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East London NHS Foundation Trust (ELFT) is a major provider of mental healthcare and community health services. Quality improvement (QI) has become central to its organisational policy and goals for which it has received national and international attention.

This piece reflects on the Trust's transformation and its approach. It provides many examples and discusses several of the associated challenges in building and sustaining QI momentum. It is the result of a range of perspectives from staff involved in planning and building large-scale QI capability. It contextualises QI's current status in UK mental healthcare.

Several key factors were identified: board-led commitment to organisational transformation; investment in training and resources to support staff motivation; clear and realistic project goals in line with the service's over-arching strategic direction; support for service users and staff at all levels to get involved to address issues that matter to them; and, finally, placement of a high value on service user and staff qualitative feedback.

Building QI capability represents a significant challenge faced by all large healthcare providers. Sharing experiences of change can assist other organisations achieve the necessary buy-in and support the planning process.

Achieving and sustaining lasting organisational change in healthcare is challenging. This article provides a background on QI at ELFT and reflects on the pathway to its present position at the forefront of the application of QI within healthcare.