Wave goodbye to poor meetings

21 February 2022

In this, our latest brilliant basics article, we look at GGI’s three waves approach to quality improvement – the perfect complement to the plan-do-check-act cycle.


One of the many quality improvement tools used in healthcare management is the Plan-Do-Check-Act (PDCA) cycle, used for years by GGI as a way to help boards improve their governance – and in particular to create meeting structures that are effective, support the objectives of the organisation and provide assurance to the board.

The PDCA cycle – sometimes known as PDSA (plan-do-study-act) – is straightforward. In the ‘plan’ stage a change aimed at improvement is identified, the ‘do’ stage sees this change tested, the ‘check’ stage examines the success of the change, and the ‘act’ stage identifies adaptations and next steps to inform a new cycle.

In a recent blog post, Making meetings matter, we described how we helped to save one NHS client more than 1,000 hours of executive and director time each year by ditching 500 meetings. We also described how we use the PDCA cycle to help ensure that those meetings that do go ahead are as efficient and productive as possible.

PDCA is a tried and tested tool for improving the quality of systems – but it is nothing in isolation. Lasting improvement will only take place if the cycle is repeated. And that’s where GGI’s three waves programme comes in.

A PDCA allows organisations to rapidly test out small changes and build on successes. Running PDCAs also gives stakeholders the opportunity to see if proposed changes will succeed, while providing a powerful tool to learn from ideas, establishing what does and what doesn’t work and enhancing team collaboration.

We have generally found that running a PDCA for three meetings is enough to sustain the improvements needed – but of course clients can continue for longer if they wish to do so.

PDCA three waves
PDCA three waves


Three waves in action

With the client we referred to in our previous blog, we implemented a three waves programme with the following objectives:

  1. Create a governance assurance structure with fewer, more efficient meetings and with reduced bureaucracy.
  2. Improve the effectiveness of the governance system and how meetings operate in practice, ensuring they have a clear purpose, the right people in the room and the right supporting tools and papers.
  3. Improve reporting and escalating processes to the trust executive matching the requirements of the well-led framework.
  4. Establish an audit trail demonstrating how the new trust committee structure is playing into the overall quality governance, performance, use of resources and the assurance system from ward to board.

By the end of the process, which took six months to implement, the overall number of meetings had halved, and the quality of those meetings had improved, with attendees noticing a positive change in the discipline and rigour of meetings, a greater sense of purpose, improved efficiency and better reporting.

If you’d like to find out more about how we can help you to get more from your meetings, please visit our website, call us on 07732 681120, or email advice@good-governance.org.uk.

Meet the author: David Holden

Principal Consultant

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