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.

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.

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. Reviews in the Cochrane library are a great place to find out more.

Tips

• Learn more about the range of NICE products.
• Use the browse function to see everything we are working on in your topic.
• Read How NICE guidance and standards can help you. 

Actions

• Sign up to our newsletter.
• Follow us on Facebook, X, YouTube and LinkedIn.
• Check the NICE resource planner to see what's coming up.
• Share our quick guides or information for the public to raise awareness.
• Get involved with NICE. We need your expertise!

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.

Tips

• Leadership, culture and working together are essential to improving practice.
• Read about the benefits of NICE guidance and standards.

Actions

• Connect with other people who are working to achieve similar goals. Remember to check your organisational policy.
• Collect and share stories about change and quality improvement to share learning and inspire others.
• Work with other organisations or people who may benefit from the change. Together you could develop a plan that works for everyone.

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?

Tips

• Our quality standards are designed for you to use as a measure for your service. Our quality standard service improvement template can help.
• Our measuring the use of NICE guidance webpage shows the uptake of our guidance and quality statement measures. There are baseline assessment, audit, costing and service planning tools to help improve services and can now be found on the tools and resources pages of relevant guidance.

Actions

• Connect, gather and share information with other interested people.
• Run a webinar or online meeting to find out how services currently work.
• Audit your service against NICE guidance or standards at the same time as running a national audit to save time.
• Record the results in a spreadsheet you can share easily so everyone can see the current picture.

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.

Tips

• The System implementation team work on a regional footprint and can advise you on the most effective ways of putting NICE guidance into practice and how best to use other NICE resources.
• Check out the tools and resources tab for all guidance we publish. Here you will find tools that can help you develop your action plan.

Actions

• Think about running a pilot to test ideas.
• Try using post it notes to help you map out the service: you can re-arrange them easily as your plan develops.
• Use plan, do, study, act cycles to test an idea by trialling a change on a small scale. Assess its impact, building on the learning from previous cycles in a structured way.
• Investigate action learning as a way to solve problems and encourage people to work collaboratively.
• Find a network of people who can offer advice and support. For example, the Healthcare Quality Improvement Partnership run local quality improvement networks.
• Good communication is important. Share your plans with the organisation and everyone involved in the service.