NHS Partnership SASH+ graphic - Safety, Value, Learning - Virginia Mason InstituteSASH+ is our improvement methadology that enables our staff to make things better for their patients and their colleagues every day.

The SASH+ culture of continuous improvement (kaizen) focuses on putting the patient first and making changes to improve patient care. SASH+ provides the structure, tools, training and development to make continuous improvement a reality. It has been a key part of our journey to being rated Outstanding.

You can read more about SASH+ and watch videos on how we're using it, below. 

A good place to begin is this short introduction to SASH+, 'It's the little things', filmed before the COVID-19 pandemic:

It's the little things

In 2015, we became one of just five NHS trusts in the country to work in partnership with the healthcare experts at the Virginia Mason Institute in Seattle, USA and NHS Improvement. As part of the partnership our staff are supported to develop a culture of continuous improvement based on lean principles. The SASH+ culture of continuous improvement (kaizen) focuses on putting the patient first and making changes to improve patient care.

The other Trusts that took part in this national partnership were:

Transforming healthcare

At SASH we have a range of topics, value streams. These value streams are areas that we are committed to improving. Our value streams are:

Diagnostic imaging

The diagnostic imaging department at SASH perform a total of 180,000 x-rays and scans for patients per year, including 64,000 CT scans. Staff at various levels within the department have already embraced SASH+ through Lean for Leaders and started to innovate and develop ways of reducing waste and improving patient experience. The Trust guiding team and the department agreed the time was now right to build on those initial successes and engage imaging more widely with a value stream. The team have chosen outpatient CT as the focus for the value stream as this is a high volume area and there was a strong feeling that our processes there had room for improvement, particularly in terms of reducing unwarranted waits for patients. We expect many of the learnings will be transferrable to other types of imaging.

The value of inpatient nursing 

We all know how important the nurse’s role is to patient care and safety. Our challenge is to consider our nursing role from the perspective of our patients whilst adding value to everything we do.


In the UK sepsis affects 260,000 lives per year and has a huge financial impact on the UK economy.  We aim to improve sepsis care across the Trust by focusing on early identification, treatment within the “golden hour” and definitive management of patients with sepsis. This work will help raise awareness across the Trust and give confidence to our staff to identify potential sepsis and, where necessary, escalate to colleagues.


The Trust sees more than 310,000 outpatients every year making it the area of the organisation that has more patient contact than any other. In our CQC inspection in May 2014 this was an area that was rated as requiring improvement so we know we have got some work to do to get this rating to outstanding.

Management of diarrhoea

Diarrhoea affects a significant proportion of our inpatients. It’s an uncomfortable and unpleasant experience and we are seeking to standardise practice across the hospital and reduce time taken treat the condition.

The Effective Management of Diarrhoea (with subtitles)

Lean for Leaders

Our SASH+ transformation work includes our Lean for Leaders development programme that has helped our teams adopt a wide range of effective tools and techniques, which have led to significant improvements for both patients and staff. Take a look at the videos below to see how SASH people are using the SASH+ improvement methodology and applying the principles of lean across the organisation.

SASH Clinical and Non Clinical Staff Working Together
SASH Improving Leadership in All Areas
SASH Next Steps to Improve Leadership
SASH Rooming In to Increase Capacity
SASH Small Changes for Big Improvements
SASH Measuring for Improvement