• A two year improvement collaborative involving 26 hospitals in the north west of England.
  • Aimed to significantly change frontline practice and improve the rates of stroke sufferers leaving hospital without serious disability.
  • Stroke 90:10 was also supported by NHS North West, the Stroke Association, the Royal College of Physicians and the Institute for Healthcare Improvement.

Stroke 90:10 was a two-year stroke improvement collaborative between hospitals in the north west of England. It aimed to significantly change frontline practice and improve stroke care. It was the first time that a stroke improvement programme had been attempted on this scale.

The programme used the Breakthrough Series Collaborative (BSC) model from the Institute of Healthcare Improvement. This model structures the change process around three face-to-fae learning events (90 days apart) and focuses improvements around a number of evidence-based clinical processes. This cycle of learning sessions and action periods is repeated twice.

Phase 1 trusts took part in interventions (across two care bundles) to improve the systems of care for patients in the first week after a stroke, such as brain imaging, swallowing assessments, aspirin prescriptions and assessments by physiotherapists and occupational therapists.

Phase 2 trusts put in place refined interventions and learning developed during the first phase.

Each hospital taking part in the programme had a participating multidisciplinary team led by a stroke physician. Hospitals developed improvement teams who attended learning sessions and had support from a faculty team. Teams contributed data and reports to an e-learning network where they were also able to access resources and teaching.


Sites taking part found that compliance to both care bundles improved over the course of the programme (details of data are in the poster download below).

The programme also found that teams who are new to improvement can learn quickly as part of an established collaborative.