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Value Based Health and Care | Turas | Learn

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Health inequalities exist across every part of our health and care system. The Health Inequalities and Value Based Health and Care eLearning module is designed to help learners understand why these inequalities persist and how they show up in everyday practice — whether through missed appointments, variations in outcomes, or the growing pressure on frontline teams.

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Shared Decision Making Learning Resource

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Shared Decision Making Learning Resource

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Having realistic conversations about what matters to a person and options we have available for them is important for shared decision making and future care planning. We have effective communication models and language to help us with these discussions.

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Person centred care and Realistic Medicine Learning Resource

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Person centred care and Realistic Medicine Learning Resource

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Person-Centred Care & Realistic Medicine learning resources

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There are four new learning resources to support person-centred care and Realistic Medicine. Each module is available via Turas Learn and contributes to your CPD hours.

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This resource has been collated to assist you in accessing good quality resources in relation to safety, quality, design, civility and kindness, leadership, Realistic Medicine and  Duty of Candour.  You should be able to use these resources to help meet some of the requirements for your FY and speciality curriculum as well as portfolio and ARCP requirements.  If you come across other articles, courses, podcasts that you think would be helpful to add to this resource send them to vicki.tully@nhs.scot 

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Welcome to this Healthcare Improvement resource 

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Welcome to this Healthcare Improvement resource 

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This site has a range of resources that focus on how we learn from excellent healthcare practice which can create new opportunities for learning and improving resilience and staff morale 

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BMJ article - From Realistic Medicine to Realistic Health

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BMJ article - From Realistic Medicine to Realistic Health

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I've just had the privilege of talking at the Realistic Medicine conference in Glasgow, and the opportunity led me to think about Realistic Health.

Realistic Medicine is a creation of the Scottish chief medical officers, initially Catherine Calderwood and now Gregor Smith. It was introduced in the chief medical officer's report of 2014-15. 1 Evidently civil servants were wary of the term realistic medicine-perhaps worried by the implication that there might be too much unrealistic medicine. But the chief medical officers prevailed, and Realistic Medicine has become an international brand, joining the Welsh Prudent Medicine, the Italian Slow Medicine (based in part on the idea that slow cooking is the best cooking), and the American Choosing Wisely. All share the aims of making care more humane, safer, and sustainable.

The six components of Realistic Medicine are: shared decision making; a personalised approach to care; reducing harm and waste; reducing unwarranted variation; managing risk better; and health professionals becoming improvers and innovators. The Scottish government is serious about implementing Realistic Medicine and have committed staff, funds, and digital tools. The programme is aiming for a cultural shift, which cannot be achieved overnight. Not only patients, but also staff should benefit.

I fully support Realistic Medicine, but I've played around with the idea of Realistic Health, recognising, as does the Scottish Government, that care services are responsible for only 10-20% of health. My starting point is health not care services, but there is of course a role for care services. Realistic Health has 10 components.

1. PRIORITISE health, recognising that health is not the product of health systems, is much more than the absence of disease, and that planetary and individual health are one.

2. ACCEPT that health is driven mostly by social determinants, that political and community action is needed to improve health, particularly to reduce inequalities, and that interventions by professionals can have only limited impact.

3. RECOGNISE the importance of relationships and communities for health.

4. EMPHASISE public health, avoiding professional domination and working through coproduction with communities. Community power can achieve much that care services cannot.

5. ENSURE equal partnership between health and social care, acknowledging their indivisibility.

6. MAXIMISE the ratio of team-based primary care to secondary care, as we know that the higher the ratio the better outcomes, the higher patient satisfaction, and lower the cost. 2

7. BALANCE community over hospital, teams over individuals, non-drug treatments over drug treatments.

8. ACKNOWLEDGE that with chronic conditions (most of sickness care) individuals and their families and communities have more influence over outcomes than clinical teams

9. SHIFT power from professionals and institutions to people and communities.

10. PUT responding to suffering ahead of responding to disease.

A system genuinely built around promoting health rather than responding to disease would be more sustainable than our present system, but I acknowledge the huge challenge in moving in high income countries from what we have now to what I'm proposing. It's much more feasible in the low-and-middle income countries that have only a rudimentary sickness system.

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From Realistic Medicine to Realistic Health

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I've just had the privilege of talking at the Realistic Medicine conference in Glasgow, and the opportunity led me to think about Realistic Health. Realistic Medicine is a creation of the Scottish chief medical officers, initially Catherine Calderwood and now Gregor Smith.

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Within your FY1 teaching programme you will receive safety teaching to enable you to keep yourself safe as well as your patients safe.  You will get the opportunity to attend several Morbidity and Mortality meeting as part of this programme to understand how adverse events occur as well as learning from these.

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Within your FY2 teaching programme you will receive QI teaching and mentoring around your QI project for ARCP as well as the opportunity to present the work you have completed at a FY2 QI event in June

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FY QI Handbook to support you with your Qi project

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FY QI Handbook to support you with your Qi project

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Working with healthcare students and young professionals to develop our healthcare leaders of the future.​ That cultivates leadership. The Healthcare Leadership Academy

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An Illustrated Guide to Quality Improvement - Quality Improvement - East London NHS Foundation Trust

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Enjoy exploring the Illustrated Guide to QI. If you would like a printed copy please find out below how you can order using Blurb. ELFT staff, service users and carers can access a free copy, please get in touch if you’re interested. Click the Expand Button to Open in Full Screen Order... Rea…

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Lancet Countdown: Tracking progress on health and climate change

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Lancet Countdown: Tracking progress on health and climate change

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The 2023 Report is out now. Click here to read it in full

Download Now

The 2023 Report is out now. Click here to read it in full

The full report is available free of charge at The Lancet.

Download now

2023 Report

Read the key findings and messages from the 2023 Report of the Lancet Countdown on Health and Climate Change.

Lancet Countdown Community

Learn more about the Lancet Countdown regional centres.

Data Explorer

Our data explorer allows you to discover and interact with the data behind our 41 indicators at a national and regional level.

Need more detail? Download the report

Download Now

Need more detail? Download the report

The full report is available free of charge at The Lancet.

Download now

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Climate change is a public health issue. The Lancet Countdown brings together experts from across the globe to track how climate change is affecting our health, and how the world is responding

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Foundations in System Leadership; collaborating in health and care

A programme for people working in health and care, who want to improve the way they collaborate across organisational and professional boundaries to design and deliver better health outcomes Find out more about the programme
CMI Accreditation

NHS Leadership Academy is working with Training Provider Pearson TQ to offer access to our leadership development programmes with CMI accreditation
Apprenticeships

NHS Leadership Academy is working with apprenticeship providers to offer access to our leadership development programmes as part of apprenticeships Find out more about apprenticeships
Hope European Exchange programme

This programme offers those with managerial responsibilities in healthcare a unique opportunity to exchange time with an EU member state for four weeks Find out more about the programme
Core Managers: Developing Inclusive Workplaces programme

Are you a manager or supervisor in health and care looking to develop your inclusive leadership skills?
This programme is a suite of self-guided online short courses
Find out more about the programme
Sustainability Leadership for Greener Health and Care Programme

Want to develop your leadership skills and knowledge to build a greener and more sustainable health system?
A 16-week programme with a choice of online learning or face-to-face learning
Find out more about the programme
Coaching and Mentoring

Coaching and mentoring are helpful tools to support health and care leadership development
Search or sign up to the Coaching and Mentoring Register and explore regional offers
Find out more about coaching and mentoring

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A programme for people working in health and care, who want to improve the way they collaborate across organisational and professional boundaries to design and deliver better health outcomes Find out more about the programme NHS Leadership Academy is working with Training Provider Pearson TQ to offer access to our

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The November 2023 run of School Is now Closed!
Thank you to everyone who has taken part!

Stay tuned for more updates for the next run of School or you can register your interest for the next run here: Register your interest

In the meantime - check out the magic of School below....

On this page - please click on any of the links below to go directly to that item

Build your network

The lively community of fellow learners on FutureLearn (as well as on Twitter, and in the Facebook group) means that you not only gain a wealth of useful knowledge, you can also build your networks and learn from each other as you reflect on how you can use the skills you've gained to take action.

The School for Change Agents Celebration Report!

We are delighted to share the #S4CA celebration report 2022: Celebrating 9 years of a social movement.

Discover the global impact of the School and hear from the Alumni who were inspired

Listen to our podcast

If you enjoyed School, you may also appreciate our podcast, which goes "behind the scenes" with the team who are responsible for School. You can also access transcripts of the podcast.

What you will learn

The School for Change Agents by NHS Horizons is a free, online, self-paced course designed for health and care staff at any level to build the confidence and community to unleash their inner change agent!

The School for Change Agents takes place on FutureLearn. There are five interactive sessions to complete:

1. Change starts with me

2. Resourcefulness

3. Using power to make a difference

4. Using stories to create change

5. Making sense of complexity

Each session includes a range of articles and videos that feature people like you talking about their own experiences of creating change.

How to take part

School is free to join, and to take part in. All you need is an internet connection. The sessions are arranged into 'bite-sized' chunks so that you can complete them in your own time, and in your own way. You can take part on a computer, tablet or mobile device. School is currently closed but you can register your interest for the next run here: Register your interest

Live sessions

Alongside the FutureLearn sessions, we held three live webinars. These were optional and were a way to interact with concepts and themes covered in the FutureLearn sessions. They have been recorded and you can watch them via YouTube on the link below.

To upgrade you need to:

Engagement Pack
Spread the word and help promote the School For Change Agents with your networks!

Images, copy and downloads available here: https://horizonsnhs.com/the-school-for-change-agents-engagement-pack/

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The School for Change AgentsA free, online, self-paced course designed for health and care staff at any level to build the confidence and community to unleash their inner change agent! The November...

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-Suzanne Gibbs Howard, Dean of IDEO U

In our Creative Confidence Series chat with IDEO Design Researcher Silvia Vergani and Principal Research Scientist at Verily Life Sciences Danielle Schlosser, we discussed the challenges and opportunities in healthcare innovation today and how healthcare practitioners can begin to apply a more human-centered approach to their work. When design thinking methodologies are applied to healthcare they lead to a human focus and an openness to generate and test lots of ideas to find more innovative, far-reaching solutions.

Applying Design Thinking to Schizophrenia Care

With a deep expertise and passion for working with individuals with schizophrenia, Danielle Schlosser wanted to change the way we think about schizophrenia treatment. While working toward this goal at the University of California San Francisco, she became curious about the design thinking approach and how IDEO may be able to help.

Shortly after meeting Silvia and her team at IDEO, Danielle was surprised by the types questions they asked and the style of their approach. "The design researchers asked me so many questions that made me think differently about a problem I'd been thinking about for a really long time. I loved being challenged with new ideas in a space that I'd thought I was an expert already."

An early insight came for Danielle when Silvia conducted her first interview of a schizophrenia patient. "She didn't use clinical terms during the interview and she connected so well with the patient, putting him at ease and getting him to open up and express himself." Danielle realized that Silvia was anticipating talking to a person while she herself was anticipating talking to a patient. " I realized that the providers in the clinical system itself are part of the problem because I was not seeing my patient as a person first. This was tough for me to admit to myself."

As a result of the work between UCSF and IDEO, Danielle and Silvia's team created Prime -an app that helps individuals with schizophrenia achieve goals and engage with others for support. The aim is to improve quality of life and alleviate hard-to-treat symptoms within this population, and so far the early trial results are promising.

I realized that the providers in the clinical system itself are part of the problem because I was not seeing my patient as a person first. "

Mindset Shifts in Healthcare

Danielle and Silvia mentioned three mindset shifts that are currently moving healthcare in a more human-centered direction.
1. Shifts to Value-based Care
Healthcare is moving beyond the walls of hospitals and into communities and the role of healthcare providers is shifting. We're seeing new questions like, what do we do about loneliness; as it turns out loneliness is as much of a killer as smoking and diabetes. These types of questions lead to a better understanding of patients and creating whole ecosystems of care.

Dahlia Campus in Denver is a great example of healthcare adapting to the needs of the community. It's an integrative health center in a neighborhood with limited access to healthy food and resources. Before opening, Dahlia sought insight from the community around what would help them improve their health. They've focused on building around the needs of the community and thoughtfully measuring the impact of their approach.
2. Shift from Being Reactive to Proactive
Everyone is empowered to get to know their bodies and their health before anything is wrong with them. Health is becoming this process of self-exploration, which creates entry points for people into healthcare offerings. We're seeing a shift from healthcare to consumer products that can help us better understand who we are.

Examples of these consumer products include 23andMe, Color Genomics, and uBiome.
3. Balance High Regulation with Experimentation
Privacy and risk committees often block tools out of security controls. But there's opportunity to invite people to be fully informed about the choices they make in terms of the technology they use and give them the choice to opt into the tools. We should have high standards of privacy and make sure our tools are secure, but there's still room to experiment and use informed consent to prototype tools that may not be ready for primetime yet.

Apply Design Thinking to Your Healthcare Challenges

Start by defining the problem you're trying to solve early. Before moving toward solutions, spend time gaining a deeper understanding of the needs of the people you're serving. Find the pockets of creative work happening out in the field, go out, and get inspired; get in context with people.

Once you have an understanding of the people you're serving, start ideating. Brainstorm, what might be some solutions; what might be some ways of approaching this? With a long list of things to try, you'll feel more comfortable experimenting and failing, knowing that you have many more ideas. The idea isn't to succeed immediately but to learn as much as possible.

Learn more about building the skills and abilities to deepen your design thinking practice with our Advanced Design Thinking Certificate.
Interested in more design thinking exercises? Check out our Design Thinking Resources page.

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In our Creative Confidence Series chat with IDEO Design Researcher Silvia Vergani and Principal Research Scientist at Verily Life Sciences Danielle Schlosser, we chatted about the challenges and opportunities in healthcare innovation today and how healthcare practitioners can begin to apply a more human-centered approach to their work.

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Compassionate and Inclusive Leadership - Michael West

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Compassionate and Inclusive Leadership - Michael West

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Michael West On Compassionate And Inclusive Leadership | The King’s Fund

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In this video Michael West shares his thoughts on compassionate and inclusive leadership.

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NHS Education for Scotland have developed a suite of eLearning modules suitable for anyone working in the public-sector looking to improve local services using Quality Improvement tools and methodology. These modules are a great way of introducing yourself to the key concepts and use scenarios to illustrate their use in practice.

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Realistic Medicine is an approach to healthcare that aims to put the patient at the centre of decisions made about their care. Shared decision making and a personalised approach to care are key elements of practising Realistic Medicine.

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Faculty of Medical Leadership & Management

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Faculty of Medical Leadership & Management

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Faculty of Medical Leadership and Management

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Leadership and Management Standards for Medical Professionals

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Essential information about key topics, drawing on Health Foundation projects and research.

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Every month Kindness in Healthcare community members from around the world come together for a Conversation for Kindness, for conversation and reflections about kindness in healthcare. Each conversation has a focus on listening, learning, thinking differently and mobilising for action, and an open culture of sharing resources, ideas and energy.

Guest speakers usually lead the conversation before members divide into smaller break-out groups for further reflection.

Meeting are held on the third Thursday of the month, at 6pm GMT. All are welcome - if you would like to join, please contact us.

Below you can see insights, presentations and videos from the meetings.

December 2023 - Compassion and kindness in leadership

For this Conversation, we were joined by Professor Michael West who spoke on compassion and kindness in leadership.

Michael first discussed the relationship between happiness and work. He spent time exploring what compassion actually means, and looked at the challenge of creating the conditions for compassion inside our healthcare environments.
Download the insights and summary of the conversation
Watch the conversation below.

November 2023 - Kindness and psychological safety

Our conversation was led by Amy Edmondson, Novartis Professor of Leadership and Management at Harvard Business School, who is renowned for her world-leading research into the concept of psychological safety.

Her work focuses on the study of interpersonal relationships, underpinned by the belief that this has a great impact on organisational development.
Download the insights and summary of the conversation
Watch the conversation below.

October 2023 - 36 months of conversations so far

Our purpose in coming together for this session was to get feedback from members of the Kindness in Healthcare community on the future direction and priorities of the group. We wanted to hear everyone's thoughts on where we should focus our efforts going forward.
Download the insights and summary of the conversation
Watch the conversation below

September 2023 - Kindness and our education systems

James Mountford, founder of theLondon Interdisciplinary School, coordinated this conversation. For the first time as a group, our topic shifted away from healthcare and into education.

We heard from two speakers, Ed Fidoe and James Handscombe, who both spoke to their experiences with kindness in different educational settings.

Download the insights and summary of the conversation.

August 2023 - Exploring the role of education and learning in building kindness

The session centred on the role of education, training, learning and teaching in and around the topic of kindness. Bob Klaber and Maureen Bisognano led the discussion.

Download the insights and summary of the conversation.

Watch the conversation below

July 2023 - Detoxifying healthcare: leading practically with and for kindness

This month, we discussed practical applications of kindness, specifically breaking the rules and telling a meaningful story.

We were guided through the discussions by Gabrielle Matthews, a member of the NHS Youth Forum and a medical student at Imperial College School of Medicine, and Maureen Bisognano, President Emerita and Senior Fellow at the Institute for Healthcare Improvement.
Download the insights from and a summary of the conversation
Watch the conversation below

June - Listening to patients

In this conversation, Henrietta Hughes, the first appointed Patient Safety Commissioner for England, led the conversation on listening to patients and relatives, and also reflected on the role of social movements.

To close the conversation, the group reflected on the themes and learnings that have emerged during more than two years of Conversations for Kindness.
Download insights from and a summary of the conversation
Watch the conversation and presentation below

May 2023 - Whose story is it anyhow? Creating safe spaces for patient storytellers

In this conversation, author and patient advocate Sue Robins led the conversation about creating safe spaces for patient storytellers, exploring how sharing stories in the healthcare world helps to make it a kinder place.

She shared her own story of how she started advocating for families after her son was born with Down Syndrome, and more recently, having been diagnosed with breast cancer, how she became a patient storyteller as well.
Download insights from and a summary of the conversation
Watch the conversation and presentation below

March 2023 - Kindness in the face of conflict

How do clinicians manage to maintain compassion when their clinical, ethical and moral judgement is being contested at the highest level?

Paediatric intensivists from Evelina Children's Hospital - Miriam Fine Goulden, Marilyn McDougall and Shelley Riphagen - reflected on their professional and personal experiences in this month's conversation for kindness.
Download insights from and a summary of the conversation
February 2023 - Regulation in healthcare: exploring if and how this can be done with kindness

Our February conversation covered the role of regulation in healthcare, whether kindness can and should be regulated for, and whether the process of regulation itself can be done with kindness.

We heard from: Victoria O'Brien, a geriatrics registrar on secondment to the Care Quality Commission: Astrid Etherington, who is completing a fellowship with the General Medical Council in Wales; and Nigel Acheson, Regional Medical Officer for the South Region of the NHS England, and previously Deputy Chief Inspector for the Care Quality Commission.
Download insights from and a summary of the conversation
Watch the conversation and presentations below.

January 2023 - Kindness in Healthcare: Exploring the gap between what we want and what we have in healthcare

More than 80 Kindness in Healthcare community members came together for this conversation about the gap between what we want and what we currently have in healthcare.

They heard from John Ballatt, author of Intelligent Kindness: Reforming the Culture of Healthcare, and consultant paediatrician Dr Kate Pryde, before spending time in groups for the breakout discussion. Paul Batalden, Emeritus Professor at The Dartmouth Institute, also spoke before community members shared their thoughts and reflections.
Download insights from and a summary of the conversation
Watch the conversation and presentations below.

December 2022 - A Christmas Advent calendar: kindness efforts from our community

This meeting had a special format - we heard from 'kindness experts' from within our wider community. Eight groups shared a 2-3 minute presentation about how they are focused on returning humanity to the centre of health and care around the world.
Download insights from and a summary of the conversation
Watch the conversation and presentations below.

November 2022 - Kindness: big and little acts to try

Maureen Bisognano, President Emerita and Senior Fellow, IHI, and Gabby Matthews, Youth Expert Adviser, NHS England, share thought-provoking insights into different acts of kindness we can try.

Watch the conversation below.
Download insights from and a summary of the conversation
October 2022 - Gathering of Kindness

Cath Crock, Sue Robins and Nicki Macklin discuss their experiences of kindness in healthcare and the work they are doing through Gathering of Kindness events, involving arts and music in health settings, to help spread an environment of kindness in healthcare.
Download insights from and a summary of the conversation
Watch the conversation below.

September 2022

Dr Robin Banerjee and Dr Gillian Sandstrom share their work in understanding what kindness looks like at work - and specifically in healthcare - discuss the benefits and downsides of kindness in the workplace, and highlight the barriers that prevent people from being kinder at work.

Watch the conversation, hosted by Bob Klaber and Suzie Bailey, below.
Download insights from and a summary of the conversation
August 2022

Kindness in Healthcare community members came together to connect and discuss the concept of a movement for care.

Watch the conversation hosted by Suzie Bailey with guest speakers Dr Victor Montori and co-speaker Dr Dominique Allwood, who shared their work on careful and kind patient care and the challenges to this posed by 'industrialised' health care.
Download insights from and a summary of the conversation
July 2022

Watch the presentation from Maureen Bisognano, President Emerita and Senior Fellow, Institute for Healthcare Improvement, on the concept of Eudaimonia, a new way to think about caring.
Download insights from and a summary of the conversation

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Every month Kindness in Healthcare community members from around the world come together for a Conversation for Kindness, for conversation and reflections about kindness in healthcare. Each conversation has a focus on listening, learning, thinking differently and mobilising for action, and an open culture of sharing resources, ideas and energy.

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Since 2008, the Centre for Sustainable Healthcare has engaged healthcare professionals, patients and wider community to understand the connections between health and environment, and to reduce healthcare's resource footprint. The Centre offers strategic input and consultancy on sustainable healthcare research and practice.

Our Sustainable Specialties programme mainstreams sustainability within clinical areas so that it is integral to the planning of health systems and healthcare practice. The programme is supported by our work in medical education and in carbon modelling of clinical care.

Our Sustainable Networks Community is a free online resource where you can join an engaged online forum of peers and experts in sustainable healthcare.

Our green space projects, including our NHS Forest, assist organisations to improve their natural environment and reconnect their staff, patients and the wider community with their local green space to benefit their health.

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Since 2008, the Centre for Sustainable Healthcare has engaged healthcare professionals, patients and wider community to understand the connections between health and environment, and to reduce healthcare's resource footprint. The Centre offers strategic input and consultancy on sustainable healthcare research and practice.

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Download these ten essential quality improvement tools to help you with your improvement projects, continuous improvement, and quality management, whether you use the Model for Improvement, Lean, or Six Sigma.
Note: Spanish and Portuguese translations of this toolkit also available for download.
IHI's Quality Improvement Essentials Toolkit includes the tools and templates you need to launch a successful quality improvement project and manage performance improvement. Each of the ten quality improvement (QI) tools can be used with the Model for Improvement, Lean, or Six Sigma, and includes a short description, instructions, an example, and a blank template.

The QI tools include:

Cause and Effect Diagram: Also known as the Ishikawa or fishbone diagram, this tool helps you analyze the root causes contributing to an outcome.

Failure Modes and Effects Analysis: Also used in Lean management and Six Sigma, FMEA is a systematic, proactive method for identifying potential risks and their impact.

Run Charts: These charts help you monitor performance over time.

PDSA Worksheet: Plan-Do-Study-Act rapid-cycle testing helps teams assess whether a change leads to improvement using a methodical learning process.

Download the complete toolkit with all ten tools, or download individual tools as you need them to guide your continuous improvement work.
*NOTE: Before filling out the templates, first save the PDF files to your computer. Then open and use that version of the tool. Otherwise, your changes will not be saved.
How to Cite This Document:
Quality Improvement Essentials Toolkit. Boston: Institute for Healthcare Improvement; 2017. (Available at ihi.org)

IHI QI Essentials Toolkit Overview

Related Content

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Download these ten essential quality improvement tools to help you with your improvement projects, continuous improvement, and quality management, whether you use the Model for Improvement, Lean, or Six Sigma.

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What is Value Based Health & Care?

We know that demand for health and care services is increasing and in order to meet that demand we must consider how to make optimal use of the resources we have to ensure the best possible care for our populations and the individuals who need help.

Healthcare professionals want to ensure or patients have the right treatment at the right time. They aim to 'do no harm', and that can sometimes lead them to err on the side of caution with patients: just one more test, or one referral, or one procedure.

The quality and safety, effectiveness and cost effectiveness of care remain vitally important. However, it is possible to provide interventions of high quality and which are safe, effective and cost effective, but if provided to the 'wrong' patients at the 'wrong time' they will be of low value.

We need to ensure the prevention of harm and waste from overuse and overtreatment, freeing up resources currently used without benefit to clinical outcomes in order to address under-provision of care elsewhere. By freeing up resources which are currently being used to no clinical benefit, we will be able to re-invest in healthcare that people really value.
Read the vision for Scotland here.

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Shared decision making, reducing harm, waste and tackling unwarranted variation

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Duty of Candour

The organisational duty of candour procedure is a legal duty which sets out how organisations should tell those affected that an unintended or unexpected incident appears to have caused harm or death. They are required to apologise and to meaningfully involve them in a review of what happened.

When the review is complete, the organisation should agree any actions required to improve the quality of care, informed by the principles of learning and continuous improvement.

They should tell the person who appears to have been harmed (or those acting on their behalf) what those actions are and when they will happen.

The duty of candour procedure provisions reflect our commitment to place people at the heart of health and social care services in Scotland.

We recognise that when unexpected or unintended incidents occur during the provision of treatment or care, openness and transparency is fundamental. This promotes a culture of learning and continuous improvement.

We have produced guidance on the implementation of duty of candour for all organisations that provide health services, care services or social work services in Scotland.

A Duty of Candour e-learning module has been produced by NHS Education for Scotland, the Scottish Social Services Council, the Care Inspectorate and Healthcare Improvement Scotland. Relevant staff should be encouraged to complete the module which takes no longer than an hour.

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Scottish Government information about the organisational duty of candour procedure.

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Skip to content

The toolkit was created by Nesta in partnership with STBY and Quicksand, and made possible by the Rockefeller Foundation.

Key features

The free toolkit includes 30 tried and tested social innovation tools, all grounded in existing theories and practices of innovation, design, and business development.

As well as the downloadable full toolkit, each of the individual tools is available in a range of sizes as a pdf template for use in the field, so practitioners can dive straight into action.

The DIY toolkit website also features a range of case studies and expert blog posts to help people put the tools into practice.

The website is also available in Spanish, Arabic, Mandarin, French and Russian.

The original toolkit was designed for people working in development, but the tools are relevant for any project or group.

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Skip to content The toolkit was created by Nesta in partnership with STBY and Quicksand, and made possible by the Rockefeller Foundation. The free toolkit includes 30 tried and tested social innovation tools, all grounded in existing theories and practices of innovation, design, and business development.

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Leadership at all levels

Explore offers, resources and opportunities that are open to all, from all sectors and leaders at all levels, roles, career stages and backgrounds. This space is for everyone.

Show me offers in...

Leading to Change app

The Leading to Change app (previously Project Lift) is our tool to help you explore how you can live your potential, whatever your level or role. You can access the app from the 'My Account' icon in the top right hand of every page.

Featured Resources

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Influencing Styles - overview

As well as our power base we can use different approaches to persuade others. There are many different styles of influencing and it is important to recognise which styles will work for different situations.

We will look at two different styles and the various types of approach within each.

These two styles are:
1. Push 2. Pull Push Styles
Push is more about moving or forcing someone to a change rather than motivating them to want to make the change. Push styles tend to involve logical reasoning, threatening punishment, or offering rewards or incentives. They seek to increase the 'forces' and rationale for change. They can often be referred to as the 'stick and carrot' approach. Push styles can be effective in achieving compliance but may not achieve commitment. They may bring about quick results.

Push Energy:

Comes from my agenda

Intention - changing others' position

Direction chosen by questioner

Timing set by questioner

Questions may be both open and closed

Focus - information wanted by questioner

Use your energy to penetrate areas of information which will undermine others' case

Others will feel defensive

Pull Styles
Pull is generally about motivating the individual to want to change. They tend to involve personal disclosure, involvement and showing the possibilities that will result from change. They tend to work on decreasing the forces or rationale against change. Insincere pull styles can however be seen as manipulative and dishonest. Pull styles can be effective in gaining commitment and high quality but they may be slower in achieving results.

Pull Energy:

Comes from your agenda

Intention - deeper understanding

Direction chosen by others

Explorer matches pace of other party

Questions may be both open and closed

Focus - information and feelings of others

Use your energy to enlarge mutual understanding of others' position

Others will feel understood

There are pros and cons for both Push and Pull styles and it is important to understand the uses of each.

The following tables outline the different types of Push and Pull styles and how they may be useful.
Push Styles

Assertion

'I would like you to do X'. Statement of personal wishes in a non-aggressive manner acknowledging the other person's rights, wishes or viewpoint. Power Source: Personal, Position.

Where there is a clear course of action easily identifiable by both parties. When there is a good relationship or when there is obvious rank/hierarchy.

Effective in achieving compliance but not commitment. If influencer compromises then it can become
negotiation or joint problem solving.

Pull Styles Which Style is most effective?
There is no right or wrong, both styles have some use and will be appropriate for different circumstances, but it is fair to say that Pull, when combined with the minimum amount of Push needed to achieve compliance, is the most effective approach in developing commitment and attitude change.
Summary

We all may need to develop influencing skills whatever our role or position

Everyone has a source or sources of 'power or authority' and these will have an impact on our approach and ability to influence

There are various styles of influencing, however Push and Pull are the two main styles

Push styles are generally about 'moving' a person to another viewpoint or position

Pull styles are generally more about motivating a person to see the possibilities of changing to another viewpoint or position.

Push and Pull styles have many different uses, however in general terms a combination of the two will be most effective.

Influencing Styles - Push and Pull Questionnaire
Acknowledgements: Mye-coach Ltd 2005 Overview
The purpose of this diagnostic tool is to enable individuals to assess their influencing skills and create awareness of two particular styles of influencing, Push and Pull. It will be useful for individuals who wish to identify their preferred influencing style and those who wish to develop their range of influencing styles. It requires completion and scoring of a questionnaire and personal reflection and analysis.
Introduction
This questionnaire is designed to help you assess your preferred influencing style. Reflect on each item and allocate points, on a scale of 0-4, that best represent how you generally behave when you are influencing others.

Use the following to allocate points:

0 means 'I never do this'

1 means 'I rarely do this'

2 means 'I sometimes do this'

3 means 'I often do this'

4 means 'I always do this'

Influencing Styles Questionnaire Now go to the answer grid below to score and interpret your responses.
Instructions:

1. Enter your item scores from the questionnaire against the relevant number on the left hand side of the grid.

2. Add your score for each row across the page to give you a total score for each style.

3. Add your scores in the style totals column to give you a total score for PUSH and PULL styles.

4. Reflect on your scores using the interpretation guidelines on the next page.

Item scores - style totals:

Analysis Guidelines

Are your total Push and Pull Scores equally balanced or is one much higher than the other? The higher the score the more likely you are to use this style.

Do you have a spread of scores across the different styles in the Push and Pull sections or are some significantly higher than others? Again, the higher the score the more you favour this influencing style.

How relevant is your influencing style to your role and to the people you work with or line manage?

If you have some styles that you appear to favour more than others is there a particular reason for this? How might you vary your approach?

Does your role require you to gain commitment from people over the longer term or change attitudes? If so are your styles of influencing appropriate? Remember push styles alone may get quick results but may not gain commitment.

Does your role require you to ensure compliance with rules, for example for legislative or health and safety reasons, if so is your range of influencing styles relevant to ensure compliance?

Consider any actions you may want to take to adjust or develop your influencing styles?

Materials courtesy of People and Organisational Development

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As well as our power base we can use different approaches to persuade others. There are many different styles of influencing and it is important to recognise which styles will work for different situations. We will look at two different styles and the various types of approach within each.

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This video features Dr Chris Turner. It is shared here as published on TEDx.

Duration: 15 minutes

Excerpt:
'How we treat each other at work has an enormous impact on how teams perform - with potentially fatal consequences if you work in healthcare. Chris Turner reveals the shocking impact of rudeness in the workplace, arguing that civility saves lives. Chris Turner is a consultant in emergency medicine at University Hospitals of Coventry and Warwickshire. He founded and runs Civility Saves Lives, a campaign that aims to raise awareness of the power of civility in healthcare. This talk was given at a TEDx event using the TED conference format but independently organized by a local community.'
This is a recommended resource relating to the Leading to Change Community Event: Having challenging conversations with respect.

Watch the video or find out more about the Community event.

What is this for?

Click this button to record your learning in the Leading to Change app. If you have a profile in the Leading to Change app you now have the ability to record any learning showing this button. If you do not have a profile you can register with a TURAS account or create one for free.

15 minutes and : 00 seconds till you can record this learning activity

We have estimated that this resource will take 15 minutes to complete. Once the timer below is complete you will be able to select 'Record your learning'.

Explore your potential with the Leading to Change app

Visit the National Wellbeing Hub for resources on how to stay well

Follow us

Leading to Change is a Scottish Government programme of work commissioned to NHS Education for Scotland as the main delivery partner

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leadingtochange.scot . This video features Dr Chris Turner. It is shared here as published on TEDx. This is a recommended resource relating to the Leading to Change Community Event: Having challenging conversations with respect.

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Infographics

Here at Civility Saves Lives we love infographics!
Here are some of our creations, each with a key message of civility within!

The evidence shows that rudeness impairs performance, and we're not good at recognising it at the time! This applies across healthcare, not just to surgeons.

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We love infographics, and we love to make them! Come view some of ours here.

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NHS Forest - Nature positive health service 

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NHS Forest - Nature positive health service 

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96,491 trees planted on or near NHS sites since 2009

300 NHS Forest sites located across the UK

15,721 trees planted in the 2021-22 season

Get involved

There are many ways you can get involved with the work of the NHS Forest, from registering your healthcare site to sponsoring your own NHS Forest tree.
Click here to see more ways to get involved.

Nature is fundamental to how we address health. A huge body of evidence suggests that people who live in greener environments tend to be healthier and that access to green space can reduce the impact of income-related health inequalities.

Green your site

The NHS Forest is about far more than just trees. Find out more about the ways you can green your healthcare site, to benefit staff, patients, the community and wildlife.

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There are many ways you can get involved with the work of the NHS Forest, from registering your healthcare site to sponsoring your own NHS Forest tree. Click here to see more ways to get involved. Nature is fundamental to how we address health.

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Statutory duty of candour covers all care providers registered with CQC.

Applies to organisations rather than individuals, but individuals will inevitably be involved in managing and resolving incidents.

Doctors also have an ethical duty of candour to be open and honest when things go wrong.

Duty of candour categories

Ethical duty

Low threshold for notification - any harm or distress to patients.

A 'duty of candour' is familiar to most doctors, at least in principle. Doctors have an ethical duty to tell patients when things have gone wrong, apologise and try to put things right. The MDU has been advising this approach since the 1950s.

The GMC's 'Good medical practice' (2024) says that doctors "must be open and honest with patients if things go wrong" , and guidance on the professional duty of candour explains what to do if a patient suffers harm or distress.

Statutory duty

Higher threshold, includes prolonged psychological harm to patient.

The statutory duty was introduced in November 2014 for NHS bodies such as trusts and foundation trusts in England. It was extended in April 2015 to cover all other care providers registered with the CQC.

Statutory duty: key points

The statutory duty of candour has several key principles.

Care organisations have a general duty be open and transparent in relation to care.

The duty applies to organisations rather than individuals, but staff should cooperate to make sure the organisational obligation is met.

Patients should be told of a 'notifiable safety incident' as soon as is practical.

A notifiable safety incident has two statutory definitions, depending on whether the healthcare organisation is an NHS body or not.

The organisation has to explain to the patient what's known at the time, what further enquiries will be made, offer an apology and keep a written record of the notification to the patient. Failure to do so could be a criminal offence.

The patient should be given reasonable support. This could be practical (eg, an interpreter) or emotional (eg, counselling).

The patient must get written notes of the initial discussion and of the notification, including details of further enquiries, their results and an apology. The organisation needs to keep copies of all correspondence.

Threshold for notification

The threshold for what constitutes a notifiable patient safety incident under the statutory duty of candour differs depending on whether the organisation involved is an NHS body. The definitions are set out below.

NHS body (trust, foundation trust, etc.)

Something unintended or unexpected in the patient's care that, in the reasonable opinion of a health care professional, could result in or appears to have resulted in:

their death (not relating to natural progression of an illness or condition)

them suffering severe or moderate harm, or prolonged psychological harm - see below.

Non-NHS body (GP, independent practitioner, etc.)

Something unintended or unexpected occurring in the care of a patient that, in the reasonable opinion of a health care professional, appears to have resulted in:

their death (not relating to natural progression of the illness or condition)

impairment of sensory, motor or intellectual function, lasting or likely to last for 28 days

changes to the structure of the body (eg, amputation)

prolonged pain or psychological harm (defined as experienced or likely to be experienced for at least 28 days

shortening of life expectancy

the need for treatment to prevent death or the above adverse outcomes.

Definitions of harm

Severe harm: a permanent lessening of bodily, sensory, motor, physiologic or intellectual functions, directly related to the incident.

Moderate harm: needing a moderate increase in treatment, and significant, but not permanent, harm.

Prolonged psychological harm: experienced or likely to be experienced for at least 28 days.

Scottish law

The statutory duty of candour in Scottish law is governed by the Health (Tobacco, Nicotine and Care etc.) (Scotland) Act 2016 and the Duty of Candour Procedure (Scotland) Regulations 2018. It came into effect on 1 April 2018.
See our full guide to the duty of candour in Scotland.
Summary points and advice

Ethical duty applies to all doctors, in all parts of the UK, in all circumstances.

Statutory duty applies to organisations, not individuals - but individuals should co-operate as necessary.

Patients should be told of a notifiable incident as soon as practical.

If something has gone wrong, apologise. It's the right thing to do, and isn't an admission of negligence.

Keep written records of discussions and correspondence with patients.

The thresholds for notification in the statutory duty depend on different factors. If in doubt, it's safer to assume it applies.

MDU members can contact the advice line if there's any confusion.

This page was correct at publication on 30/01/2024. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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Your quick guide to the duty of candour.

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This programme is in partnership with...

About the Environmentally Sustainable Healthcare programme

NHS England has committed to reducing its direct emissions to 'net zero' carbon emissions by 2040, with most of the reduction by 2030. There are similar initiatives underway in Wales and Scotland.

The Environmentally Sustainable Healthcare (ESH) programme was developed with the Centre for Sustainable Healthcare and the HEE Northeast Faculty of Sustainable Healthcare to provide the healthcare workforce with the knowledge and skills to deliver healthcare for financial, social and environmental sustainability.

About the elearning

There are 3 sessions in the Environmentally Sustainable Healthcare programme, all presented through key concepts and case studies. Sessions 1 and 2 are suitable for all in the NHS healthcare workforce.

1. Building a Net Zero NHS
An introduction to environmentally sustainable healthcare.

By the end of the session, learners will be able to:

Describe how the climate emergency affects health

Explain the relevance of the NHS Net Zero plan to their work

Identify case studies that reduce waste and pollution

2. Environmental Sustainability in Quality Improvement
Integrating environmental, social and financial considerations into quality improvement.

By the end of the session learners will be able to:

recognise sustainability as a domain of quality

describe how sustainability adds value to each step of a QI process

identify the steps for embedding sustainability into quality improvement

identify appropriate resources for undertaking a sustainable QI project

3. Environmental Sustainability in Dentistry
Prepares dental care professionals and support staff in primary and secondary care to implement changes in practice that reduce cost and pollution while improving dental health.

By the end of the session learners will be able to:

Describe the contribution of dentistry to environmental degradation

Explain the relevance of the NHS Net Zero plan to your work

Improve carbon literacy and identify carbon 'hotspots'

Identify case studies to reduce waste and pollution in your practice

Each session can be completed in approximately 30 minutes. Certificates are available to download on completion of the sessions.

More information

Learn more about "Delivering a Net Zero NHS" on the Greener NHS website

The Centre for Sustainable Healthcare develops methods to reduce healthcare costs and carbon emissions, while improving care quality and staff wellbeing.

Learn more about the CSH.

How to access

In order to access the Environmentally Sustainable Healthcare programme, you will need an elfh account. If you do not have one, then you can register by selecting the Register button below.
Register >
To view the Environmentally Sustainable Healthcare programme, select the View button below. If you already have an account with elfh, you will also be able to login and enrol on the programme from the View button.
View >
NHS healthcare staff in England

The Environmentally Sustainable Healthcare programme is also available to NHS healthcare staff via the Electronic Staff Record (ESR). Accessing this elearning via ESR means that your completions will transfer with you throughout your NHS career.

Further details are available here.

Not an NHS organisation?

If you are not an NHS health or care organisation and therefore do not qualify for free access elfh Hub, you may be able to access the service by creating an OpenAthens account.

To check whether or not you qualify for free access via OpenAthens, you can view the eligibility criteria and register on the ' OpenAthens ' portal.

Registering large numbers of users

If you are a HR, IT or Practice Manager and would like to register and enrol large numbers of staff within your organisation for access onto the Environmentally Sustainable Healthcareprogramme, please contact elfh directly.

Organisations wishing to use their own LMS

For HR departments wanting to know more about gaining access to courses using an existing Learning Management System please contact elfh directly to express interest.

More information

Please select the following link for more information on how to use the elfh Hub.

elfh is a NHS England programme in partnership with the NHS and professional bodies

© elearning for healthcare 2023

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Environmentally Sustainable Healthcare - elearning for healthcare

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How healthcare contributes to the climate crisis, why it matters for health, and what the healthcare workforce can do to help