TY - JOUR T1 - Beyond improvement skills: what do clinicians, managers, patients and others need to do to make improvement happen? JF - BMJ Quality & Safety JO - BMJ Qual Saf DO - 10.1136/bmjqs-2021-014181 SP - bmjqs-2021-014181 AU - Graham P Martin Y1 - 2021/10/05 UR - http://qualitysafety.bmj.com/content/early/2021/10/06/bmjqs-2021-014181.abstract N2 - In this issue of the journal, Wright et al offer an in-depth examination of the implementation of six improvement projects in three English hospitals to elucidate the work that matters most to those directly involved. The framework they inductively derive from their analysis—a set of ‘socio-organisational functional and facilitative tasks’, or SOFFTs—gives substance to the activities undertaken by practitioners at the sharp end of improvement projects, beyond the technical skills involved in delivering quality improvement methods.1 The notion that this class of activity may be important to the success of improvement work is not new: previous researchers, the authors of this study among them, have drawn attention to the range of organising activities that are central to success or failure of improvement efforts, for example, in engaging colleagues and ensuring fit with organisational processes, structures and culture.2–5 Research in the field of implementation science, such as the Consolidated Framework for Implementation Research and Normalisation Process Theory,6 7 also set out a similar range of influences on improvement efforts. This paper helpfully adds to this literature by specifying in some detail what this SOFFT work involves, with a particular focus on its implications for improvement practitioners.To varying extents, the 20 subcomponents of the SOFFT framework that Wright et al set out represent bundles of activities that are closely entwined. ‘Inculcating dedication to high-quality care’, for example, combines work to integrate and communicate evidence-based standards, to embody and exemplify … ER -