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Improving Improvement

A toolkit for Engineering Better Care


Agree the Scope

The scope describes the context of the improvement envisaged in terms of the extent of the ambition for improvement and the boundary of the system of interest.




The need to Agree the Scope is the last of the seven strands in the improvement model. It underlines the importance of reflecting on all that has been learned from the previous six elements, namely: understanding the system, defining the problem and developing the solution, collecting the evidence, making the case and managing the plan. The result should be an agree statement of the scope of the improvement programme which may be refined, as appropriate, as the process develops.


Agreeing the Scope has vital importance to systems improvement: exploring the context of the challenge and possible solutions; establishing a clear case for change and plan for delivery; and developing a clear statement of the intended scope of the improvement to the system.


The process of collecting the evidence may include a wide range of activities including, but not limited to: Agree Aim Statement.


The practice of agreeing the scope may draw on a wide range of tools including all those that may be used to address the other six elements of the improvement process, but is likely to be focused on discussions by the improvement team.

Getting Started

Agreeing the scope is vital to the successful evaluation of an improvement project. It is particularly important to agree the scope from the beginning of the improvement process and to update the description as necessary during the remainder of the process.

The Understand, Design, Deliver and Sustain stages of an improvement process were previously described within the Introduction section, where each stage will likely comprise a preliminary activity, followed by a number of stage activities.

For the Agree the Scope strand of the Understand phase, the preliminary activity is entitled Challenge the Scope. This encourages the team to discuss the most appropriate programme scope to respond to the proposed solution(s) for improving the system. For the Design, Delivery and Sustain stages, the scope should be revised to ensure the intended benefits remain appropriately focused.

Challenge the Scope

This preliminary activity encourages people to consider different levels of scope and pick the most appropriate level for the project to succeed and discuss the most appropriate programme scope to respond to the proposed solution(s) for improving the system.

Worksheets: Improvement Questions, Improvement Stakeholders, Improvement Stands Canvas, Improvement Plan

Top tips:

  • Expand the scope by asking why does this happen?
  • Consider the balance of risk and reward for different levels of scope
  • Review the system sketches and identify what is in or out of scope

Following on from this preliminary activity, the remaining stage activity is Agree Aim Statement. This is now described, together with the tools that may be used to support it.


Agree Aim Statement

The drafting and communication of an agreed statement of purpose and direction of improvement for the system

Purpose: to agree and communicate a clear description of the overall aim for improvement of the system

Inputs: Define Requirements, Develop Concepts, Synthesise Evidence, Present Case for Change

Tools: tbd

Worksheets: Improvement Strands Canvas

Outputs: a succinct statement describing the overall aim for improvement of the system

Top tips:

  • Consult likely stakeholders and influencers to define the aim
  • Define realistic targets for the overall improvement process
  • Establish a clear and effective communication strategy


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