The AF improvement cycle

This cycle was developed through understanding the critical success factors within AF service improvement work undertaken by the AHSNs. It should be used to help you understand the impact of potential improvements across the whole AF patient pathway.


The first stage in any service improvement is to understand the local AF data, identify trends and the potential areas for improvement. National data sets such as NHS Digital’s Quality and Outcomes Framework, the Sentinel Stroke National Audit Programme and the CVDprevent Audit will help you to do this.


The AF improvement cycle helps you to consider what resources and support you may need at each of the stages of improvement and which stakeholders should be involved. It encourages you to test service changes on a small scale and learn from the cycles in a structured way each time.


Plan how to secure resources

Appoint a team including clinical lead and project manager

Secure senior/ executive support

Agree project governance, baseline metrics and reporting structure


Analyse local population data and benchmark against peers

Learn from success elsewhere

Review performance of existing services against agreed local or national standards

Engage stakeholders and assess readiness
for change


Build capacity through engagement and training

Agree an achievable target and how to track progress against baseline performance

Create enablers for change e.g. incentives, practical resources, guidelines

Agree the ‘opportunity for improvement’, target setting and patient cohort

Implement & evaluate

Project manage the improvement and any risks

Measure progress against improvement metrics as frequently as possible

Collect and set up feedback from providers and users

Capture and share learning


There are many more detailed resources available online to support NHS teams in undertaking service improvements, these include The Health Foundation, NHS Improvement and The Kings Fund.
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