Background When I became senior partner at my general practice I undertook a part time MBA at Manchester Business School in the late 90s to learn the things medical school hadn’t taught me; organizational design and behaviour, finance, strategic management and human resources (as it was then called). My dissertation was on quality methods in other industries that could be applied in healthcare.

Journey We tried out total quality management methods in my practice and began to demonstrably improve care, services and the use of resources. I titled this in presentations in the early noughties the Quality Trinity, which morphed into the now widely adopted triple aim. The practice won awards and I became a sessional advisor to the Dept of Health. I was invited to Boston by Don Berwick and saw the collaborative method of improvement. When a new Government came to power pledging to improve quality I designed a means of using the collaborative for large scale change. This opened a parallel career in quality improvement for the next 20 years, though I continued to be a practicing GP for the majority of that.

Reflections When I started there was literature on total quality management in other industries but very little in healthcare, and nothing on large scale change. The methods challenged orthodoxy about how you changed healthcare delivery and met resistance, even hostility. Much that was suspect is now embraced, techniques that were unheard of are now common and the literature is expanding. This article gives experiential insight into large scale change gathered in my career that I hope may help others now charged with these tasks.