Complete guide to NHS quality improvement in the UK — QI methodology, patient safety initiatives, CQC outcomes, significant event analysis, mortality reviews, and QI software.
The NHS Patient Safety Strategy aims to reduce avoidable harm by 50%. 11,000 patient safety incidents are reported per week. Quality improvement is a CQC inspection domain and essential for all NHS trusts.
NHS QI Methodology
| Method | Description | Best For |
|---|---|---|
| PDSA cycles | Plan-Do-Study-Act iterative testing | Small-scale changes |
| Lean | Eliminate waste, streamline processes | Process efficiency |
| Six Sigma | Reduce variation using statistics | Defect reduction |
| Root Cause Analysis (RCA) | Investigate serious incidents | Patient safety events |
| Significant Event Analysis (SEA) | Learn from significant events | Primary care, small incidents |
| Quality Improvement Collaboratives | Trusts working together | System-wide improvement |
| Breakthrough Series | Collaborative learning over 12-18 months | Complex problems |
Patient Safety Initiatives
- PSIRF: Patient Safety Incident Response Framework — new approach to incident response
- Medical Examiners: Independent scrutiny of all deaths (not coroner-referred)
- Patient Safety Specialists: Trained specialists in every trust
- National Patient Safety Alerts: Mandatory safety alerts from NHS England
- LFPSE: Learn from patient safety events — national reporting system
- Never Events: Serious, largely preventable patient safety incidents
- Harm Free Care: Eliminate pressure ulcers, falls, UTIs, VTE
- Safety culture: Just culture, psychological safety, speaking up
Mortality Review Process
- SJR (Structured Judgement Review): Structured review of all inpatient deaths
- Case selection: 100% of deaths reviewed, detailed review for concerns
- Judgement: Structured judgement of care quality at each phase
- Learning identification: Identify learning points and improvement actions
- Action tracking: Track implementation of improvement actions
- Mortality and Morbidity (M&M) meetings: Regular departmental review
- SHMI: Summary Hospital-level Mortality Indicator — trust-level monitoring
Frequently Asked Questions
- What is NHS quality improvement?
- NHS quality improvement (QI) is a systematic approach to improving patient care using evidence-based methods. It involves: identifying problems, understanding causes, testing changes (PDSA cycles), measuring impact, and spreading successful changes. All NHS trusts must have a QI strategy and infrastructure.
- What is the NHS Patient Safety Strategy?
- The NHS Patient Safety Strategy (2019-2024, updated 2025-2030) aims to reduce avoidable harm by 50%. Key elements: 1) Patient Safety Incident Response Framework (PSIRF), 2) Medical Examiner programme, 3) Patient Safety Specialists in every trust, 4) National Patient Safety Alerts, 5) Learn from patient safety events (LFPSE).
- What is a mortality review in the NHS?
- Mortality review (Structured Judgement Review - SJR) is a structured process for reviewing in-hospital deaths to identify care quality issues. All trusts must review 100% of inpatient deaths. SJRs identify learning opportunities, prevent future deaths, and improve care quality. Medical Examiners scrutinise all deaths.