Tools, Tips and Links Resources

Models, examples, checklists, articles and information to help you take your quality system - and your care - from good to great.



High quality care at Beaufort Skipton Health Service

Check out what 120 community members can do when they collaborate on the care they want from their health service, and how everyone must work together to achieve it, using the strategic quality system.  Easy to see the SQS Purpose, People and Pillars of governance there from the consumer and community perspective. Magic! So to all those who say that 'quality' can't be defined...Thanks to Beaufort Skipton Health service for organising this great event and asking me to be part of it, and to Alice Edy for the 'Great Care' work of art!

Care and services should be GREAT!


But! - care and services can't be consistently Great until we clearly define what that means, and align our organisations around achieving it for every consumer.  So, how better to define Great Care - than GREAT? (c)Cathy Balding, 2017.

New research on making quality systems more useful and effective drivers of high quality care

Many health service staff do not see their organisation's quality system as a useful support for providing good care.  So what are we going to do about it? In this new 2017 article, Professor Sandra Leggat from La Trobe University and I report on our research into what makes an effective quality system.

What do health service staff really think about theiorganisation's quality system? - and what can boards and executives do to make it a driver, rather than a distractor?   Read our research findings in the attached pdf article, published in Health Services Management Research, August 2017. 

Quality-systems-implementation-article-HSMR-Leggat-and-Balding-2017.pdf Quality-systems-implementation-article-HSMR-Leggat-and-Balding-2017.pdf (143kB)

The Strategic Quality System Model

The SQS Model helps boards, executives and clinicians to design and operationalise their strategic vision for great care for every consumer, every time by clearly identifying:

  • the Purpose - a concrete definition of the quality of care they want to create and sustain with every consumer, every day  
  • the People - staff characteristics required to create great care with every consumer
  • the Pillars - organisational governance and systems required to drive and support consistently great care within complex systems.

Watch this video for an overview of the SQS Model, learn how to implement it in my 'Create a Great Quality System' Book, and contact us if you think it would help you to create, monitor and manage the care you want to provide for every consumer.

Read testimonials from individuals and organisations on how the SQS inspired and supported them to pursue great care with their consumers here.

SQS in Action

Western Health, a large multi-campus teaching health service in western Melbourne, implemented the Strategic Quality System to bring all their good improvement work together, identify their gaps and focus more completely on their consumers.  Here's an overview of their progress a year later.


See poster attached; and watch a video of the CEO discussing their progress.

Poster-template-WH-Best-Care-final.ppt Poster-template-WH-Best-Care-final.ppt (3MB)

Ten Leadership Practices for Great Care

Great care for every consumer is not set and forget - you have to work at it! Here's 10 leadership practices that will help guide your organisation to care greatness.

The Quality System Maturity Scale

Where is your organisation on The Quality System Maturity Scale? Use my scale to start a conversation about the health and effectiveness of your current quality system - and to plan how you'll evolve it to create even better care and experiences for consumers.

Organisational Quality System Maturity Scale (Balding, 2013)

Maturity Level


1. Informal


  • Driven by lone ‘champions’ with an interest in improvement.
  • Lack of systematic approach: random improvement activities based on minimal and poor data.
  • Managerial response to quality problems largely dependent on staff ‘trying harder’.
  • Limited staff input into identifying problems and improvements.  

2. Compliance


  • Focus on compliance with external/funding requirements.
  • Problem based and reactive approach with minimal systematic collection or analysis of data on key issues.
  •  ‘Doing quality’ is staff code for auditing and other data collection with little impact on consumer care.
  • ‘Quality’ seen as the responsibility of the quality manager. 

3. Reactive


  • Focus on risk management and compliance with accreditation and other external requirements.
  • Systematic tracking of key indicators, consumer feedback and incident reporting.
  • Evidence of some system improvement and follow up.
  • No agreed change and improvement model in use. 
  • Reliance on policy change and education as key change tools.
  • Leaders are developed to improve safety.

4. Proactive Improvement

  • Quality system is a key component of clinical/quality governance system, with plans for improvement at organisation-wide and local levels.
  • Lack of common and uniting goals with the improvement program comprising a series of (possibly unrelated) monitoring, improvement and redesign projects.
  • Minimum dataset reported across all quality dimensions.
  • Data analysed and reported through organisational levels to the governing body, with evidence of effective systems improvement as a result.
  • Strategies in place for developing leaders to engage staff in improvement across the dimensions of quality, with some consumer input.

5. Strategic


  • The desired quality of the consumer experience at point of care is defined with staff and consumers, and achieving it is a strategic priority.
  • The organisational quality plan is designed and systematically implemented to create the defined quality consumer experience, through developing people and improving systems.
  • Roles and responsibilities at all levels of the organisation for creating the quality consumer experience are described and supported.
  • Governance systems are owned by the governing body and executive team and designed to support staff to create the quality consumer experience.
  • An agreed and consistent model for change and improvement is in use. 

The Will and Skill Change Model


Change is an ongoing challenge in the world of creating quality care. But too often, change doesn't work, or doesn't stick, and you're back to square one having wasted time, energy and resources for little gain - and annoyed a whole lot of people in the process!  This is because we usually focus on the project management side of change - the tasks required for things to be done differently - and forget that people also need to make a mindset change in order to support the change to be successfully implemented.  I developed the 'Will and Skill' change model to address both of these key change components in one change process.  

The six achievements of an effective quality system.

Checklist for a hard working quality system.

Quality systems can and should do so much more for health, aged and community services than they do.  Why?  Partly this is becuase many boards and executives don't understand the potential of their quality system, and how it must be running like a well oiled machine to drive great consumer care and experiences within complex environments.

 Click on the pdf below for the six acheivements - and the corresponding components required to make them a reality in your organisation.

Strategic-Quality-System-Logic-one-pager.pdf Strategic-Quality-System-Logic-one-pager.pdf (1MB)

Characteristics of high performing health services 2016

How does yours stack up?

High-performing-health-services-2016.pdf High-performing-health-services-2016.pdf (392kB)

Creating Great Care in Complex Systems Resource List

Helpful information for creating safety and quality in complex systems

Amalberti, R, Vincent, C, Auroy, Y and de Saint Maurice G (2006) Violations and Migrations in Health Care: A Framework for Understanding and Management. Qual Saf Health Care. December 15 (Suppl 1):i66–i71. (Accessed November 2010)

Balding C (2015) Leading a strategic quality governance system online course.

Balding C (2012) '5 Essential Skills for 21st Century Quality Managers.'  InTech Open Access

Balding C (2011) The Strategic Quality Manager:  A Handbook for Navigating Quality Roles in Health and Aged Care.  Arcade Custom, Melbourne.  Available as a handbook or ebook from:

Dekker S (2011) Drift Into Failure – From Hunting Broken Components to Understanding Complex Systems. Ashgate Publishing Company, UK

Flin R, O’Connor P, Crichton M (2008) Safety at the Sharp End – A Guide to Non-Technical Skills. Ashgate Publishing, UK

Lillrank P, Liukko M (2004) Standard, routine and non-routine processes in healthcare.  International Journal of Health Care Quality Assurance; 2004; 17, 1; ABI/INFORM Global pg. 39

Meadows DH (2008) Thinking in Systems – A Primer. Sustainability Institute, USA

NHS (2016) Developing people, Improving care. a national framework for action on improvement and leadership development in NHS funded services. NHS, UK.

NZ Health Quality and Safety Commission (2016) From knowledge to action: a framework for building qulaity and safety capability in the NZ health system. (Health Q&S Commission, NZ.

Plsek P, Wilson T (2001) Complexity Leadership and Management in Healthcare Organisations. BMJ, 323, no.7315, pp. 746–49

Weick KE, Sutcliffe KM (2007) Managing the Unexpected. John Wiley and Sons Inc, USA

Five Favourite Change for Improvement Books

My Five Favourite ‘Incredibly Useful Change for Improvement’ Books

These are my current ‘go-to’ books for understanding and making change for improvement in complex organisations. They live in the real world and are full of useful explanation, practical solutions and tools for making process and culture change a reality. 

Byham, W (1993) Zapp! Empowerment in Health Care.  Fawcett, USA.

Connors R, Smith T (2011) Change the culture, Change the game.  Penguin Books, New York, USA.

Heath D & C (2011) Switch: How To Change Things, When Change is Hard. Random House Business Books, USA.

Kotter J (2014) Accelerate: Building Strategic Agility for a Faster-Moving World. Harvard Business Review Press, USA.

Lencioni P (2012) The Advantage: Why Organizational Health Trumps Everything Else in Business. Jossey-Bass, USA.