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Organisations within healthcare increasingly operate in rapidly changing environments and present wide variation in performance. It can be argued that this variation is influenced by the capability of an organisation to improve: its improvement capability. However, there is little theoretical research on improvement capability. The purpose of this paper is to set out the current diverse body of research on improvement capability and develop a theoretically informed conceptual framework.

This paper conceptualises improvement capability as a dynamic capability. This suggests that improvement capability is comprised of organisational routines that are bundled together, and adapt and react to organisational circumstances. Existing research conceptualises these bundles as three elements (microfoundations): sensing, seizing and reconfiguring. This conceptualisation is used to explore how improvement capability can be understood, by inductively categorising eight dimensions of improvement capability to develop a theoretically informed conceptual framework.

This paper shows that the three microfoundations which make up a dynamic capability are present in the identified improvement capability dimensions. This theoretically based conceptual framework provides a rich explanation of how improvement capability can be configured.

Identifying the component parts of improvement capability helps to explain why some organisations are less successful in improvement than others. This theoretically informed framework can support managers and policy makers to identify improvement capability dimensions in need of development. Further empirical research, particularly in non-market settings, such as publicly funded healthcare is required to enhance understanding of improvement capability and its configuration.

Healthcare regulation is one means to address quality challenges in healthcare systems and is carried out using compliance, deterrence and/or improvement approaches. The four countries of the UK provide an opportunity to explore and compare different regulatory architecture and models. The purpose of this paper is to understand emerging regulatory models and associated tensions.

This paper uses qualitative methods to compare the regulatory architecture and models. Data were collected from documents, including board papers, inspection guidelines and from 48 interviewees representing a cross-section of roles from six organisational regulatory agencies. The data were analysed thematically using an a priori coding framework developed from the literature.

The findings show that regulatory agencies in the four countries of the UK have different approaches and methods of delivering their missions. This study finds that new hybrid regulatory models are developing which use improvement support interventions in parallel with deterrence and compliance approaches. The analysis highlights that effective regulatory oversight of quality is contingent on the ability of regulatory agencies to balance their requirements to assure and improve care. Nevertheless, they face common tensions in sustaining the balance in their requirements connected to their roles, relationships and resources.

The paper shows through its comparison of UK regulatory agencies that the development and implementation of hybrid models is complex. The paper contributes to research by identifying three tensions related to hybrid regulatory models; roles, resources and relationships which need to be managed to sustain hybrid regulatory models.

In America they do not tell Englishmen the story of George Washington and his exceptional devotion to the truth. The reason for that is, I think, because they are too busy telling us yarns illustrative of their conviction that we are entirely devoid of any sense of humour, the favourite, of course, being the one about “we eat what we can and can what we can't.” But even if we are dense and slow‐witted and have no Washington story, we are not without our Washingtons. Myself, I have discovered one and in the most unexpected of situations—in the milk trade, in fact, It was not with a little hatchet he said he had done it, of course; it was with his little bucket. And having prefaced his statements, as did the illustrious original, with the ringing declaration “I cannot tell a lie,” he explained just how the water found its way into the milk. It was because, taking his little bucket and filling it with water, he went round all the milk pails and he swilled them out and then added all the rinsings to the churn containing the milk, all ready for distribution. It was not that he wanted to adulterate the milk; it was that he wanted to make sure that no single drop of milk given by the cows was lost. Not for a moment did it occur to him that the rinsings consisted mainly of water and that the bulk of the milk would be diluted to such an extent that in the churn containing 7½ gallons about a gallon was water. How there could be so much, my lacteal Washington could not understand, as for rinsing purposes he was convinced he used no more than a pint. No one in court or in the witness box could tell him, or his judges either for that matter, and so it finished up with him being called upon to pay a fine of £10 with costs £2 18s. And all because he used his little bucket as he ought not to have used it. I forget what G. Washington's father did to him for demolishing the cherry tree with his little hatchet. The next time I am in America, interrupting somebody's funny story about the uselessness of expecting an Englishman to see anything funny in a funny story, I must ask about this.

Hitherto we have been able to record the fact that, in spite of the War, the circulation from libraries has remained practically stationary. The library reports for 1915–16, which are now flowing into the editorial office, show that this position has not been maintained so far as superficial figures are concerned. A number show a decrease in circulation ranging from about five to ten per cent. of the entire issue. At the same time the number of borrowers has declined in an even greater proportion. Both facts are due to the operation of the Military Service Act, and a consideration of the relative figures is distinctly not a matter for discouragement, but the exact contrary; because it will be found, that the large depletion of borrowers' registers has not been accompanied by a proportionate depletion of the issues; in short, the borrowers who remain are actually reading much more than they did before the war. Our contention that readers turn to libraries for help and refreshment in these critical days can now be proven by actual figures. The time is an opportune one for determining the character of the books read by the men of our new armies as compared with those read by people who remain in civilian life. In one library that we have checked carefully the curious fact emerged that the issue of most books in the class Sociology ceased at the end of 1915. Fiction, we know, has been in slightly greater demand everywhere— for the reason just given. It would be an interesting, and not useless, work, if all libraries would take a census of this kind, so that we could see exactly by whom books are borrowed. General classified statistics scarcely meet the case; the examination of the issues of individual books gives more illuminating results.

At a meeting of the Council of the Royal Borough of Kensington on June 5th Councillor A. J. RICE‐OXLEY, M.D., Chairman of the Public Health Committee, brought up a report as follows:—