boundaries (e.g. what is a process map?, identifying sources of waste, current and future state mapping, and facilitating a mapping event).

Demand and Capacity

Tools and techniques to better understand and manage demand and capacity in any environment, and to improve flow and decrease waiting times (e.g. understanding demand, capacity, activity and backlogs, understanding flow, why do we get queues?, and how do we balance demand and capacity?).


NHS Improvement (2021). Quality, service improvement and redesign programmes: providing participants with the know-how to design and implement more efficient and productive services. NHS Improvement.


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