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A country’s performance in health attainment refers to both its achievement (level) and its improvement (evolution) in the health domain. Studies on performance generally measure health attainment using the average health level of the population and quantify health improvement employing the change in attainment over time. However, this approach is flawed because the change in attainment does not satisfy good properties, on the one hand, and because health attainment should not only account for the average health level but also for disparities in health in the population, on the other hand. We propose a solution to the first limitation by following the lead of Kakwani (1993), who uses achievement and improvement measures which are based on attainment measures and which satisfy important properties. For the second limitation, we extend the work of Kakwani and propose new definitions of attainment that account for the average health level but also for health inequalities in the population. Specifically, we focus on overall and social health inequalities and on the health of the poor. By including these new attainment variables into Kakwani’s indices, we generate new classes of achievement and improvement indices. Using data on 11 low- and middle-income Asian countries in the twenty-first century, we highlight that child and maternal health have generally improved in recent decades, due to both an increase in the average health level and a decrease in inequalities.

This article briefly outlines some of the debates and discussions currently taking place in public health with regards to what ‘counts’ as evidence, as well as evidence use. This provides the context for describing a new programme of work currently being developed in Scotland by the national health improvement agency, as one of several support functions for the implementation of the Scottish Executive National Programme for Improving Mental Health and Well‐Being. This programme of work is aiming to support evidence into practice and practice into evidence in mental health improvement in Scotland.

The purpose of this paper is to study the mutual disruption and support of economic growth and health improvement in the last 500 years in the UK.

The paper is a general review and it compares institutional development, public policy, technological advances and scientific discoveries in economic growth with those in health improvement.

The paper finds the co-existence of slower economic growth and less increasing life expectancy from 1541 to 1871 and that of faster economic growth and rising life expectancy from 1871 to 2001. It is organized health improvement that effectively propelled economic growth in the time span of 1871-2001.

The findings may contribute to the literature on mutual enhancement between economic growth and health improvement.

The findings may also provide implications to the policy makers how important organized health improvement is to economic growth.

The findings show that when UK Government was leading in organized health improvement for the population, economic grown got propelled into a faster lane.

This paper is among the first to unveil that a socially responsible government has permanent impact on the paths of both economic and social growth. It has value to other researchers attempting to understand the mutual disruption and support of economic growth and health improvement in the historical UK.

The current interest in evidence‐based practice has led to a growing literature on the role of education and training in getting evidence to inform professional practice. This report outlines the findings of an evaluation of a series of evidence‐into‐practice training workshops designed to strengthen evidence‐based practice in the delivery of mental health improvement in Scotland. Evaluation was conducted in two phases, in order to assess the extent to which the training had influenced practice. The findings suggest that, in addition to providing high quality learning opportunities for mental health improvement, considerable attention needs to be given to the barriers that inhibit putting learning into practice. These barriers may need to be taken much more fully into account in the design and delivery of evidence‐into‐practice training.

The purpose of this paper is to present a co‐authored reflection on the health improvement leadership development programme and the key evaluation messages derived from piloting in an English National Health Service region. It highlights the specific attributes of this approach to health improvement leadership development and clarifies health improvement development issues.

Appreciative inquiry and soft systems methodology are combined in an evaluation approach designed to capture individual as well as organisation learning and how it impacts on leadership in specific contexts.

The evaluation exposes the health improvement leadership needs of a multi‐organisation cohort, offers some explanations for successful achievement of learning needs while also exposing of the challenges and paradoxes faced in this endeavour.

There are limited reported templates of how to develop leadership for health improvement. This paper details a whole systems approach, acknowledging the impact of context on leadership and an approach to evaluating such complex initiatives.

In 2016, New Zealand's Ministry of Health introduced the System Level Measures Framework which marked a departure from health targets and pay-for-performance incentives towards an approach based on local, collaborative approaches to health system improvement. This exemplifies an attempt to “overwrite” New Public Management (NPM) institutional practices with New Public Governance (NPG). We aim to trace this process of overwriting so as to understand how attempts to change institutional practices were facilitated, blocked, translated and edited.

We develop a conceptual framework for understanding and tracing institutional change towards NPG which emphasises the importance of discursive strategies in policy attempts to overwrite NPM with NPG. To analyse the New Zealand case, we drew on policy documents and interviews conducted in 2017–18 with twelve national key informants and fifty interviewees closely involved in local development and/or implementation of the SLMF.

Policy sponsors of collaborative approaches to health system improvement first attempted formal institutional change, arguing that adopting collaborative, quality improvement (NPG) approaches would supplement existing performance management (NPM) practices, to create a superior synthesis. When this formal approach was blocked, they adopted an approach based on informal persuasion of local organisational actors that quality improvement should supplant performance improvement. This approach was edited and translated by local actors, and the success of local implementation varied considerably.

This article offers a novel conceptualisation of public management institutional change, which can help explain why it is difficult to completely erase NPM practices in health.

This paper explores the rhetorical practices that are used in the introduction of a New Public Governance policy framework.

In 2002/3 the Health Foundation launched an ambitious five‐year Programme of investment in leadership development. This investment included resource for simultaneous evaluation (Lucas 2006). Against a background of unprecedented upheaval in healthcare systems in the UK, the Leadership Programme has evolved, encompassing initiatives aimed both at individuals and teams. The Programme has been refined to provide a more explicit focus on leadership for quality improvement. This article reviews what has been learnt from this investment to date, focusing on lessons both for practitioners and for academics.The focus of this paper is what has been learnt from running the Foundation's three individual leadership schemes over the past three years. The authors argue that to be effective talent spotting needs to develop rigorous mechanisms for identification of potential; that there needs to be a sustained focus on quality improvement outcomes if leadership programmes are to deliver more than personal development; that the most effective development is work rather than classroom‐based; and that organisational commitment for leadership development is critical if the full impact is to be realised. The authors draw on an extensive evidence base from the Programme evaluation, including some case studies.

In the recent climate of consumerism and consumer focused care, health and social care needs to be more responsive than ever before. Consumer needs and preferences can be elicited with accepted validity and reliability only by strict methodological control, customerisation of the questionnaire and skilled interpretation. To construct, conduct, interpret and implement improved service provision, requires a trained work force and infrastructure. This article aims to appraise various aspects of consumer surveys and to assess their value as effective service improvement tools.

The customer is the sole reason organisations exist. Consumer surveys are used worldwide as service and quality of care improvement tools by all types of service providers including health service providers. The article critically appraises the value of consumer surveys as service improvement tools in health services tool and its future applications.

No one type of survey is the best or ideal. The key is the selection of the correct survey methodology, unique and customised for the particular type/aspect of care being evaluated. The method used should reflect the importance of the information required.

Methodological rigor is essential for the effectiveness of consumer surveys as service improvement tools. Unfortunately so far there is no universal consensus on superiority of one particular methodology over another or any benefit of one specific methodology in a given situation. More training and some dedicated resource allocation is required to develop consumer surveys. More research is needed to develop specific survey methodology and evaluation techniques for improved validity and reliability of the surveys as service improvement tools. Measurement of consumer preferences/priorities, evaluation of services and key performance scores, is not easy.

Consumer surveys seem impressive tools as they provide the customer a voice for change or modification. However, from a scientific point‐of‐view their credibility in service improvement in terms of reproducibility, reliability and validity, has remained debatable.

This artcile is a critical appraisal of the value of consumer surveys as a service improvement tool in health services – a lesson which needs to be learnt.

The purpose of this paper is to explore some of the key factors that trigger and drive improvement in the NHS and in health care more widely, and to suggest what practical steps can be taken to speed it up.

The paper outlines the varied improvement drivers that impact on health care organisations today – establishing a basic understanding of the different motivating factors behind each. Building on this, the paper explores the shared attributes of successful health care improvement practice and highlights the processes and tools that are helping many frontline NHS organisations achieve faster and better improvement locally.

There are many reasons that trigger improvement efforts in the health service and most have a valid role to play. But underpinning them all are four fundamental skill and knowledge sets: leadership; performance and metrics; the right tools and processes; and relationships. One important way to unlock the potential for faster improvement in patient care is for organisations and individuals to understand the profound relevance of these four areas to their own improvement work, and to know about the tools and techniques that are proven to help.

This paper helps address the broad and recognised need across the NHS and wider health service to build service improvement capacity, capability and will. It clarifies the priority areas where organisations, clinicians, health care professionals and improvers at all levels need to develop, and it offers practical steps to help ensure this happens.

The purpose of this paper is to describe a quality improvement collaborative conducted in 33 Nigerian facilities to improve maternal and newborn care outcomes by increasing compliance with high‐impact, evidence‐based care standards. Intervention costs and cost‐effectiveness were examined and costs to the Niger Health Ministry (MoH) were estimated if they were to scale‐up the intervention to additional sites.

Facility‐based maternal care outcomes and costs from pre‐quality improvement collaborative baseline monitoring data in participating facilities from January to May 2006 were compared with outcomes and costs from the same facilities from June 2008 to September 2008. Cost data were collected from project accounting records. The MoH costs were determined from interviews with clinic managers and quality improvement teams. Effectiveness data were obtained from facilities' records.

The average delivery‐cost decreased from $35 before to $28 after the collaborative. The USAID/HCI project's incremental cost was $2.43/delivery. The collaborative incremental cost‐effectiveness was $147/disability‐adjusted life year averted. If the MoH spread the intervention to other facilities, substantive cost‐savings and improved health outcomes can be predicted.

The intervention achieved significant positive health benefits for a low cost. The Niger MoH can expect approximately 50 per cent return on its investment if it implements the collaborative in new facilities. The improvement collaborative approach can improve health and save health care resources.

This is one of the first studies known to examine collaborative quality improvement and economic efficiency in a developing country.