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Innovation and Improvement Clearinghouse

*The Innovation and Improvement Clearinghouse is a Ko Awatea resource supporting health system innovation and improvement.


What's new - Latest MUST Reads
Selected documents and resources
Selected learning opportunities
Staying current
Innovation and improvement at Counties Manukau Health & Ko Awatea
Innovation hubs (NZ)
Innovation hubs (International)


What's New

Spotlight on Innovation and Improvement.  Latest MUST Reads



Building a Better Operating Room: Views from Surgery and Architecture

The operating room is the single most important place in the hospital for surgeons. Despite enormous innovation in surgical practice, relatively fewer advances have been made to the actual operating room itself. New technology and devices have been introduced to crowd the space, but changes to the actual lay out and how to organize the room remains largely unchanged. Indeed, many of the design shortcoming described by surgeons 4 decades ago—“faults in equipment, inaccessibility of necessary items, problems in communication, inefficient handling of materials, unconscionable delays … that are an expression of a hazardous environment”1—could readily be identified by surgeons today.

The problem of building a better operating room is not new and arises largely from knowledge gaps between architects and users of the operating room. Many surgeons and nurses who have been involved in operating room planning and are around to occupy that space afterwards are often disheartened by the gap between their suggestions and the result. The architects, however, are faced with enormous constraints—budgets, regulatory codes, materials limitations—that they cannot or do not communicate well. Revisions made to accommodate these constraints can often make the initial plan unrecognizable leaving care providers wondering why they ever offered their input to begin with.

In this perspective, we take both an architectural and surgical view to outline current limitations of operating room design and emerging solutions to facilitate improvement

Driving improvement: Case studies from eight NHS trusts

Care Quality commission

We spoke to staff, patients and local patient representative groups at eight trusts that have shown significant improvement.

We set out to explore what a selection of NHS trusts had done to become 'well-led'. We chose eight trusts that had shown significant improvement since a previous inspection.

We asked people in those trusts how they had achieved improvements, looking at the steps their leaders had taken and the effect of those actions on staff and patients.

We interviewed a range of people from each trust, including chief executives, medical and nursing directors, non-executives, heads of communications, frontline staff, patient representatives and external stakeholders.


Mindshift: activities for teams, innovators and change agents

BC Patient Safety & Quality Council

This resource is intended to facilitate working with groups to accelerate improvement through interactive team-building activities. It is designed to develop communication skills, model adaptive systems, shift culture, and foster innovation, creativity, and thought diversity.

For each of the activities in this resource, we outline the purpose, category, instructions, time commitment/range, number of participants, resources required, and debriefing notes.


Pulling out all the stops: How a focus on whole-system flow can drive greater collaboration and improve quality

NHS Confederation 

Healthcare today is all about cooperation. Everywhere you look new networks, federations and communities of practice are emerging. 

Acute providers that once had little inclination, or, they argued, the time to look beyond their own walls are forging ties with their primary and community care neighbours. Multi-professional working, once the exception, is now the norm in many parts of the NHS. And innovative ways of capturing and using data from multiple organisations are now being developed. 

All of this activity is helping to improve the quality and safety of patient care. But there is still plenty of work to do. 

Many of these fledging collaborations are still feeling their way and are a long way from being embedded into the healthcare landscape. Overcoming the legacy of 70 years of siloed working within the NHS and professional divides that often go back even further is far from easy. Nor are there any shortcuts or quick fixes: mandating collaborative working, or trying to force the issue through structural change, doesn’t work – this much we know from previous re-organisation attempts.

So what can we do to build on what’s been done to date and galvanise the rest of the healthcare system? One area of real potential is flow, or more specifically, the way in which patients, staff, information and resources flow between services and organisations. Read more


David Oliver: Should practical quality improvement have parity of esteem with evidence based medicine?  


As I qualified in 1989, my career has coincided with the growing evidence based medicine movement. It’s been a major advance in evaluating clinical interventions, defining best practice, and moving beyond a reliance on expert opinion or tradition. It’s given us methodologically consistent systematic reviews such as Cochrane, and evidence based guidelines such as those from NICE.123

Medics learn that good systematic reviews and meta-analyses top the evidence pyramid, then randomised controlled trials (RCTs).45 In conventional evidence based medicine, even good local observational and implementation data are ranked as less weighty evidence. This may skew our world view—making it harder for quality improvement (QI) work to find academic funding, prestige, or publication impact.

Shouldn’t we start giving QI work equal status to evidence based medicine, given its powerful ability to tackle pressing and relevant problems in individual systems and services in real time? Read more


Raising the Bar on the National Patient Experience Survey: Report Findings and Recommendations 

Health Quality and Safety Commission 

Raising the Bar on the National Patient Experience Survey responds to the national inpatient experience survey results by investigating the lower scoring areas of the survey and recommending interventions to improve these results. Four DHBs participated and provided opportunities for staff and patients to explore the reasons behind the responses to information about medication side effects and discharge from hospital through interviews, observation and focus groups. The results suggest there are interventions that could improve the experience for patients and staff and lead to improved patient outcomes, reduced readmission rates, and reduced health care costs associated with these readmissions. 


Pushing the frontiers of improvement research

Health Foundation

Since 2010 the Health Foundation has been investing in and promoting improvement research; the work they have supported has improved care and altered national policy. We are delighted that the Foundation is now investing around £40 million in the establishment of an improvement research institute. This new organisation is being set up and run by the University of Cambridge, working closely with a wide range of partners including the health service, university and charity sectors and from other sectors across the UK.

Our vision for the institute is bold and ambitious: we want to create the enabling infrastructure for the NHS to become the world’s largest producer of systematic learning about how to improve health care for patients. To do this, we will use innovative approaches ranging from citizen science through to large-scale research capacity building, and we will be working directly with patients themselves as partners.

The basic principle behind the institute is a simple but important one: we need to get better at getting better at delivering healthcare, and one way to make that happen is by creating a better evidence-base for improvement.  Read more


Fresh thinking about the evidence needed for a healthier UK

Health Foundation

The Health Foundation is working with Dr Harry Rutter from the London School of Hygiene and Tropical Medicine to develop a new model of evidence that will inform the policy and action needed to make our population healthier. We spoke to Dr Rutter about the challenges inherent in generating and using evidence in new ways, and how traditional measures alone don’t capture the complexity of work in this area.

Enabling self management support

Ko Awatea 

Ko Awatea has published a guide to enabling self-management support which describes programme options to deliver this type of support and the patient, clinician and service activators that enable these options.

The guide, Enabling self-management support, is based on learning from Ko Awatea’s Manaaki Hauora – Supporting Wellness campaign, which aimed to provide self-management support for people living with long-term conditions in Counties Manukau.

The Manaaki Hauora – Supporting Wellness campaign covered 16 collaborative teams in different settings and clinical contexts, each of which worked towards a unique aim that contributed to the overall campaign goal. Ten of the teams, whose projects demonstrated the greatest reach and impact, are featured in the guide.

Self-management support options that demonstrated reach and impact in the Manaaki Hauora – Supporting Wellness campaign include the use of peers to engage with and support patients, personalised self-management support, health passports, the use of health coaches, generic and condition-specific group-based self-management support, group care planning, and ongoing support.

These options work well when the patient, the clinician and the healthcare system are activated.

The campaign also identified six system-level enablers which must exist in complement with factors that activate patients and clinicians to establish and deliver self-management support services that work well and make a difference for people with long-term conditions.

“The support of senior managers to address barriers is important, as is making resources available. The use of co-design and collaborative methodology provides quality improvement teams with a framework for ensuring that services and resources meet the needs of patients and their families and putting improvement initiatives into practice. Quality improvement project teams also need passionate leadership, and they are more likely to succeed if staff turnover is low during the project period or succession planning is in place,” says Ms Dowdle. 


The APAC Forum Report 2016

Ko Awatea has published key learning from the 5th APAC Forum in The APAC Forum Report 2016. The report captures the highlights from the 5th APAC Forum to create a permanent, written record of the most valuable insights and ideas presented at the conference. 
The APAC Forum Report 2016 covers:

15 in-depth, full-day intensives, covering topics from leadership to gamification, mindfulness to patient safety
four inspiring and diverse keynote addresses from world-renowned presenters
48 concurrent sessions that examined key issues in healthcare and provided practical examples of change in action
six short, powerful InSight talks designed to inspire and incite action to improve and transform health and care
winners in eight categories in the Ko Awatea International Excellence in Health Improvement Awards
winners in six categories in the Poster Awards.

 A summary of the insights from each is presented in the report.


New paper highlights national success implementing orthopaedic ERAS 

Ko Awatea 

A paper published by Ko Awatea and the Ministry of Health in the New Zealand Medical Journal shows how 18 DHBs are implementing Enhanced Recovery after Surgery (ERAS) protocols in their orthopaedic services.

The paper, Implementation and effects of Enhanced Recovery After Surgery for hip and knee replacements and fractured neck of femur in New Zealand orthopaedic services describes the implementation of ERAS for elective hip and knee joint replacement and acute fractured neck of femur, and its effects.

ERAS comprises an evidence-based, multimodal, patient-centred rehabilitation programme for patients undergoing surgery. It is known to significantly improve surgical outcomes for patients and the cost-effectiveness of care.

The National Orthopaedic ERAS Collaborative, launched in 2013, implemented ERAS protocols using IHI Breakthrough Series (BTS) collaborative quality improvement methodology.

Compliance with the elements that make up ERAS increased from 33% to 75% for knee replacements, from 31% to 78% for hip replacements, and from 29% to 51% for fractured neck of femur. The length of time patients spent in hospital for knee joint replacement fell from 5.4 days to 4.5 days, and for hip replacement from 5.1 days to 4.3 days.

“ERAS can be difficult to implement because it requires all members of a multidisciplinary peri-operative team to work together to implement identified protocols. The National Orthopaedic ERAS Collaborative shows that BTS methodology works to implement ERAS on a large scale,” says Suzanne Proudfoot, Projects and Campaign Manager, Ko Awatea.

“When you look at the success we’ve had with this and our Target CLAB Zero collaborative, which reduced the national CLAB rate in intensive care units by 96%, you can see the potential of this methodology to address other problems in healthcare.”


Leading a Culture of Safety: A Blueprint for Success


Patient safety experts and researchers have increasingly pointed to the role of organizational culture in the success of patient and workforce safety initiatives. Yet, creating a culture of safety in healthcare settings has proven to be a challenging endeavor, and there is a lack of clear actions for organizational leaders to take in developing such a culture. 

Leading a Culture of Safety: A Blueprint for Success was developed to bridge this gap in knowledge and resources by providing chief executive officers and other leaders with a useful tool for assessing and advancing their organization’s culture of safety. This guide can be used to help determine the current state of an organization’s journey, inform dialogue with the board and leadership team, and help leaders set priorities. 

The high-level strategies and practical tactics in the guide are divided into two levels:

The foundational level provides basic tactics and strategies essential for the implementation of each domain.
The sustaining level provides strategies for spreading and embedding a culture of safety throughout the organization. 



Open innovation in health: A guide to transforming healthcare through collaboration 


What role can open innovation play in addressing health challenges around the world? In this report, we explore the ways that companies, governments and researchers around the world are collaborating to improve the innovation process in health, from the way that problems are identified to how new products and services are created and then adopted by providers of healthcare.

The guide is the result of a collaboration with the State of São Paulo and the UK government and involved testing open innovation methods in Brazil through two pilot projects. It identifies open innovation approaches across the innovation cycle.


The Winter’s Tale: Leadership lessons from Emergency departments under pressure

Institute of Healthcare Management

The report focuses on the processes and behaviours of the emergency teams that are managing to deliver outstanding results despite the ever increasing challenges. The report is a must for anyone that works in or interacts with A&E departments or is interested in how human factor changes can positively influence difficult situations.

This report highlights the importance of using data to identify and shape solutions to this challenge; listening to the people in the frontline, staff and patients; and of planning improvement as part of a whole system.  


Caring to change : How compassionate leadership can stimulate innovation in health care

King’s Fund

This paper looks at compassion – which involves attending, understanding, empathising and helping – as a core cultural value of the NHS and how compassionate leadership results in a working environment that encourages people to find new and improved ways of doing things.

 It also describes four key elements of a culture for innovative, high-quality and continually improving care and what they mean for patients, staff and the wider organisation: inspiring vision and strategy positive inclusion and participation enthusiastic team and cross-boundary working support and autonomy for staff to innovate.

The paper also presents case studies of how compassionate leadership has led to innovation.


How Cultural Alignment and the Use of Incentives Can Promote a Culture of Health: Stakeholder Perspectives


This report draws on interviews with Culture of Health stakeholders whose work focused on culture, incentives, or both to learn how organizations are addressing and leveraging culture and incentives to promote health and well-being. 

Key findings include the following:
Equity is often addressed in silos, which impedes progress toward a unified goal of health equity for all;
members of specific cultural groups need to be given a voice in health-related activities;
systems are built around prevailing cultural norms, making it challenging for those working with specific cultures to make cultural adaptations; and not all incentives are monetary. 

Recommendations include institutionalizing practices that ensure ongoing input from marginalized populations, identifying ways to help smaller organizations overcome structural inequalities, and institutionalizing health promotion efforts in sectors other than public health or health care to sustain collaborative efforts. 


Increasing patient engagement in healthcare service design: a qualitative evaluation of a co-design programme in New Zealand

Patient Experience Journal

The Health & Quality Safety Commission New Zealand commissioned Ko Awatea, an innovation and improvement centre, to deliver a co-design programme to nine teams of healthcare providers. The co-design programme was part of Partners in Care, a broader programme developed in 2012 to support and enable patient engagement and participation across the health and disability sector.  Health professionals identified key challenges to patient engagement as capturing diverse experiences, clear communication of project details and the availability and health of the patient. Patients advised the importance of improved communication, planning in advance and providing feedback and assurance about the value of their contribution. There are several important considerations to secure and maintain patient engagement in co-design. These include tailored strategies for approaching patients and capturing their experiences, pre-existing relationships and continued rapport building between patients and health professionals, good communication throughout the project, planning, and visibility of outcomes.


Spotlight on Innovation and improvement MUST reads - archive


Latest publications

Publications archive


Newsletters and Updates

Grey Matter
Grey Matter is compiled by the Ministry of Health Library and provides access to a selection of the most recent NGO, Think Tank, and International Government reports that are relevant to the health context.

Transforming Care: Reporting on Health System Improvement [Commonwealth Fund]
Quarterly newsletter focuses on new models of care and patient engagement.

The Edge- Cutting edge ideas curated by the innovation hub team at The Edge

Health in the news

Latest health news


Research Review [NZ]
Research Review is an independent publishing company that harnesses the expertise of New Zealand's leading specialists to select and advise on the most important medical research and the local implications. We condense what's important and bring it to subscribers on a regular basis as a four page summary with a specialist opinion and a web link to the full study. The Reviews keep medical professionals up to date in over 40 interest areas.

Health Systems Evidence database
Maintained by McMaster University this database is a comprehensive, free access point for evidence to support policy makers, stakeholders and researchers interested in how to strengthen or reform health systems or in how to get cost-effective programs, services and drugs to those who need them.

BMJ Quality improvement Reports

A new searchable repository of global quality improvement evidence and best practice.
Search BMJ Quality improvement Reports
or Browse by topic
Implementation Science
Implementation Science is an open access, peer-reviewed online journal that aims to publish research relevant to the scientific study of methods to promote the uptake of research findings into routine healthcare in clinical, organisational or policy contexts.
Healthcare Transformation
Peer-reviewed, open access journalzine, delivers foremost research in re-imagining healthcare delivery, education, technology, innovation, and discovery.
Counties Manukau Health Library Innovation and Improvement Clearinghouse Super Search
A customised google super search engine to retrieve the latest news, developments and publications from more than 70 leading innovation hubs worldwide.
Research HINTS
When searching databases such as PubMed / Medline / CINAHL add "quality improvement" as a subject heading ( MeSH) to your search.
When looking for Randomised Controlled Trials and/or Systematic Reviews in an area identified for improvement do your subject search on PubMed and then use the 'Article type' filter to only include RCTs and systematic reviews in your results list.
Example :
SEARCH: AND "quality improvement"[MeSH Major Topic] AND (Randomized Controlled Trial[ptyp] OR systematic[sb])

Search Strategy Used to Create the Systematic Reviews Subset on PubMed

This strategy is intended to retrieve citations identified as systematic reviews, meta-analyses, reviews of clinical trials, evidence-based medicine, consensus development conferences, guidelines, and citations to articles from journals specializing in review studies of value to clinicians. This filter can be used in a search as systematic [sb].

     Example: exercise hypertension AND systematic [sb]

This filter is also available on the Filters sidebar under "Article types." It is also available on the Clinical Queries screen.  Use the  'Clinical Queries'  search template in PubMed to identify Systematic Reviews on your topic of interest.
When reviewing abstracts identified in your search results on PubMed use the 'Similar articles' and 'Cited by' features to read more widely on the topic.

Selected documents and resources

Open innovation in health: A guide to transforming healthcare through collaboration [Nesta, 2017] 

Caring for Quality in Health: Lessons Learnt from 15 Reviews of Health Care Quality [OECD, 2017]

Care Redesign Guide [IHI, 2017] 

Building the foundations for improvement: how five UK trusts built quality improvement capability at scale within their organisations [Health Foundation]

Exploring the links between quality improvement strategies and organisational outcomes in four New Zealand district health boards [NZ MoH, 2016]

Performance Improvement Framework: Core Guide 3: Getting to great: Lead reviewer insights from the Performance Improvement Framework [NZ State Services Commission] 

Evaluation: what to consider. Commonly asked questions about how to approach quality improvement in health care [Health Foundation]

Communications in health care improvement - a tool kit [Health Foundation]

Using communications approaches to spread improvement [Health Foundation]

Overcoming challenges to improving quality [Health Foundation, 2012]

Findings from a survey of healthcare delivery innovation centers [Commonwealth Fund]

Leading large scale change: a practical guide. Part 1 [NHSIQ, 2014]

Leading large scale change: a practical guide. Part 2 [NHSIQ, 2014]

Improving quality and achieving equity: a guide for hospital leaders [Disparities Solutions Centre]

Roadmap to Reduce Disparities: a six-step framework for healthcare organisations to improve minority health and foster equity [Finding Answers: Disparities Research for Change]

The Art of Making Change - theories, approaches, tools and techniques for creating meaningful change [Leadership Centre, 2015]

A guide to quality improvement methods [HQIP, 2015]

Quality improvement made simple: what everyone should know about healthcare quality improvement [Health Foundation, 2016]

RCEM Quality Improvement Guide: a practical guide for clinicians undertaking quality improvement in Emergency Departments [RCEM, 2016]

Evidence scan: Quality improvement training for healthcare professionals [Health Foundation, 2016]

Crossing the quality chasm:a new health system for the 21st century [NAP. 2001]
see also 10 New Rules to accelerate healthcare redesign

Improving care delivery through Lean: implementation case studies [AHRQ, 2014]

The CAHPS Improvement Guide [AHRQ]

Improving Patient Safety in Hospitals: A Resource List for Users of the AHRQ Hospital Survey on Patient Safety Culture [AHRQ]
This document contains references to Web sites that provide practical resources hospitals can use to implement changes to improve patient safety culture and patient safety.

Standards for Quality Improvement Reporting Excellence [SQUIRE]

Designing and growing innovation: a case study [State Services Commission study of Canterbury District Health Board]

Experience Based Co-Design Toolkit [Kings Fund]

Health Service Co-Design Toolkit [Waitemata DHB, NZ]

Co-design: shared perspectives on authentic co-design: putting consumers and carers at the center of mental health reform (Co-design Initiative, 2016)

The quest for integrated health and social care: a case study in Canterbury, New Zealand [The Kings Fund]

Stewarding regional health transformation: a guide for changemakers [ReThink Health, 2015]

Global Diffusion of Healthcare Innovation - Report of the GDHI Working Group 2015

Performance Improvement Framework [NZ State Services Commission]

A directory of organisations, groups and teams that support innovation, improvement, leadership development and systems leadership in the UK [NHS] 

Posters on healthcare improvement and innovation presented by Ko Awatea and our international partners at the APAC Forum and other symposia [Ko Awatea]

Who's who in healthcare sustainability? [Counties Manukau Health]

 see also


Case Studies, Posters and Examples of Innovative Practice:
Accreditation Canada; Commonwealth Fund; Health Foundation; IHI; Ko Awatea KoLab; NHS Improving Quality; NHS Scotland

Kings Fund Reading Lists
Contain selected references on a wide range of healthcare topics


Selected learning opportunities


Ko Awatea
Exciting programme of courses, workshops and learning events hosted by Ko Awatea - see also APAC - Asia Pacific’s premier healthcare conference, managed by Ko Awatea, the centre for health system innovation and improvement at Auckland’s Counties Manukau Health.

Ko Awatea LEARN
LEARN is an interprofessional educational community that gives healthcare professionals the skills they need to become change agents in health care improvement.  We’re talking about skills like quality improvement, patient safety, communication, leadership, and patient-centered care. Leaders are looking for these skills, and patients expect providers to have them.

Improving Together
Improving Together is a national learning programme that focusses on quality improvement for people delivering education, social services and health services. You can find out how improvement methodologies accelerate learning and innovation, and how it can be applied to improve the quality of social service delivery in New Zealand.

LEAN Thinking
LEAN Thinking is a methodology that will help you improve quality of care, increase efficiency of processes, and identify and eliminate waste. LEAN Thinking evolved in the manufacturing industry but is now routinely applied in the health sector. This course introduces the LEAN methodology and a number of associated tools to implement the methodology in your work environment.

Lifehack Resource Library
Guidelines and workshops to support design thinking to support better health outcomes. Lifehack is a space where people can come together to develop new approaches, projects and ventures, with young people at the centre of the process. We bridge backgrounds, skill sets and place, and empower young people and communities to redefine their own version of success. In short, Lifehack is the R&D ground for Youth Wellbeing interventions.

School for Health and Care Radicals
Brought to you by NHS Improving Quality, the School is entirely online, free, backed by the world’s largest health organisation: the UK’s National Health Service (NHS), and is a platform for radicals to learn together, using powerful, guided learning which also qualifies for Continuing Professional Development points.

Learning opportunities for change activists (curated by The Edge)
"We’ve searched through many pages and sources of free online courses that will offer you the very best opportunities to learn and develop as a change activist."

IHI Open School Video Library (videos)
The growing library of freely available IHI Open School videos is one way to learn from health care leaders and experts from around the world as they share bite-sized pearls of knowledge and advice. In the newly reorganized IHI Open School Video Library, browse by topics such as improvement capability; patient safety; person- and family-centered care; Triple Aim for populations; quality, cost, and value; and leadership.

Health Improvement Scotland QI Global Webex series
Hour long webinars from global leaders in health care transformation and innovation.

Leading Health Systems Network (LHSN) Webinar Series
An initiative of Imperial College in partnership with the World Innovation Summit for Health (WISH)

Risky Business
Exceptional talks sharing ideas on risk, culture, human performance, teams and leaders.

TedMed talks (videos)
TEDMED is the independently owned and operated health and medicine edition of the TED conference, dedicated to “ideas worth spreading.” TED Talks have been viewed online over two billion times around the world.
"TEDMED convenes and curates extraordinary people and ideas from all disciplines both inside and outside of medicine in pursuit of unexpected connections that accelerate innovation in health and medicine".

Stanford Centre for Professional Development: Innovation and Entrepreneurship Series
View online, without charge, webinars, seminars, and lectures presented by Stanford faculty, industry experts, and senior researchers.
see also Institute of Design at Stanford
A range of free resources, and learning experiences to develop design thinking. Includes a virtual "90 minute crash course in design thinking".

Leadership in Healthcare: a Clearinghouse of Resources for Health Professionals
Curated by the Counties Manukau health Library


Staying current



Grey Matter
Research Review [NZ]
Health Improvement and Innovation Digest -
NZ Ministry of Health Library roundup of literature, research, tools and case studies
Health Roundtable Roundup
Ko Awatea Newsletter
The Edge
The Hub
On the Radar [ACSQHC)
Health Quality & Safety Commission e-update
NHSIQ Better knowledge, better care RSS Feed package


Follow (via twitter)

Counties Manukau Health [NZ]
Counties Manukau Health Library [NZ]
The Edge
Health Affairs
Health Foundation
Health Quality and Safety Commission [NZ]
Health Research Council New Zealand [NZ]
Health Roundtable
Healthcare Improvement Scotland
Institute for Healthcare Improvement (IHI)
Ko Awatea [NZ]
Māori Health [NZ]
Ministry of Health (NZ)
National Institute for Health Innovation [NZ]
NHS Improving Quality
Nuffield Trust
Nursing Review New Zealand [NZ]
NZ Doctor [NZ]
Quality Watch [UK]
Research Review NZ [NZ]
TeamHQi [NZ]
The King's Fund

See also

Health twitter handles, hashtags and tweetchats

Innovation and improvement at Counties Manukau Health & Ko Awatea


CM Health : Achieving Balance
A portfolio of work that has been developed to allow us to tackle our strategic objectives in alignment with our commitment to the Triple Aim of: improved health and equity for all populations; improved quality, safety and experience of care; and best value for public health system resources.

Counties Manukau Health Performance and Planning
Health Targets
Serious Adverse Events
Current Projects
Planning Documents
Health Status Documents

Counties Manukau Health Quality Accounts 2015/2016

Counties Manukau Health blog

Quality Improvement at Counties Manukau Health: A case study evaluation


A collaborative, interactive atlas of system improvement activities designed to collect international knowledge and experience.

Ko Awatea Campaigns

Includes: 20,000 Days ; Beyond 20,000 Days; Community Organising: Handle the JandalSafety in Practice; Manaaki Hauora -Supporting Wellness; Target CLAB Zero


Ko Awatea Publications and media

Ko Awatea newsletter - subscribe

Health Transformation series

Creating Systems (Healthcare Transformation Book 1)
by David Galler , Jonathon Gray , Muir Gray [Kindle edition]
September 2015 LINK

Population Medicine (Healthcare Transformation Book 2)
by Jonathon Gray, Karina McHardy, Muir Gray  [Kindle edition]
June 2015 LINK

Creating Culture (Healthcare Transformation Book 3)
by Geraint Martin, Jonathon Gray, Mataroria Lyndon, Lynne Maher, Muir Gray [Kindle edition]
September 2015 LINK

Knowledge Management (Healthcare Transformation Book 4)
by Muir Gray , Jonathon Gray, Eli Rotenberg, Clare Nelson, Peter Murgatroyd & Lynne Armstrong [Kindle edition]
April 2017 LINK

Ko Awatea White papers:
White Paper 1 – A Case for Change – Moral Obligation and Pursuit of Quality
White Paper 2 – Establishing an Independent Commentator Panel
White Paper 3 – The Ko Awatea Leadership Academy

Patient experience week

A range of resources to support and inspire healthcare innovation and transformation:

APAC Forum Report 2016

Healthcare improvement posters
APAC Forum 2015: Programme and background
APAC Forum 2014: Presentations
APAC Forum 2012: Selected keynotes and videos
APAC Forum 2012: Workshop summaries
Ko Awatea Presentations
Presentations by our guests and visitors

Ko Awatea Campaign Publications
20,000 Days Campaign: from small revolutions to big change
An evaluation of CMDHB 20,000 days campaign
20,000 Days and Beyond Evaluation of CMDHB’s Quality Improvement Campaign A report for Counties Manukau District Health Board
Target CLAB Zero: National Collaborative to Prevent Central Line Associated Bacteraema: Final report
Handle the Jandal: a report assessing social mobilisation and community organising in the Counties Manukau District Health Board, with Ko Awatea, Health System Innovation and Improvement

Health system inprovement guides

Acute care for the elderly

Development of a collaborative and integrated medication management service for patients at high risk of medication related harm at discharge using an electronic Assessment of Risk Tool (ART) [SMOOTH* COLLABORATIVE (*Safer Medication Outcomes On Transfer Home)]

Early delirium identification and management

Enabling patients at high risk of hospital readmission to self-manage and remain well at home [VHIU* Link Collaborative (*Very High Intensity User)]

Enabling self management support

Feet for life [ Feet for Life is a multidisciplinary collaborative project that has improved access to podiatry services for diabetic patients receiving dialysis in Counties Manukau by incorporating podiatry care into dialysis units ]

Kia Kaha: Manage better, feel stronger

SKIN INFECTION: Emergency Care/General Surgery /TADU Collaborative

Supporting life after stroke: early supported discharge

Transitions of care: Goal discharge date and POAC facilitated change

Well managed pain: an integrated pain service [Well Managed Pain Collaborative]

Evaluations and Joint Publications

Co-design programme evaluation and case studies 2015–16. Prepared for the Health and Safety Quality Commission. 2016.
   Co-design Programme 2015-2016: Report of the evaluation survey and interviews
   Case Study: Safe, effective and efficient discharge (SEED) team (Central PHO)
   Case Study: ED patient experience from the front door to seeing the first treating clinician (MidCentral DHB)
   Case Study: Severe nausea and vomiting in pregnancy (SNVP) - 'suffering in silence' (MidCentral DHB)
   Case Study: Spiritual care at end of life for refugee communities (MidCentral DHB)
   Case Study: A review of the patient experience when accessing head and neck cancer services (Nelson Marlborough DHB)
   Case Study: Radiology service improvement initiative (Nelson Marlborough DHB)
   Case Study: 'Through the eyes of children' (Nelson Marlborough DHB)


Search Ko Awatea


New Zealand

Ko Awatea [NZ]
Counties Manukau Health's centre for innovation and improvement

Health Improvement and Innovation Resource Centre (HIIRC) [NZ]
* ceased operation 1 July 2015.  Archive only.
Improvement and innovation is occurring throughout New Zealand’s health care system. The HIIRC supported this by providing: an extensive knowledge library of literature directories of individuals and organisations access to improvement projects, tools and initiatives the latest news, events and innovations.  Whilst the site is no longer being updated the Ministry of Health library continues to curate and disseminate the Health Improvement and Innovation Resource Centre Digest .

Health Innovation Hub [NZ]
Confidentially and alongside the clinicians, we provide industry with access to clinicians and their new ideas. We also provide innovative clinicians with advice on product design and health innovation funding options.

Health Navigator [NZ]
An excellent selection of resources to support :
healthcare improvement
integrated care
quality improvement

Health Quality and Safety Commission [NZ]
The Health Quality & Safety Commission works with health professionals, patients and consumers across health and disability services to improve the quality and safety of care. A range of resources including: Open Book - reports to alert providers to the key findings of adverse event reviews. The reports emphasise the changes implemented to stop the event happening again.
See also District health board quality accounts for details of strategies, project and outcomes for each DHB.

Health Research Council of New Zealand [NZ]
The HRC supports research that has the potential to improve health outcomes and delivery of healthcare, and to produce economic gain for New Zealand.

Health Roundtable [NZ / Aus.]
We are a non-profit membership organisation of health services across Australia and New Zealand. We exist to:
Provide opportunities for health executives to learn how to achieve Best Practice in their organisations

Collect, analyse and publish information comparing organisations and identifying ways to improve operational practices

Promote interstate and international collaboration and networking amongst health organisation executives

Members are provided with a wide range of documents and presentations that identify innovations in health care practice, as well as comparative information and meeting notes. Any staff member from a member health service can access these reports by registering for access with their health service email address.

89 health service organisations across Australia and New Zealand are currently members of The Health Roundtable. Many health service members have multiple facilities. A total of 155 facilities currently provide data for comparative analysis.

First Do No Harm [NZ]
The First, Do No Harm patient safety campaign launched at the beginning of 2012 is one of the primary goals of the Northern Region Health Plan – outlining a set of shared objectives for the major public healthcare providers in the top half of New Zealand’s North Island including
Auckland District Health Board (DHB), Counties Manukau Health, Waitemata DHB and Northland DHB.

NZ Innovation Council [NZ]
NZ Innovation Council provides innovators, entrepreneurs and business people with access to innovation experts, forums, events and resources nationwide via our online hub.

State Services Commission [NZ]
Drawing on international best practice, the State Services Commission’s continuous improvement centre of expertise has developed the “better every day” approach with six partner agencies – Land Information New Zealand, New Zealand Police, New Zealand Customs Service, Ministry of Business, Innovation and Employment, Ministry for the Environment, Inland Revenue – and the Public Service Association.

Telehealth Resource Centre [NZ]
Brings together information about the various regulations and guidelines that apply to telehealth as well as explaining services the centre provides like free on-site visits and education workshops. Includes case studies and resources to support implementation.

Innovation hubs (international)

International Society for Quality in Health Care (ISQua)
ISQua's mission is to inspire, promote and support continuous improvement in the safety and quality of health care worldwide.

WHO Patient Safety portal
"Adverse events may result from problems in practice, products, procedures or systems. Patient safety improvements demand a complex system-wide effort, involving a wide range of actions in performance improvement, environmental safety and risk management, including infection control, safe use of medicines, equipment safety, safe clinical practice and safe environment of care"

World Innovation Summit for Health (WISH)
A global healthcare community dedicated to capturing and disseminating the best evidence-based ideas in healthcare, providing global solutions that will save both lives and much needed resources.




Australian Centre for Health Innovation [Aus.]
The Australian Centre for Health Innovation (CHI) connects diverse health, policy and industry communities to more effectively address the changing needs of healthcare and improve patient experience.

Australian Commission on Quality and Safety in HealthCare [Aus.]
The Australian Commission on Safety and Quality in Health Care (the Commission) was created by Health Ministers in 2006, and funded by all governments on a cost sharing basis, to lead and coordinate health care safety and quality improvements in Australia.

Australian Institute of Health Innovation [Aus.]
We are leading researchers investigating many aspects of health care. The Institute comprises the Centres of Clinical Governance Research (CCGR), Health Informatics (CHI)and Health Systems and Safety Research (CHSSR). We are a major national resource for many people whose work is intrinsic to strengthening health systems, organisations and services.

ACI: NSW Agency for Clinical Innovation - see also the ACI Innovation Exchange [Aus.]
The Agency for Clinical Innovation (ACI) works with clinicians, consumers and managers to design and promote better healthcare for NSW.

Clinical Excellence Commission [Aus.]
The Clinical Excellence Commission (CEC) is responsible for leading safety and quality improvement in the NSW public health system. It was established in 2004 to promote and support improved clinical care, safety and quality across NSW.

Australasian Association for Quality in Health Care [Aus.]
It is a member-driven, not-for-profit organisation served by a volunteer Council comprised of representatives from all Australian States and Territories and New Zealand.

Health Issues Centre [Aus.]
We support and inform consumers and the health sector to partner for health care improvements.

Improvement Foundation[Aus.]
Formed initially as a subsidiary of the UK Improvement Foundation, the Improvement Foundation (Australia) Ltd was established in Adelaide in 2006 as a not-for-profit organisation. We provide expertise in the development and delivery of quality improvement techniques, such as the Collaborative methodology, to bring about small and large system change. We support improvement work by providing specialist change management advice, and leading edge IT systems, which enable robust measurement of improvement efforts.


United Kingdom

1000 Lives Improvement [NHS Wales]
The national improvement programme, supporting organisations and individuals, to deliver the highest quality and safest healthcare for the people of Wales.

Advancing Quality Alliance (AQuA)
Is a NHS health and care quality improvement organisation who are at the forefront of transforming the safety and quality of healthcare.

AHSN NetworkThere are 15 Academic Health Science Networks (AHSNs) across England, established by NHS England in 2013 to spread innovation at pace and scale – improving health and generating economic growth. Each AHSN works across a distinct geography serving a different population in each region.

Better Value Healthcare
BVHC have a range of resources that can be used by individuals or organisations. These are designed to help people develop the capacity to achieve the aim of triple value. "BVHC solutions packages give you access to this extensive knowledge and help build your skills so that you can increase the value in your local service. Delivered through a mixture of podcasts, videos and face-to-face support, our solutions packages will help you imagine, plan and build a healthcare service that is fit for the future"
see the BVHC 21st Century Glossary

BMJ Quality Improvement Reports
A new searchable repository of global quality improvement evidence and best practice. It aims to help healthcare professionals improve healthcare by providing a new structured format for healthcare professionals to document innovations and excellence in care.

Cochrane [UK]
We are a global independent network of researchers, professionals, patients, carers, and people interested in health.

Haelo [UK]
Haelo is an innovation and improvement centre which hosts improvement experts, clinicians, improvement fellows and researchers. We are a joint venture between Salford Royal NHS Foundation Trust, Salford Clinical Commissioning Group and Salford City Council. The primary purpose of Haelo is to improve population health and healthcare for Salford residents; however we believe this is only possible if we invest in learning partnerships with like-minded providers which centre on shared ambitions for excellence, inclusion and learning.

Healthcare Improvement Scotland [UK]
We produce a range of resources from evidence based reports to best practice and improvement guides. All our resources are designed to support healthcare improvement.

Healthcare Quality improvement Partnership [UK]
The Healthcare Quality Improvement Partnership (HQIP) was established in April 2008 to promote quality in healthcare, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales.

The Health Foundation [UK]
The Health Foundation is an independent charity working to improve the quality of health care in the UK. We are here to support people working in health care practice and policy to make lasting improvements to health services. We carry out research and in-depth policy analysis, run improvement programmes to put ideas into practice in the NHS, support and develop leaders and share evidence to encourage wider change.
see also Health Foundation Patient Safety Resource Centre
see also Improvement Research Institute [UK]

The Health Innovation Assessment Portal (HIAP-Scotland)
The Health Innovation Assessment Portal (HIAP-Scotland) to encourage prospective providers of new and/or innovative products and solutions to put them forward. This will allow NHSScotland to assess how the solution might support NHSScotland's strategic aims, and what the associated costs and benefits would be

Health Quality Improvement Partnership [UK]
The Healthcare Quality Improvement Partnership (HQIP) is an independent organisation led by the Academy of Medical Royal Colleges, The Royal College of Nursing and National Voices. We were established in April 2008 to promote quality in healthcare, and in particular to increase the impact that clinical audit has on healthcare quality improvement.

Improving Quality Together: NHS Wales [UK]
IQT is the national learning programme for all NHS Wales staff and contractors. It provides a common and consistent approach to improving the quality of services in NHS organisations across Wales.

Improvement Research Institute [UK]
The University of Cambridge has been chosen to establish and run a new improvement research institute, the first of its kind in Europe. Led by Mary Dixon-Woods, RAND Professor of Health Services Research and Wellcome Trust Investigator at the University of Cambridge, the institute will work closely with a wide range of partners across the UK. The Health Foundation will support the institute by providing in the region of £40m over a period of 10 years

Institute of Global Health innovation [UK - Imperial College London]
The Institute of Global Health Innovation (IGHI) works to design & diffuse high impact global healthcare innovations and to reduce health inequalities worldwide.

Leading Health Systems Network [UK]
LHSN is a collaborative network of healthcare leaders and organisations dedicated to improving health care delivery by effectively and efficiently using available resources.

NHS Improvement [UK]
NHS Improvement works to improve health outcomes across England by providing improvement and change expertise.
see also the NHS Improvement directory : A list of websites that provide online improvement tools, resources or networks on health and social care.
See also
The Edge [UK] - an innovation hub curated by The Horizons Group, part of NHS Improving Quality.
see also
Better knowledge, better care RSS Feed package

NHS Right Care [UK]
The primary objective for Right Care is to maximise value: the value that the patient derives from their own care and treatmentthe value the whole population derives from the investment in their healthcare.

NHS Scotland, Quality Improvement Hub [UK]
Includes a section on quality and efficieny supporting the business case for safety.

The Nuffield Trust [UK]
The Nuffield Trust is an authoritative and independent source of evidence-based research and policy analysis for improving health care in the UK.

Q is an initiative, led by the Health Foundation and supported and co-funded by NHS Improvement, connecting people skilled in improvement across the UK. 

Q will make it easier for people leading improvement to share ideas, enhance their skills and make changes that bring improvements to health and care. Q will cultivate the connections that are urgently needed to ensure patient care benefits from existing expertise and will lead innovations from across the health and care system.

Quality Watch
Ajoint research programme of the Nuffield Trust and the Health Foundation monitoring how the quality of health and social care is changing over time. Highlights areas where improvement is possible.

Royal College of Emergency Medicine QI Resources [UK]
This page collates some of the most useful quality improvement resources for EDs.

Scottish Health Innovations Ltd. [UK]
Scottish Health Innovations Ltd works in partnership with NHSScotland to protect and develop new innovations that come from healthcare professionals.

Scottish Patient Safety Programme [UK]
National initiative that aims to improve the safety and reliability of healthcare and reduce harm, whenever care is delivered.

NHS Scotland Quality Improvement Hub [UK]
Contains resources, case studies, and networks for knowledge sharing.

Scottish Patient Safety Programme [UK]
The Scottish Patient Safety Programme (SPSP) is a unique national programme that aims to improve the safety and reliability of healthcare and reduce harm, whenever care is delivered.

The King's Fund [UK]
The King's Fund is an independent charity working to improve health and health care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate.


United States

Agency for Healthcare Research & Quality (AHRQ) [US]
The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.

see also AHRQ Innovations Exchange
The Innovations Exchange is expanding efforts to scale up and spread innovations by sponsoring three Learning Communities (LCs) focused on the following high-priority topic areas: “Advancing the Practice of Patient- and Family-Centered Care in Hospitals,” “Reducing Non-Urgent Emergency Services,” and “Promoting Medication Therapy Management for At-Risk Populations.”

Centre for Health Care Innovation [US: Penn Medicine]
The Penn Medicine Center for Health Care Innovation facilitates the rapid, disciplined development, testing and implementation of new strategies to reimagine health care delivery for dramatically better value and patient outcomes.

The Center for Health Organization Transformation
The Center for Health Organization Transformation, or CHOT, is an industry-university cooperative research center (I/UCRC) funded by the National Science Foundation and health organizations to conduct research supporting major management, clinical, and information technology innovations in healthcare.
See 2014/2015 Research Compendium

Healthy Mendocino Promising Practices Database
The Promising Practices database informs professionals and community members about documented approaches to improving community health and quality of life. The ultimate goal is to support the systematic adoption, implementation, and evaluation of successful programs, practices, and policy changes. The database provides carefully reviewed, documented, and ranked practices that range from good ideas to evidence-based practices.

Institute for Health Care Improvement [IHI] [US]
The Institute for Healthcare Improvement (IHI), an independent not-for-profit organization based in Cambridge, Massachusetts, is a leading innovator, convener, partner, and driver of results in health and health care improvement worldwide.

Institute for Healthcare Optimization [US]
An independent not-for-profit 501(c)(3) research, education and service organization focused on bringing the science and practice of operations management to healthcare delivery.

The Commonwealth Fund [US]
The Commonwealth Fund is a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.

Institute of Medicine [US]
Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely.

Mayo Clinic's Centre for Innovation [US]
Mayo Clinic's Center for Innovation fuses design principles with the scientific method to uncover human needs in the health care environment, which include empathy, creativity, systems thinking and a human-centered focus.

National Patient Safety Foundation [US]
The National Patient Safety Foundation’s vision is to create a world where patients and those who care for them are free from harm. A central voice for patient safety since 1997, NPSF partners with patients and families, the health care community, and key stakeholders to advance patient safety and health care workforce safety and disseminate strategies to prevent harm.

Network for Regional Healthcare Improvement [US]
The Network for Regional Healthcare Improvement (NRHI) is a national organization representing over thirty member Regional Health Improvement Collaboratives (RHICs). These multi-stakeholder organizations are working in their regions and collaborating across regions to transform the healthcare delivery system and achieve the Triple Aim: improving the patient experience of care, including quality and satisfaction; improving the health of populations; and reducing the per-capita cost of healthcare.

ReThink Health [US]
We work with visionary leaders to transform health at the regional level – their neighborhoods, cities, counties, or states. Our hope is that by demonstrating regional success, we inspire transformation across the country.

The Beryl Institute
The Beryl Institute is the global community of practice and premier thought leader on improving the patient experience in healthcare. *Full text access to resources is limited to Beryl Institute members.

Choosing Wisely [US]
Choosing Wisely aims to promote conversations between clinicians and patients by helping patients choose care that is: Supported by evidenceNot duplicative of other tests or procedures already receivedFree from harmTruly necessary.

Planetree [US]
Planetree, Inc. is a mission based not-for-profit organization that partners with healthcare organizations around the world and across the care continuum to transform how care is delivered




Accreditation Canada: Leading Practices Database
Leading Practices Database is proud to serve as the new location for innovative practices from the former Health Council of Canada Health Innovation Portal. The Leading Practices Database fosters inter-organizational learning and harvesting of new ideas. It includes nearly 1,000 practices recognized as being particularly innovative and effective in improving quality.

Canadian Foundation for Healthcare Improvement
A not-for-profit organization funded by the Government of Canada, dedicated to accelerating healthcare improvement. CFHI plays a unique, pan-Canadian role in supporting healthcare delivery innovation. We help teams from different jurisdictions work together on common improvement priorities, providing opportunities to share and implement evidence-informed solutions across regions, provinces and territories.

Canadian Health Human Resources Network Innovations Portal
CHHRN partnered with the Health Council of Canada to initiate and populate a health human resources (HHR) innovations portal to showcase innovative approaches to health human resource issues.

Canadian Patient Safety Institute
The Canadian Patient Safety Institute (CPSI) is a not-for-profit organization that exists to raise awareness and facilitate implementation of ideas and best practices to achieve a transformation in patient safety.

The Change Foundation
An independent health policy think tank, The Change Foundation is changing the debate, practice and experience in Ontario health care, prompting system-wide, patient-centred improvements.

Ideas: Improving and Driving Excellence Across Sectors
Health care quality improvement project repository



The Ubora Institute
Africa’s first institute dedicated to the use of improvement science to achieve the best in health and health care for the people of Africa. Launched in February 2016, Ubora, which means “excellence” in Swahili, has already lined up work in partnership with IHI to support health systems in Ghana and Liberia.

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This page was last updated at 12:00PM on June 26, 2017.