This is a 6- to 15-month learning system that brings together clinicians, managers and other individuals within a service to seek improvement in a focused area. An issue for improvement is identified, key individuals with the capacity or accountability to bring about change are brought together, objectives and metrics are agreed, the plan-do-study-act (PDSA) cycle of change is started, and repeated as new learning or opportunities emerge. Some examples of improvements include the reliable implementation of care processes that prevent Intensive Care Unit acquired infections. Initiatives to prevent ventilator acquired pneumonia and central venous catheter related infections have been widely implemented, with evidence of improvements in clinical outcomes across Scotland.