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Improving Improvement

A toolkit for Engineering Better Care


Understand Stage

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




The following steps, described in more detail in the Understand Stage Guide, describe possible elements of a systems-based approach for planning the Understand 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 — Identify key stakeholders, their interest in the system and potential to influence the outcome of the process.

(3) Stakeholder Needs — List the full range of stakeholders’ essential needs and their particular reasons for these needs.

(4) System Boundaries — Highlight the extent of the systems of interest and influence relating to the scope of the proposed improvement.

(5) Rich Picture — Sketch details of the systems of interest and influence specifically relating to the scope of the proposed improvement.

(6) Design Themes — Translate the essential needs into key design themes and a prioritised, clearly articulated set of design requirements.

(7) Persona Descriptions — Co-design a representative set of personas to capture and characterise key users and/or stakeholders.

(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 understand stage plan.


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


A summary of the improvement model and its role in driving improvement is given in an Understand 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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