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Based on our own experiences leading healthcare improvement in the English National Health Service (NHS), we identify seven themes that connect with the story of front-line ownership (FLO): Create investors not buyers of change - "buy-in" is too late in the change process; We need to combine both technical and cultural aspects of change - go slow to go fast and make sure that we pay attention to the human dimensions of change; Build strong ties AND weak ties - reach out to your usual suspects AND find your unusual suspects and unlikely allies; If we want innovation, we need to create psychological safety - the conditions of trust and support that make people feel safe to try new things that might fail; Build energy for change for the long haul, right from the start of your change efforts - go beyond the typical "intellectual" energy and build "social" and "spiritual" energy that create strong foundations for change; Challenge "the myth of the disinterested" - everyone is passionate about something; The leader as coach and team member - be the leadership role model that enables change.

Across the world, healthcare organisations are implementing radical change strategies in the face of unprecedented financial challenge. In this context, a focus on building capacity and capability for improvement is a key strategy. Global analysis shows that the most common characteristic of healthcare organisations that deliver outstanding performance in cost and quality is a systematic approach to capability building for improvement. The paper looks at where to start in order to build improvement skills at every level of the healthcare system and empower frontline staff to make changes that will deliver results. The current situation of the English NHS is used to illustrate the points made. What will it take to skill up and mobilise the entire healthcare workforce, to create a mass movement of change agents, to sustain the energy for change for the longer term and deliver the transformational results in cost and quality that are sought for patients and populations? [ABSTRACT FROM AUTHOR]