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Improving Improvement

A toolkit for Engineering Better Care


Initiate Stage

This section provides a brief description to the application of a systems approach to the initiate stage of health and care design and continuous improvement.




The following steps, described in more detail in the Initiate Stage Guide, describe possible elements of a systems-based approach for planning the Initiate Stage of an improvement process — leading to a description of the current system (now), a common understanding of the problem, a consensus view of what the future system might look like (better) and a clearly articulated case for changing the system.

(1) Improvement Canvas — Describe the context and nature of the challenge and current ideas for improvement and measurement.

Agree the scope of the proposed improvement or decision-making process and identify the team required to deliver it.

(2) Stakeholder Influence — List the desired outcomes of the improvement process and the resources and permissions required to deliver them.

(3) Theory of Change — Develop a comprehensive description and illustration of how and why a desired change is expected to happen.

(4) Stage Plan — Define the outputs or outcomes required for the each of the elements of the improvement or decision-making process.

Select the activities and tools required to deliver these outputs and the critical dependencies between them.

Use the Questions Map poster to identify the key questions that would help to deliver the outputs required.

Alternatively, use the Stage Activities poster to identify the improvement activities that would help deliver the outputs required.


A sample of possible Activities which may be added to the initiate stage plan.


A sample of possible Tools which may be added to the initiate stage plan.


A summary of the improvement model and its role in driving improvement is given in an Initiate Stage Guide, designed to facilitate the early planning of an improvement process. This guide accentuates the role of stakeholder analysis, problem structuring using an improvement canvas, and planning in ensuring the right people are solving the right problem.

The guide provides an introduction to the improvement process and further detail can be found in the resources section of the toolkit and in the sections that follow.

Useful toolkit resources: printable PDFs for all of the Stage Guides are included in the Stage guide PDFs part of the Resources section.



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