ABSTRACT
'Large-scale improvement' and 'scale-up' are terms that refer to efforts that seek to stimulate positive and sustainable change within the organisation and beyond on a regional and national basis, through the mobilisation of hundreds or thousands of healthcare workers. The existing evidence suggests that there are several large-scale change programme drivers, and these drivers are not dissimilar to what Brandrud et al. described in the factors for successful continuous Quality Improvement programmes. However, the combination of continuous Quality Improvement with major healthcare transformation in the English National Health Service is unprecedented. Leadership is the key to change with "strong and capable leadership being the key to driving transformational change and the taking of bold decisions". Strong leadership is required to develop a new culture of collaboration and co-operation for the good of the patient and their family and for good practice to be actively shared.
