Introduction (Approx. 250 words)
You are expected to introduce the reader to your essay/assignment- briefly provide an overview of the
subject of quality improvement and explain what will be discussed in your essay. Although your
introduction should be concise/brief (word count should be about 250 words), it should reflect the
different areas that are expected to be covered in the essay. Some subject-specific references can be
used in this section.
Critical reflection on the experience or episode of care (approx. 1000 words)
In this section, you are required to provide the context of your work. You do this by introducing the reader
to an episode of caring for a patient. Then present a critical reflection of this episode of care using a
reflective cycle/model e.g. Driscoll (2007) to structure your reflection- What? So What? Now What?
Within this model, you must identify the three dimensions of quality (patients’ safety, effectiveness of
care and patient’s experience) and explain how they were met, how they could have been met more
extensively and what can be done in the future by healthcare providers (and nurses) to improve this. It
is expected that you add relevant evidence to support the critical discussion (e.g., NICE, RCUK, NHS
online, NPSS, Kings Fund, NHS Next stage review, peer-reviewed sources that are subject-specific,
like clinical guidelines). All information about patient and practice area must be adequately anonymised.
This section should have a good structure. It should be structured as follows:
Description (What?)
Explain what has prompted your decision to implement a service improvement. Discuss what you
noted/observed in clinical practice that suggest that change was needed? Which experience in practice
made you feel there was a need for change?
So what? (Rationale for service improvement proposal)
Following from your experience, write up a critical reflection in which you discuss the experience
considering the benefits and challenges to people using healthcare services and critically utilise this
discussion to generate a rationale for a service/quality improvement proposal.
[Explain why the event was significant, break down the event that occurred and critically reflect on it. This means
you break it down to different parts, e.g. different parts of quality that were affected- what happened in terms of
patients’ safety and other dimensions of care (effectiveness of care and patient’s experience). It might be that one
or more dimensions of quality were affected or were involved in this. Identify at least one dimension. You must
identify relevant evidence to support this. You don’t need to explain all evidence about this as you will need to
utilize this in the second part of the assignment (service improvement proposal). Give a brief idea of, if you think
that this should be improved, why should this be improved. For example, if you think that medication errors in a
certain ward could be improved because you have witness a few, what is the impact of that for patients’ safety,
where is it recognized that medication errors are a significant problem for patients- consider what the
national/international level literature say about this issue? Are there any major reports that highlight this problem?
This is the sort of evidence that is required in this section.
Now What? (Action Plan/Recommendations for Practice)
You briefly explain why you want to change what you want to change and what exactly is your service
improvement proposal (SIP). This then leads to the other part of your assignment, the actual SIP which
should be around 2,500 words.
SID: Page 4
Service Improvement proposal (approx. 2,500 words)
• Description (Detail of the SIP)
Describe the idea of what you are proposing to make it clear to the reader. Is there a name you want
to give to your SIP, is it a single thing or a series of things you want to implement in practice? Keep
it simple, if there is a picture/image of it you can include it as an appendix.
• Detailed implementation plan using the guide provided (including impact to service user
and NHS (including economic and business case discussions).
Use the suggested NHS 6-stage project management guide (NHS England and NHS
Improvement, 2022) to structure this implementation plan. It is in form of a table, but you are
expected to copy and paste this table anywhere. You are expected to write it in a text and not in
format of a table. You may choose to use the sub-headings from this guide to help you structure
your SIP. (NHS England and NHS improvement (2022) Project management – an
overview. Available on: https://aqua.nhs.uk/wp-content/up
1. Start out.
State the title of your SIP, what is your SIP called and you can also lay out a rationale that builds up
from your previous section without repeating yourself.
2. Definition and scope
Present a summary of the rationale of your SIP. You have written this in your critical reflection,
and you can use the same references. Consider if the rationale for your SIP fits within the
national priorities and if it supports good quality of care (safe, effective, person-centered). Identify
the scope of your SIP.
3. Measure and Understand
In this section, you are required to outline the information that has led you to plan your SIP as
well as how you will measure and understand success of your SIP. This could be infection rates,
patient satisfaction levels, feedback from patients, feedback from staff, mortality rates,
knowledge (or lack of knowledge), personal observation of poor practice, covert observation
reports, etc. You should also provide information on when and how you will collect these data.
What do you think is important to do first? Who will be the key people (stakeholders) in your
project and how will they be involved? What are the costs (finance, staffing, equipment,
resources, time). What are the benefits (to service users, to the NHS)? What are the
assumptions/ barriers/ resistance to change that might be experienced when implementing this
change? Ensure you discuss a Change Management theory/ model in this section.
4. Design and Plan
Outline the main aim of your SIP and the smaller objectives. Describe your intervention and the
steps required to achieve this intervention. Consider the issues of resistance to change and how
to overcome these barriers.
5. Pilot and Implement
In this section, you are expected to discuss how you will pilot your SIP at a small scale and then
implement it. Consider if you need to pilot your SIP in a small population/ group of people or a
ward in the hospital. State when you will implement the SIP and how long it will take as well as
the steps that will be taken to ensure the SIP is fully running. You should also discuss how you
will engage with the stakeholders during implementation. It is also important that you identify and
discuss the leadership approach you would take to successfully implement this SIP.
SID: Page 5
6. Handover and Sustain
Consider the information you had when you started the project, discuss how you will gather more
data after the intervention so that you can measure the impact of your project. Discuss how you
will sustain the project (ensure that everyone will be on board with your project). In addition, it is
important to discuss how you will ensure your SIP is consolidated to enable long-term benefits
(ensure that organisation can continue the project independently from the original team that
implemented the project).
Conclusion (Approx. 250 words)
In your conclusion, you should provide a summary of what you have discussed in your essay.
No new concepts should be introduced. If a new concept is introduced, please question why it
has not been highlighted in the body of the essay. Conclusion doesn’t need to have references,
unless there is a specific issue you wish to highlight/reinforce. However, be mindful that if you
are going to incorporate a reference that you have not mentioned before, think about whether
it is a new idea. It should not contain new information. It should contain key aspects in the
essay. If you are about to bring in a new idea in the conclusion, consider whether you should
be mentioning it earlier on in the assignment.