Background Quality improvement (QI) has been shown to deliver better patient outcomes, and improved operational, organisational and financial performance when led effectively and supported by organisational systems and training. Surveys of staff and patient satisfaction also show positive effects. In many trusts that Care Quality Commission (CQC) has rated as outstanding, a culture of QI has been embedded throughout the organisation.

Objectives We wanted to hear trusts’ experiences of using QI as a systematic approach to improving service quality, efficiency and morale, and share learning from these organisations to drive further improvement to quality of care.

Methods Using CQC’s comprehensive inspection programme of all healthcare providers nationally, we identified 19 trusts for inclusion and carried out an in-depth review of their improvement journeys.

Results We found that commitment from the board and senior leadership is crucial to ensuring success on the QI journey, modelling effective leadership behaviours that enable all staff to deliver improvement. These organisations have a systematic approach to QI, using a consistent model, anchored in a systems perspective, and often across a health system. The model of improvement requires leaders of all backgrounds and frontline staff to work together in improvement, and can help to break down barriers between managers and clinicians, and providers and patients, so there is a shared purpose to deliver better care to patients.

Conclusions QI is not a magic bullet, but is an important factor in the evolution of an organisation from a traditional ‘command and control’ form of management towards higher performing approaches to the design and management of work.