The NHS stands at a critical juncture. Record waiting lists, workforce shortages, and financial constraints have created an urgent need for reform. At the heart of this challenge lies a single, unavoidable truth: the NHS must deliver more care, more efficiently, without compromising safety or quality. In other words, clinically effective productivity is now mission-critical.

The Clinical Effectiveness - Productivity Dilemma

Clinical effectiveness and improved health outcomes won’t be achieved just by increasing productivity. Yet, recent figures paint a stark picture: by 2022–23, the NHS was producing 5.4% less care for every £1 spent than before the pandemic, despite significant increases in staffing and funding. 

The government’s response is clear. Every NHS trust has been issued a ‘Productivity and Efficiency Opportunities Pack,’ with a mandate to improve productivity by 4% in 2025/26 just to maintain financial stability. But if productivity is framed purely as cost-cutting, it risks eroding staff morale and compromising patient safety. As one analysis warns, ‘Requiring staff to do more with less is likely to be counterproductive.’
So how do we square the circle—boost productivity while safeguarding quality? The answer lies in Quality Improvement (QI).

Why Quality Improvement (QI) is Central to Productivity

QI can be misunderstood as a technical exercise—audits, compliance, and tick-box projects. In reality, QI is a mindset: a commitment to continuous learning and adaptation. It focuses on improving processes, reducing waste, and enhancing patient experience. Crucially, QI and productivity are not competing goals; they are two sides of the same coin.

Research shows that productivity peaks when care processes are efficient, adaptable to demand, and consistently achieve positive outcomes. QI provides clinical services with the tools to make this happen—services can better understand the needs of the patient population to manage patient flow, tackle failure demand, and embed evidence-based practices.

Leadership and Culture: The Cornerstone of Sustainable Improvement

Leadership and culture are the bedrock of any successful improvement programme. Without visible commitment from senior leaders, QI risks being perceived as an optional extra rather than a strategic priority. Whether it’s through incremental or continuous change or larger scale transformation, it requires boards and executives to champion QI as a driver of productivity and sustainability.<

Culture change is equally critical. A culture that values learning, transparency, and empowerment enables staff to innovate and improve. Leaders create psychological safety, enabling frontline teams to feel confident to raise issues and test solutions without fear of blame. Practical steps include embedding QI into organisational objectives, celebrating improvement successes, and investing in capability-building for all levels of staff.

Key Enablers

To support with embedding a continuous QI improvement approach, three enablers stand out:

1. Digital Tools and Data: Real-time dashboards and automation reduce administrative burden and enable rapid-cycle improvement to evaluate impact and outcomes.
2. Leadership Commitment: Boards must frame productivity as a quality-driven goal, not a cost-cutting exercise. This means investing in QI capability and governance.
3. Workforce Engagement: Empowering frontline teams to identify problems and test solutions fosters ownership and morale. Improvement is most effective when it becomes part of everyday work.

Conclusion

The NHS cannot achieve reform and sustainability without changes that address the clinical effectiveness – productivity dilemma. Productivity without quality is unsafe—and ultimately unsustainable. Quality improvement provides the bridge: it turns the ambition of ‘doing more’ into the reality of ‘doing better.’
As the NHS navigates its most challenging era, leaders must ask: Are we embedding QI into every transformation programme? Are we equipping staff with the tools and time to improve? Are we using technology to enable—not replace—human care?

The vision is clear: a sustainable NHS, powered by quality improvement, strong leadership, and a culture of continuous learning—delivering safe, effective care for every patient, every day.