• Healthcare quality improvement
• Quality improvement methodologies
• Health professions education

Improving healthcare services can all too easily become synonymous with the use of certain in vogue tools for improving quality. Trigger tools, run charts and driver diagrams are just three examples of techniques used by frontline staff who are undertaking improvement work. Educators seeking to teach improvement are similarly faced with long lists of possible approaches and techniques with which to fill their course descriptions. As a consequence the temptation for improvement leaders and teachers is to include yet another technique in an already crowded curriculum, to add in more ‘stuff’.

But what if focusing so much on the tools is actually unhelpful? What if our attempts to create better and safer organisations is muddled rather than enhanced by the growing interest in so many techniques? Could we be putting off the very people we need to engage by the use of what can be seen as jargon? Might it lead people to see improvement as an event or a ‘project’ rather than as a way of working?

Sure, knowledge and skill are vitally important and we must be able to measure the impact of any changes over time. But maybe we need a way of framing improvement, that is, somewhere between the abstract ambition of ‘improvement’ and the specific methods which have come to be known as the tools of quality improvement.

Healthcare services will never realise their full potential until improvement becomes part of every worker's day job1 rather than a temporary phenomenon. For such a paradigm shift to occur, caregivers will need to learn and, most importantly, unlearn behaviours. At the individual level considerable habit change will be required. Within teams and across organisations such habits will become enshrined in new patterns of social interaction.