Practical steps to improving the quality of care and services using NICE guidance

This practical guide shows how YOU can use evidence to improve care and services. It is for anyone with an interest in improving practice. You might work in social care, public health or healthcare. You might work in a charity or voluntary organisation. You might be a person using services, a patient, relative or advocate. You can make a difference, no matter what your background, and we can help you.

These practical steps are drawn from our work with NHS organisations, local authorities, social care providers and voluntary organisations, as well as published literature (see further reading).

Our work has shown that there isn’t one way to put evidence-based guidance into practice; different people do it, and succeed, in different ways. Here, we have set out the most common steps taken when putting evidence-based guidance into practice. You can follow them exactly or take a more flexible approach. Each step has tips and actions to help you get started: pick and choose what suits your project.

Practical steps to improving the quality of care and services using NICE guidance

Practical steps to improving the quality of care and services using NICE guidance

Be informed

a row of books a row of books

The first step in putting evidence-based guidance into practice is to be informed. If you want to improve the quality of care and services you need to know what works and what is good value for money. To get an informed view you can rely on our guidance and quality standards. They are based on the best available evidence and developed by committees with a wide range of experience. We have guidance on public health, social care and clinical topics, as well as on drugs, technologies and procedures. We also publish standards that define the priorities for quality improvement in health and social care.

When reading our guidance it is natural to compare what we have recommended with the way you currently work, or the way your care is given. Being informed about the evidence is the first step in improving services. You can talk about what you have read and your reflections on how it matches your current situation with colleagues, staff or other people using the service.

We all struggle to keep up with all of the information available to us, be it articles, evidence reviews, blogs, tweets or messages. The easiest way to keep up with best practice in your area of interest is to use a source you can trust. Our guidance is that source. Our committees have reviewed all of the best evidence and expert opinion and turned it into actionable recommendations. We also have alerts and newsletters to help you keep on top of what’s going on.

In healthcare, a systematic process is often applied to every piece of NICE guidance as it is issued. This ensures that all recommendations that relate to current services are considered carefully. Often organisations will look ahead at what NICE is working on so that they can plan and set aside resources for any quality improvements needed.

In local authorities or social care, a review of practice can happen because of a political or financial need or when the quality of a service needs improving. NICE guidance can be used with local data to help inform the changes needed.

As well as being informed about evidence-based practice, it is a good idea to find out about the evidence behind different implementation practices. In general, when changing practice, a combination of methods may work best, including for example, education strategies, audit and feedback, reminders, and involving opinion leaders and patients. Cochrane Effective Practice and Organisation of Care Reviews are a great place to find out more.

Take a lead

Woman presenting in front of a screen Woman presenting in front of a screen

Anyone can take a lead. Leading is about taking action, showing others that change is possible. The best place to start when making change is to consider how you can change your own way of working. Take the initiative and then share what you find out with your colleagues. Or perhaps you are looking to start a campaign to make sure people get the care and services they deserve. Use our guidance and standards to get conversations started. Having this guidance gives you authority when explaining the changes you want to make to others.

In some organisations you might be part of a team responsible for putting guidance into practice or improving quality. Or you might be working across many organisations and sectors and have the opportunity to connect people and share the knowledge you have gained by reading our guidance. If you have the vision and can clearly communicate it, you can make a difference.

Understand current ways of working

A selection of post-it notes on a wall A selection of post-it notes on a wall

Before you start planning changes to services or implementing new guidance, you need to understand how the service works at the moment. This is your baseline and can be used to measure the effect of any changes you make.

You might do this as part of a team or you can start by looking at your own area of responsibility or experience.

You can find out about how the service works in lots of different ways. Informal discussions, online questionnaires, workshops or a review of local policies and procedures could help. Remember to look outside of your organisation and see how your service fits into the wider community.

  • Exactly what happens now?
  • Where does it happen?
  • What resources are being used?
  • How much does it cost?
  • What do people say about their experience of the service?
  • What impact does it have on them?
  • What outcomes are you measuring?
  • Are these outcomes important to patients or people using services?
  • What is missing?

Make a plan

a group of people collaboratively working in a circle a group of people collaboratively working in a circle

Take the information you gathered in the last step and map the results against our guidance or quality standards. Note what you are doing already, what might need to change and what is missing or might need to be stopped.

Now you need to decide what actions could be done to meet the guidance. This is a great opportunity to work with a range of people who work in the service or who are using the service. Together you can co-produce an improved service, or even a new service, building on everyone’s different perspectives and knowledge.

Sometimes small changes can make a difference quickly. But perhaps bigger changes are needed and a long-term plan that can be broken down into a series of steps and delivered over a longer period is best.

Coordinate actions across services or communities to reduce duplication and improve how services link together. You need to work with your business planning team to estimate the resource impact of each action. You may be able to show how it will save money or resources. Remember to set out timelines and milestones and consider staffing and training.

Your action plan should also include information on how you will measure the effect of the changes. Think about where you can get the data you need and how it will be collected.

Improve and measure

Now it’s time to carry out the actions you identified to improve care and services. Keep talking to everyone involved and remind them all of the benefits of the project. Deliver training and create materials to help support the new way of working.

It is important to measure the impact of any changes made. Measures should be clear and specific so that the same information can be collected before and after each change. You also need to decide how to present your data and how to share it. Consider sharing it publicly to get buy-in from the whole community.

Developing and redesigning services isn’t easy. With careful monitoring you can see what’s working and what isn’t working so well.

  • Have the changes improved the service?
  • How do service users feel?
  • How are staff adapting?
  • Is there anything that could be done better?

Make changes as and when needed to keep things moving forward.

Janet Wylie and Carol Evans, Quality Improvement Facilitators, First Community Health and Care said: “We have found that keeping in touch with our local NICE implementation lead helps us to keep improving, providing us with support and challenge. We also presented our work at the South East Clinical Effectiveness Network and we encourage staff to present examples of good practice at our annual quality improvement day.”

Keep going

After all the initial hard work it is important to take a step back and reflect on what you have achieved. Take time to talk about how much has changed with everyone involved. Sharing your success helps to motivate everyone to keep going and may even lead to other improvement projects.

Healthwatch Isle of Wight set up their own care awards in 2016 to celebrate outstanding practice in nursing and care homes. Joanna Smith, Manager, said: “We knew there were many concerns about the quality of care and we worked with everyone connected to the services to make sure improvements were made. The care awards celebrated the hard work of everyone involved and are an opportunity for everyone to hear new ways of working have led to real improvements to people’s lives.”

"Don’t lose sight of what you’ve achieved. Taking time to stop, look back and reflect on the journey so far is important. It is key to ongoing learning, generating new ideas and keeping the energy and momentum moving forward."

Helen Hanks, Quality Improvement Manager, Devon Partnership Trust

Further reading

Grol R (1997). Beliefs and evidence in changing clinical practice. British Medical Journal 315:418–21

Grimshaw J, Eccles M, Lavis J et al. (2012). Knowledge translation of research findings. Implementation Science 7: 50

Ivers N, Jamtvedt G, Flottorp S et al. (2012). Audit and feedback: effects on professional practice and healthcare outcomes. The Cochrane Database of Systematic Reviews 6: Cd000259

Leng G, Moore V, Abraham S (2014) Achieving High Quality Care: Practical Experience from NICE. Wiley-Blackwell

Adult social care: quality matters. Department for health and social care, July 2017.

Shared commitment to quality. National Quality Board, December 2016.

Developing people - improving care. NHS improvement, December 2016.

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