Table 2

Examples of the contrasting approaches to quality improvement

The Dansworth approachThe Furnhills approach
Work first with those who are willing to improve.Focus on the poor performers/laggards.
Use data that clinicians feel they own.Use commissioners’ data.
Respectful dialogue for mutual problem solving (as in: we both want to improve care)Contract-based ‘judgement conversation’ (as in: we are here to push you to change, as adversaries if need be)
Prioritise and deal with one or two agreed problems.Set multiple improvement targets.
Use small, targeted, rapid-cycle tests of change and evolve accordingly.Try to bring about measurable change across the board.
Use evidence in a targeted, focused way.Provide maximal evidence to support change.
Encourage clinicians to develop improvement plans.Provide evidence-based guidance to clinicians.
Get engagement through early wins and word of mouth.Use incentives and sanctions to change practice.