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  • Five NHS trusts worked with Virginia Mason Institute (VMI) to develop a ‘lean’ culture of continuous improvement which puts patients first.
  • Partnering with NHS Improvement, the Health Foundation commissioned an independent evaluation to measure the impact of the partnership between VMI and the five trusts on the quality and efficiency of health care services and organisational culture in each trust.
  • The evaluation was carried out by Warwick Business School and started in early 2018. It was led by Dr Nicola Burgess and Professor Graeme Currie. The research was completed in 2021 and published in 2022.

An essential challenge for the NHS – to improve quality within the resources available – is becoming increasingly complex as demand increases in financially constrained times. Within this context in July 2015, the Secretary of State for Health announced the partnership between VMI and five NHS trusts, as part of a broader ambition for the NHS to become the world’s largest learning organisation.

The aim of the partnership was to develop a localised version of the Virginia Mason Production System, based upon ‘lean’ principles in each of the trusts. The objective was to embed and sustain a culture of continuous improvement capability within each of these five trusts and the NHS more broadly. 

A team of researchers at Warwick Business School examined the impact of the VMI partnership on each trust across the duration of the five-year partnership. Adopting a contextualist and processual approach to the study of ‘changing’, the evaluation incorporated novel methods of data collection and analysis to evidence the impact of the partnership.
Specifically, the evaluation aimed to:

  • evidence impact in terms of improving quality and efficiency of service delivery
  • identify challenges to implementation and how these might be overcome
  • consider the role of leadership in driving and sustaining change
  • understand the nuances of context that support (or hinder) the development of a culture of continuous improvement capability
  • and finally, to develop a contingency theory of implementation for wider learning and dissemination across the NHS.

Learning from the evaluation was shared with the trusts throughout the life of the programme, and with stakeholders more broadly in the form of academic publications, learning events and a final report from the evaluation.

Outcomes from the evaluation include insight on progress and achievements in each trust, helping them to further embed a culture of improvement capability. The learning will also enable systems leaders to maximise knowledge on how to support providers to embed and spread a culture of continuous improvement in the NHS.

Find out more about the NHS partnership with Virginia Mason Institute.

Contact details

For more information about this project, please contact Dr Nicola Burgess, Associate Professor Operations Management, Warwick Business School, University of Warwick or Shaun Leamon, Research Manager, the Health Foundation.

Further reading

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