Knowledge gained from a Health Foundation fellowship trip to the US is being brought into Bolton

John Dean is medical director for quality and care improvement at Bolton primary care trust. He spent a year in the United States on a Health Foundation quality improvement fellowship, working with the Institute for Healthcare Improvement on quality improvement for diabetes care.

'I learnt about quality improvement methods and approaches which I'd been unaware of in the past but are fairly systemic in the US,' John says.

'I learnt about matching up organisational learning and development with how clinical systems and teams can work on improvement. I learnt more about setting aims, the importance of measurement and feedback and working on small rather than large changes to lead to systemic improvement.'

Returning to Bolton, he acted immediately to incorporate his new learning into the delivery of diabetes care in the local area.

'I wanted to build quality improvement into care for long-term conditions on a local basis,' he says. 'I wanted to take forward the three-tier approach of working with organisations, teams and individuals and I wanted to ensure that quality was across the continuum of care.

'We are now redesigning diabetes care,' he continues. 'We are being clear about individual and team roles in the whole system, about developing clear aims, measures, skills for improvement and a culture of continuous improvement within clinical teams.'

To read more about The Health Foundation's quality improvement fellowship visit: