Post by Deborah Udy Okusaga Akanne (@deborah_udy_okusaga)
The Service Improvement Question Is Now The Deciding Question In NHS Band 6 And Above Interviews. And Almost Nobody Is Preparing For It.
There is a question in NHS interviews at Band 6 for physiotherapists, OTs, nurses, and AHPs — and at Clinical Fellow and Trust Grade level for doctors — that was rarely asked three years ago.
It is now weighted more heavily than any clinical scenario in many Trust panels.
And it is the question that is separating the candidates who receive offers from those who do not.
"Tell us about a time you identified an opportunity to improve a clinical service — and what you did about it."
Most candidates answer with an audit story.
The panel is looking for an improvement story.
These are not the same thing.
Audit identifies the gap between current practice and a documented standard. It measures. It describes. It compares.
Improvement methodology closes the gap. It tests a change. It measures the impact. It adapts and iterates. It produces a sustained change in clinical outcomes or service delivery.
The NHS IMPACT programme — launched in 2023 and mandated across all NHS Trusts — embeds continuous improvement thinking into clinical delivery.
Every Trust is delivering against it. Every hiring panel at Band 6 and above is now explicitly assessing whether candidates understand improvement methodology — not just whether they have participated in an audit.
The answer that scores a 4 uses the Model for Improvement. It names the PDSA cycle. And it demonstrates four specific things:
1. A problem analysis before the plan — process mapping, driver diagram, root cause analysis. Not "we decided to improve handover."
"We used a process mapping exercise to identify that the information loss was occurring at the specific transition between the ward round and the nursing handover, not at the point of documentation."
2. A small-scale test before implementation. Not "we rolled it out across the ward."
"We piloted the change on one bay, on one shift, with one team — specifically to identify modifications before scaling."
3. Measurement against a baseline. Not "things improved." A percentage. A number. A comparison.
4. Systemic change adopted permanently. Not a recommendation. A new SOP. A standing agenda item. A trained team.
That four-part answer is what Band 6 looks like. At every profession. In every specialty.
DM me "IMPROVE" and I will send you the full service improvement answer framework built for your specialty and your band.
Post 4 drops at 2:00 PM — and it covers a trend that the top NHS hiring managers are talking about in 2026 but that has not yet reached most IMG networks.
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