Why NHS QI Teams Aren’t Positioning Themselves as Part of the Cost Saving Solution — and Why They Must

As financial pressures continue to mount across the NHS, Trusts are urgently seeking ways to close the gap between increasing demand and tightening budgets. Cost improvement plans (CIPs) are growing in size and urgency, and many non-clinical teams are already feeling the squeeze. Yet, one group with enormous untapped potential to support financial sustainability is often absent from the cost-saving conversation: Quality Improvement (QI) teams.

It’s a missed opportunity — one that QI leaders can’t afford to ignore.

1. A Narrow View of Responsibility

Traditionally, QI teams within the NHS have focused on improving clinical outcomes, enhancing patient experience, and supporting frontline teams to make care safer and more effective. These goals remain vitally important. But by focusing exclusively on the quality side of the “value” equation, many QI teams have unconsciously taken a step back from conversations around financial improvement.

The reality is that quality and cost are two sides of the same coin. Preventing avoidable harm, reducing unwarranted variation, and improving operational efficiency all have direct financial consequences. But unless QI teams actively connect their work to these outcomes, they risk being overlooked when Trusts look for cost-saving partners.

2. From Support Function to Strategic Asset

There’s a difficult truth here: if QI teams don’t position themselves as part of the solution to the NHS’s financial challenge, they risk being seen as part of the problem.

In times of austerity, functions that can’t clearly demonstrate their value are often among the first to be cut. And while no one questions the noble aims of improving care, QI teams must evolve beyond being perceived as a “nice to have.” They need to show how they directly contribute to the financial health of the organisation.

This isn’t about turning QI into a finance function. It’s about understanding how improvement work can help Trusts meet their financial targets while continuing to raise standards of care — and ensuring that story is told effectively at every level of the organisation.

3. Demonstrating ROI Through Cost-Conscious Improvement

One of the historical challenges QI teams have faced is evidencing return on investment (ROI). While many projects undoubtedly lead to better outcomes, quantifying the financial impact of those changes has been more elusive.

That’s where a bottom-up approach to cost improvement comes in.

Supporting frontline teams to identify and lead cost-saving initiatives is a natural extension of the QI skillset. Whether it’s reducing unwarranted testing, improving patient flow to shorten length of stay, or tackling inefficiencies in procurement or workforce deployment, these are areas ripe for clinically-led, improvement-driven savings.

Not only do these projects deliver real financial impact, but they also offer QI teams the opportunity to build a portfolio of tangible, measurable results. That’s powerful evidence of ROI — and it creates a clear link between the work of improvement professionals and the sustainability of the wider system.

4. Learning from the US: QI as a Driver of Cost Improvement

In many US healthcare systems, Quality Improvement is inseparable from cost containment. Hospital QI teams are routinely tasked with identifying, leading, and measuring projects that improve care and reduce waste, because in a system where reimbursement is closely tied to outcomes and efficiency, there’s a clear incentive to embed financial impact into every improvement effort.

Take Intermountain Healthcare in Utah, for example. Their QI infrastructure has long focused on reducing unwarranted clinical variation, which has not only improved patient outcomes but also led to significant cost reductions. By standardising care protocols across common procedures, they’ve achieved savings in both supply costs and complications — with some reports showing over $30 million saved annually through variation reduction alone.

Similarly, Cleveland Clinic established a Quality and Patient Safety Institute that integrates financial analytics into every major QI initiative. Projects often have dual objectives: improving patient outcomes while delivering measurable savings. For instance, initiatives aimed at reducing hospital-acquired infections (HAIs) not only improved safety but also avoided millions in unreimbursed costs associated with preventable harm.

US QI professionals are often fluent in Lean Six Sigma, cost-benefit analysis, and value stream mapping — tools that explicitly link process improvements to financial outcomes. And crucially, many of these teams work hand-in-hand with finance departments to track and report on the economic impact of their projects.

Seizing the Opportunity

The NHS doesn’t have the luxury of choosing between quality and cost. It must deliver both - and QI teams are uniquely positioned to help Trusts achieve that.

But that won’t happen by accident. It requires QI teams to rethink their remit, reframe their impact, and reposition themselves as a key lever for change in both quality and cost.

The best QI teams will recognise this moment for what it is: a chance to prove their value not just in terms of better care, but as a strategic partner in the future sustainability of the NHS.

A Wake-Up Call for the NHS

NHS QI teams have no less expertise or potential - but they’ve historically lacked the financial mandate their US counterparts operate under. That needs to change.

By adopting a similar mindset and skillset, NHS teams can become proactive drivers of cost improvement, not passive observers of the financial crisis. This doesn’t mean losing sight of patient experience or safety; rather, it means recognising that better care and lower cost are mutually reinforcing goals.

NHS Trusts should take a close look at how US systems integrate quality, finance, and operational excellence - and then adapt those lessons to fit the UK’s values and structures. Doing so could be the key to protecting and empowering QI teams in the years ahead.

Check out our related blog article on Unlocking Bottom-up Cost Savings in the NHS through QI.

References

How Intermountain trimmed health care costs through robust quality improvement efforts
James, B. C., & Savitz, L. A. (2011). Health Affairs, 30(6), 1185–1191.

The promise of Lean in health care
Toussaint, J., & Berry, L. L. (2013). Mayo Clinic Proceedings, 88(1), 74–82.

Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic Way
Merlino, J. (2014). McGraw Hill Education.
Cleveland Clinic Quality & Patient Safety Institute

Health care–associated infections: A meta-analysis of costs and financial impact on the US health care system
Zimlichman, E., et al. (2013). JAMA Internal Medicine, 173(22), 2039–2046.