Welcome to Foundations of Improvement Science in Healthcare (FISH)



Here you can develop your capability and confidence with Improvement Science using step-by-step learning.

The material is presented as short topics that take only a few minutes to read.

There are formative-assessment multiple-choice questions (MCQs) interlaced with the material to help grow understanding.

10 CPD hours/points


Motivation:
"Personally I see many inefficiencies in my service which let patients down and that I would like to improve. I have done numerous courses on service improvement focusing on quality and safety but recognised that flow was an area of ignorance."

Expectation:
"I thought I would learn about flow and waste."

Experience:
"It was a delightful journey. Packed full of learning."

Worthwhile:
"The course was sponsored by the WMAHSN-PSC but I would have happily paid for it."

Recommend:
"Certainly"

Nuggets:
"The feeling that I was learning a new craft. The real time encouragement from Simon. Formative assessment makes me take it seriously."

NiceIfs:
"To be buddied up with another 'apprentice' at a similar stage of learning."

Dr HA, Consultant Paediatrician, Walsall, Sept 2017.

Motivation:
"I wanted to deepen my understanding of process improvement whilst applying for a new role in an Acute Trust's Improvement Team."

Expectation:
"I expected to learn a few tips and tricks that I could transfer to real-world improvement projects."

Experience:
"I was surprised and slightly frustrated by how little of the material I already knew. Ultimately though, I was very excited to have stumbled upon the foundations of a rigorous method to diagnose and design a productive health care system - an aspiration that didn't previously seem within reach."

Worthwhile:
"Far more valuable and pragmatic than any other management, leadership or improvement course I've been on."

Recommend:
"Absolutely - essential for anyone aiming to calm the chaos in their part of the health system. Even more important for those with a broader view who aim to orchestrate systemic harmony."

Nuggets:
"The process visualisations and the systematic, scientific approach to diagnosis and design."

NiceIfs:
"This is my second time completing FISH and the addition of a glossary has been useful in addition to an extra video or two.

I think that the Improvement Science Blog could be used more readily to explain, in a more accessible way, some of the topics in Module 3. The blog is particularly good at explaining some of the concepts using broader examples."

Mr TS, Service Development Lead, Exeter, Sept 2017.

Expectation?
"Uncertain! Some manager-type folk had whizzed through it. I was a bit more anxious about the science and the stats but was hoping for answers and a means to help me get those easy wins."

Experience?
"At the start, I wasn't convinced of the point of it as I was having difficulty putting it in context. By the end I'm bursting with ideas that I want to map and model. I think it helped doing some work with someone working towards ISP2. I've seen how useful some of the Vitals can be and am keen to try it out!"

Worthwhile?
"Yes absolutely. I'm also pleased I took the trouble to think carefully and take notes. The MCQs were tough but achievable. I've really enjoyed doing something other than MDTs and reporting!"

Dr DM, Clincal Director for Radiology, Swansea, July 2017.

A year ago I was contemplating life after the NHS; working in perpetual chaos and stress had led me to believe that the only way to survive was to jump. Before taking such a drastic step I decided to give Improvement Science a go.

Upon completing FISH and the ISP-1 training I have managed to transform the chaos into calm and I am now looking ahead to another 20 years of continual improvement for the benefit of my patients, myself and my family.

Dr DP, Consultant Oncologist, Swansea, May 2017.

Motivation?
"To improve my capabilities to be able to create a more efficient working environment."

Expectation?
"To gain knowledge to improve work in a healthcare environment."

Experience?
"Enjoyed the experience."

Worthwhile?
"Absolutley."

Recommend?
"I would."

Nuggets?
"The tools to assess work loads and identify worthless work."

EM, Pharmacy Technician, Galway, May 2017.

Having gone through the FISH, I feel like I have acquired more realistic knowledge which could be applied to real life situations. It is amazing how you have distilled academic knowledge and a combination of improvement methodologies into a workable format for use at any shop-floor with flow design issues.

Dr MA, GP Urgent Care, Chelmsford, Jan 2017.

Motivation?
"Taking part in a One Day Flow Design Workshop for Surgeons - mandatory part of preparation"

Expectation?
"Interestingly, information about course to come"

Experience?
"Excellent, interactive, challenging course with very interesting side-paths to follow - e.g. Wikipedia links and conversation links"

Worthwhile?
"Yes - not diminished by being free!"

Recommend?
"Yes"

Nuggets?
"Questions at end of sections to test learning - some were really testing"

NiceIfs?
"Very slight improvement in clarity in one or two questions for the autistically literal amongst us!"

Dr SWJ, Consultant Oncoplastic Surgeon, Sept 2016.

Where did you hear about FISH?
The Faculty of Medical Leadership and Management (FMLM)

Motivation?
"To learn more about improvement science in order to enable me to improve processes locally and support my clinical governance role."

Expectation?
"Hoped it contained new material other than the usual QI introductory courses."

Experience?
"Huge amount of new principles and practical tools to take on board - basically a new approach to understanding processes."

Worthwhile?
"Very useful investment of time - stimulating and keen to put principles in practice."

Recommend?
"Yes."

Nuggets?
"Gantt charts - so useful, never understood them before."

NiceIfs?
"More practical exercises - software to draw the charts?"

Dr PH, Consultant, Aug 2016.

Motivation?
"To understand systems better using the appropriate measurements. Very specifically what data do I need to understand how to manage our demand for cataract surgery."

Expectation?
"I did the first module before signing up so I expected it would deliver what I was needing."

Experience?
"Fantastic - I really enjoyed the whole process. It was challenging and well explained. It proves I was right (always good!) about all the things that we measure at the moment (e.g. theatre utilisation and % of people waiting more than 12 weeks) but now I can explain why and push to get the appropriate information."

Worthwhile?
"Yes"

Recommend?
"Definitely"

Nuggets?
"The practical examples and their application to healthcare made it easy to think about my system at the same time as doing the course."

Niggles?
"No"

CS, Consultant Ophthalmologist, Jan 2016.

What made you curious enough to register?
"A number of reasons really. I know someone who had completed the course and recommended it. I work in a trust which is actively encouraging greater participation in quality improvement projects and I have had no previous experience with quality improvement theory or projects. I also work in a department which I think would benefit greatly from quality improvement initiatives."

What was your expectation at the start?
"To be honest. I didn’t entirely know what to expect from the course. I wanted to gain greater insight into the theories that underlie quality improvement / improvement science and I wanted to work out how I could approach a small project of my own and encourage others to do the same."

How did you find the progress emails?
"The progress e-mails were encouraging. Telling me how many people had already completed the course provided an impetus to get a move on and finish the course."

What was your experience and how did it compare with your expectation?
"My experience was a positive one. I did find it more challenging than I thought it would be. There were a lot of concepts, definitions and ideas that were not instinctive or previously known to me. I found the examples helped to solidify the theory. Gantt charts were a revelation to me and such a simple way of presenting VSM information. I found that the section on ’Niggles’ also resonated with me. There are so many things that happen in my working day, that happen repeatedly, which annoy me and I just let them go rather than address the problem because I don’t often have time to address them."

Was it a worthwhile investment of your time?
"It was definitely 'worthwhile work’ and it has given me more than just food for thought. I have a better concept of what improvement science is about and how it can be applied in the work place and I hope to undertake my own little improvement science project."

MMcF, Histopathology SpR, Dec 2015.

"I heard about this course via social media (Twitter). I was motivated to do it by the current political climate in which junior doctors find themselves, with negative feelings surrounding proposed changes to our contracts.

I currently work in a hospital that has a very corporate environment, and as a result was feeling like a small invaluable part of an organisation that I had no impact or positive influence on.

To be honest, I thought I would find the course a bit dry and theoretical, but I think it was because I had categorised it as a tick-box exercise for the "management" part of my eportfolio, and felt that the managerial role was something I was not really interested in.

To my surprise I found the course enjoyable and a worthwhile way of spending my time. The practical worked examples were particularly helpful, especially when charts were drawn out and talked through in the videos. Having a visual representation of how a system works has really helped me to put things into context and see where I can identify areas for change.

Rather than just grumbling about things, I feel I have the tools to make a difference now. Thank you!"

HK, Doctor, Dec 2015.

What made you curious enough to register for the Foundation course?
A general and potentially erroneous scepticism about the language and behaviour of “management types.” The availability of a short, clear, and medical professional driven approach to management and service improvement, was too good to walk past. This course was an opportunity to learn more, and be a more informed, wiser contributor to my department.

What was your expectation at the start?
I must admit, my expectations were quite low, I thought in 8 hours, or 4 modules, there wouldn’t be that much information presented and that it would probably be oversimplified. How wrong I was!

How did you find the progress emails?
Progress emails, and the attachments and extra reading were great. I found them fascinating, as indeed, I did the whole subject matter.

What was your experience and how did it compare with your expectation?
My experience was of a well written, well planned, thought provoking online based course which was far beyond what I would have deemed a good course.

Was it a worthwhile investment of your time?
Yes, without doubt.

CL, Surgical Trainee, Dec 2015.

"To be honest, I was very surprised with the content of the course ... in a good way ... so much so that I sat and completed it over two days!

I was fully expecting a generic online management course filled with the usual buzz words and with no real substance or learning point to take away from it (I'm generally very sceptical of such things as I feel many courses are primarily money making exercises with little real value as the developers are well aware that healthcare professionals need to tick off the management box at their appraisals).

What I actually found was a course that presented the problems of a chaotic department (that I'm all too familiar with as a radiologist) and actually broke down the problem into its root causes and fundamental components in a logical way with simple and effective strategies to improve a service.

Considering each process in terms of a series of streams and stages and presenting these functions as a Gantt chart is brilliantly simple, demystifies what actually happens in a process, and is a simple way of identifying all the faff that goes on around the real value work that we do - something that I was all to aware of prior to the course but didn't really know how to tackle.

What I have learned is definitely a valuable foundation in managing the various processes of a department such as my own and I will certainly make use of these tools in the future."

RM, Radiology SpR, Dec 2015.
"I found it fascinating. It was challenging. A Gantt chart is my new favourite chart. After completing the FISH course, I already could see uses for applying the principles of flow science in my everyday work. I think anyone involved in booking or organising outpatient lists would find this course extremely beneficial."
AW, MRI Radiographer, Oct 2014.
"Just done the FISH course. It is brilliant."
LW, NHSIQ, Sept 2013.

The FISH course builds on traditional Quality Improvement (QI) teaching.

The FISH course consists of four modules of on-line self-paced learning.

The FISH course requires an investment of only 8-12 hours of time.

Module One is available to anyone, free of charge, as a taster.

To access Module One just REGISTER and then LOGIN.

Each module progressively builds a strong foundation of knowledge, techniques and tools. To continue with Modules Two to Four incurs a small cost but those who have completed FISH say that it is well worth the investment and excellent value-for-money.


The full FISH course includes:


There are now hundreds of holders of FISH Certificates of Achievement and many of this growing community of healthcare improvement practitioners (CHIPs) have gone on to extend their capability through the Improvement Science Practitioner (ISP) programme and are using improvement science in their daily work.

Read some of their testimonials here.

Read some of the case studies here.


The Practical Skills One-Day Workshops are the first step, FISH is the next step, ISP-1 is the third, and so on ...