For three years the NHS Institute has been improving services by helping trusts innovate. Now, says its chief executive, it relishes the challenge of expanding its role without diluting its benefits.

I don't think I will forget 1 July 2008. As the nation awoke to reactions to High Quality Care for All, my colleagues and I began an exhilarating day hosting an event to showcase innovation as part of the NHS's 60th anniversary celebrations. Later, as we shared our impressions of the day, we wished ourselves a quiet "happy birthday", as on that day the NHS Institute for Innovation and Improvement became three years old.

The institute is here to help improve services for patients and the public by finding ideas that, if we work hand in glove with the service, can be developed, adapted and adopted to help the NHS tackle its biggest challenges. We work on leadership development; on helping people learn to improve and innovate; on the identification of creative new approaches to healthcare and on supporting innovators through the journey from a great idea to a successful implementation.

Smaller than our predecessors the Modernisation Agency, the NHS Leadership Centre and the NHS University, we have focused on the most pressing NHS challenges and on a rapid process of developing tools and products for the service. We have developed more than 40 discrete products, some of which have become household names across the NHS, including Productive Ward and the No Delays Achiever.

We run the highly successful NHS graduate training schemes and have worked with the Academy of Medical Royal Colleges and professional bodies to agree a framework for all doctors to develop competence in management and leadership. Twenty-three universities have joined our programme to introduce undergraduate healthcare professionals to the basics of healthcare improvement.

Each year we have been asked to expand our portfolio, which now includes a role in patient safety and world class commissioning work.

Moving on

Now three main factors mean it is time to take stock and plan the next phase.

First, our initial plan covered three years in which we would establish the institute, engage with the service and other partners and rapidly develop a portfolio of products. This phase has gone well but we now know we initially underestimated the role we would be asked to play in helping to shape new policy.

Second, feedback from the NHS needs to set our direction. In general people in the NHS are positive about our work, from frontline staff to senior management, but some organisations do not routinely use our support. Many people are more familiar with some of our products than with the NHS Institute itself and a particular challenge for a small national organisation is that some teams want much more hands-on help than we originally envisaged. That people want more from us on an increasing number of topics, such as mental health and community services, has shaped our current development programme.

Third, the implications of Lord Darzi's report, High Quality Care for All. The new NHS Evidence service, to be run by the National Institute for Health and Clinical Excellence, will mean that the National Library for Health, currently part of our portfolio, will move to establish this service. Our work on leadership development will be commissioned by a new Leadership Council. The work we lead on supporting innovation needs to be repositioned as strategic health authorities acquire a statutory duty to promote innovation and as stronger academic, NHS and industry partnerships are promoted. And, significantly, the money with which the Department of Health commissions our work on improvement will, from next April, also be devolved to SHAs.

Practical considerations

While we sort out the practicalities of these changes, our first concern is to continue to develop high impact solutions with the NHS. The next few weeks will see the launch of the Productive Community Hospital, the Productive Leadership Team, a programme of support for world class commissioning and an Academy for Large Scale Change, while we will continue to strengthen our existing programmes.

We are introducing a more formal process to assess the potential impact of new projects and products.

We have always tried to balance the priorities of the DH as our principle funder with the views that we get from our links with the service, but as our funding base diversifies this will become even more of a challenge.

A second concern is that we are being asked to help with planning for implementation of many aspects of High Quality Care for All. This is an opportunity to capitalise on the engagement that characterised the review process itself and ensure implementation is led by the service, but it will mean a change in approach.

We have developed a series of "design rules" to guide those planning implementation. Based on successful experience of leading change at scale we think they will make a difference.

Organisational energy

One example is the need to give greater attention to the factors that generate organisational energy, which can be so potent in promoting change. Another is the proposition that the scale of ambition for change should be determined as locally as possible. A third is that most challenges in healthcare can be regarded as having an answer that combines a "what" (eg, we should improve patient safety through better handovers) with two "hows" (eg, by using a structured communication tool, which we implement using a strategy that builds commitment and monitors the reliability with which it is used). In the NHS we need to give a lot more attention to the latter.

We have until December to agree with the DH and SHAs the new arrangements that will underpin our work. Initial discussions have been very productive.

Challenges ahead

The challenge for us is to retain the attributes that people say they value most: our being part of the service, focused on a small number of important challenges and driven by the potential to transform patient care while becoming ever more responsive. It is a challenge we relish.

But the pitfall for us and for our value to the service would come if each part of the system pursued a distinctly local agenda that led to a dilution of our capacity to deliver. And we also need to remain relevant to all types of NHS organisation, so as to be able to provide the support to help develop the NHS of the future as described by the SHA clinical visions and High Quality Care for All. That is a prize worth striving for.