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Improving Improvement

A toolkit for Engineering Better Care


Sustain Stage

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




The following steps, described in more detail in the Sustain Stage Guide, describe possible elements of a systems-based approach for planning the Sustain 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 clear plan for sustaining the change to the system.

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

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

(2) Stakeholder Influence — Identify key stakeholders, their interest in the system and potential to influence the outcome of the process.

(3) Design Measurement — List the full range of stakeholders’ prioritised needs and the corresponding means to measure performance.

(4) Resilient Operation — Determine those elements of the proposed system that are core and must be present in its operation.

(5) Resilient Systems — Determine those elements of a system that are critical to resilient operation in the presence of disturbance.

(6) Design Solutions — Translate the initial ideas into viable concepts and solutions that meet the system requirements.

(7) Failure Modes and Effects Analysis — Identify the causes of all possible failures in the system and their consequent risk.

(8) 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 sustain stage plan.


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


A summary of the improvement model and its role in driving improvement is given in a Sustain 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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