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Elements of Improving Quality and Safety in Healthcare

Our open-access series brings together critical evidence-based overviews of a diverse range of healthcare improvement approaches.

Mary Dixon-Woods introduces the series
Who is it written by?

We have worked with more than 60 leading academic and clinical experts to develop the series.

Who is it aimed at?

Researchers, people involved in training on healthcare improvement, and those interested in understanding current debates.

What will I learn?

Each Element explores the thinking behind an improvement approach, examines the evidence, and identifies gaps and challenges.

🆕 Values and Ethics

Alan Cribb, Vikki Entwistle, Polly Mitchell

This Element demonstrates the ethical considerations and values that underpin both the goals of healthcare improvement and how improvement work is undertaken. It aims to help people involved in improvement activities engage in improvement ethics by highlighting how different values are embedded and prioritised in healthcare improvement.

Explore the series

Statistical Process Control

Mohammed Amin Mohammed

This Element describes statistical process control methodology, shares case studies to illustrate its application in healthcare, and provides critiques and reflections on its current use and future role in healthcare.

Approaches to Spread, Scale-Up and Sustainability

Chrysanthi Papoutsi, Trisha Greenhalgh, Sonja Marjanovic

Examines various approaches to spreading, scaling-up, and sustaining improvements in healthcare, noting their strengths and limitations. It shares case studies to highlight how different ways of viewing spread and scale-up can make a difference in practice.

Health Economics

Andrew Street, Nils Gutacker

Looks at economic approaches that can be used to encourage improvement in healthcare, and explores how economic evaluation can be used to compare the costs and benefits of using healthcare resources in alternative ways.

Governance and Leadership

Naomi Fulop, Angus Ramsey

Analyses evidence on how governance and leadership influence quality and safety in healthcare at different levels in the health system, and shows how different leadership approaches may contribute to delivering system change.

Simulation as an Improvement Technique

Victoria Brazil, Eve Purdy, Kamal Bajaj

Reviews the role of simulation as a rapidly emerging tool in improving quality and safety in healthcare, including its current use, potential applications, and challenges.

Reducing Overuse

Caroline Cupit, Carolyn Tarrant, Natalie Armstrong

Examines the successes, promising approaches and challenges in generating and using evidence about overuse, a major issue of healthcare quality, safety and sustainability.

Workplace Conditions

Jill Maben, Jane Ball, Amy C Edmondson

Reviews the evidence for the workplace conditions that are essential for improvement: the right number of staff and skills, psychological safety, and staff wellbeing.

Operational Research Approaches

Martin Utley, Sonya Crowe, Christina Pagel

Discover key concepts and common approaches in operational research and explore its potential to help analyse and improve healthcare services.

Making Culture Change Happen

Russell Mannion

Examines the evidence for linking organisational culture to healthcare quality and performance.

Implementation Science

Paul Wilson, Roman Kislov

Critically explores the theories and strategies of implementation science, and how they are or could be applied in practice.

The Positive Deviance Approach

Ruth Baxter, Rebecca Lawton

The potential of positive deviance is largely untapped. Discover how to identify those who demonstrate exceptional performance and investigate how they achieve it.

Co-Producing and Co-Designing

Glenn Robert, Louise Locock, Oli Williams, Jocelyn Cornwell, Sara Donetto, Joanna Goodrich

Examines the origins and development of co-production and co-design, their application in healthcare, and the opportunities and challenges.

Collaboration-Based Approaches

Graham Martin, Mary Dixon-Woods

Explores the evidence for collaboration-based approaches to improving healthcare, illustrated by examples and with guidance on the key challenges involved.

Watch the Elements videos

Everything you would expect from THIS


Covering a wide range of approaches, including models, techniques, major tools and methods, organising structures and strategies.


Sets out the evidence for how each approach has been used and to what effect, but without advocating for the approach or acting as a how-to guide.


Written by over 60 academic and clinical experts in healthcare improvement from over 40 organisations in the UK, Canada, France, Australia, and the USA.


Thorough editorial and peer-review process to ensure the content is accurate, accessible, and engaging.

Open access

Freely available online (under a CC-BY-NC-ND licence).

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