Many services across CNWL are facing new ways of working as we respond to the ongoing Covid-19 pandemic and it is tempting to change without thinking; to forge ahead to ‘get the job done’.  But it can be useful to add some structure to how we make these changes.  Learning as we go can help maximise the positive impact of change for both staff and service users.

Five principles of improvement


To help us think through our changes, it is useful to consider the 5 principles of improvement and how we apply each of these steps as we make changes.

These principles may be familiar to you if you know about the QI model for improvement and it might be assumed that to ‘do change rapidly’ and follow the principles, we need to set up a QI project.  But this isn’t necessarily so! 

Actively thinking about the change and seeking feedback in real time, then acting on what you find is a powerful way of making sure that your change is making things better. 

And remembering that feedback can be as simple as a daily check in conversation, along the lines of ‘how did that go today/yesterday?’, may be all that is needed to help you adapt, adopt or abandon your change.  There isn’t necessarily a need to collect data whilst we do this kind of day to day improvement, it is more about a way of working.

Remembering the Plan Do Study Act (PDSA) cycle

So how do we make our change ‘real’?  To do this, we need to apply the PDSA cycle as a way of thinking through the change.  If we have introduced a change, we need to take a little time (sometimes only 5 minutes) to reflect about whether the change has worked; we study the effects of the change and decide whether it has been beneficial or not.  Often you can get to know this simply by hearing how it went from staff around you. 

You can then decide whether to adopt (do more of), adapt (keep the change but alter it in light of how it worked) or abandon (do less of the change because it did not work).  You have then completed a PDSA cycle!

It may be helpful to very briefly capture what you have learnt.  Using a discussion huddle around a whiteboard can be a very good way of making sure everyone in your team knows what changes have happened and what you are going to test next.

The following diagram illustrates what we mean.


Capturing the learning from a PDSA cycle need not be difficult or take lots of time and effort.  Using the template below can capture the testing as it happens.  Simply printing out one of these sheets and writing down what happened can be very useful; it does not need to be neat or ‘presentation standard’, as long as it serves the purpose of recording our learning.


An example: Personal Protective Equipment (PPE) Distribution

A good example of how using the five principles of improvement and PDSA cycles is captured in the infographic below.  In March 2020, the QI Team were redeployed to set up and run the process of distributing PPE to clinical services across CNWL.  This was highly important to keep our staff safe and the team needed to get the process up and running as fast as possible.

You can see that via a set of PDSA cycles, the team went from commencing supplies to a streamlined ordering and delivery process, with stock level management and standardised PPE distribution boxes, all within 4 weeks.  The team achieved this by using daily feedback from managers ordering the PPE and a regular testing huddle to ensure that everyone in the team was kept up to date with changes.


Contact Information

For support or further information on any aspect of improvement work in CNWL, please contact the QI Team in the Improvement Academy at: