We adopted a Quality Improvement Collaborative approach and used a variety of QI methods, tools and techniques, which included:

Analysis of barriers and facilitators to improvement

  • Discovery interviews and focus groups
  • Participant and non-participant observation (ethnography)
  • Critical to quality trees

Audit and improvement cycles

  • Significant event analysis
  • Plan – do – study – act cycle

Change Management

  • WIFM (“What’s in it for me”) charts
  • SWOT or SCOT analysis

Transformation methods

  • Quality improvement (organisational change) collaborative
  • Process redesign

QI Interventions

Improvement workshops and focus group discussions were led by a QI FELLOW (a frontline paramedic trained to use QI methods) in each partcipatng trust. Collectively collaborative teams learned about QI methods; indentified and gained an understanding of barriers impeding the delivery of the care bundles: developed and tested interventions using plan-do-study-act cycles to improve patient care.


"During our workshops we have used quality improvement methods to understand exactly what we do for STEMI and Stroke patients. This has enabled us to to... think of new methods of working which may make improvements"(QI Fellow, Trust 4)

A variety of improvement initiatives were developed and piloted to address the issues identified:

  • Bulletins
  • Information posters
  • Promotional pens
  • Key fobs
  • Educational work packages
  • Presentations and fact sheets

Please take a look at the resources section of this website to see examples of some of the improvement initiatives.


We used statistical process control (SPC) methods (‘run’ and ‘control’) charts to measure change over time. These charts helped us to determine whether change was real (significant and sustained rather than a transient natural variation.

To establish a baseline performance for the AMI and stroke care bundles we collected statistically appropriate samples of cases across trusts and compared these using control charts. We extended this process to measure care bundle performance for AMI and stroke over the timescale of the project.

The annotated control charts helped us to identify whether and to what extent specific interventions or process changes affected care bundles. Baseline performance ambulance trusts of aspirin administration to patients with an AMI (National Clinical Indicator Pilot Report, July 2009).

Case study Evaluation

We also sought to evaluate the project as a whole using a multiple case study design where each participating ambulance service comprises a case. The case study evaluation sought to provide insights about how and why large-scale collaboratives work as well as indicating barriers to success. The evaluation involved analysing observational data collected during the project and undertaking qualitative interviews with QI Fellows. Using a ‘pattern matching’ approach we were able to investigate how and why short, medium and longer term outputs and outcomes were achieved by comparing the QI method used with measured improvements.

Visit Our E-Learning

Our e-learning programme is designed as an introduction for health and social care professionals interested to learn more about the science and practice of quality improvement (QI).