Cressbrook Limited

Nick Downham – Independent Improvement Expertise

Learn More
About Nick

About Nick

I am an independent organisational development (od) and improvement expert, specialising in health and social care improvement. I provide support and expertise for teams, organisations and systems. I help not only make things better, but also help organisations do better things.
You can find out about who and how I have helped here. I offer a powerful mix of exemplary interpersonal skills, core social values, engineering experience, NHS experience and deep improvement knowledge.
I take great pride in helping improve our great public services because of the role they play in supporting and caring for people when they are at their most vulnerable. I have worked with general practices, acute trusts, mental health providers, CCGs, hospice groups, local authorities, thought leaders and universities and with professionals at all levels.
You can also find out more about me on my linked in page.
Finally, I have documented a number of useful insights into improvement here.
About Nick
My Work

My Work

Examples of my work:

  • Johnson and Johnson (Hamburg) – Professional Education Workshops

    As part of their professional education programmes for clinical professionals, I designed and delivered a two-day workshop on Lean and Flow in surgical pathways. The interactive workshop was attended by senior clinicians from around the world and had very positive evaluations by participants.
  • Leading Primary Care Networks and Collaboration – Leadership Programme

    Working with the team at the Health Innovation Lab at London South Bank University, I am lead presenter for the groundbreaking leadership programme for Primary Care Network Clinical Directors. This programme provides a unique mix of highly applicable systems thinking, improvement and leadership skills building.
  • Tameside and Glossop Integrated Foundation Trust – Understanding the True Nature of Demand

    For the Person Centred Services Team, I created a bespoke set of analytical tools and resulting analysis to stimulate system thinking on the characteristics of the demands faced. In particular linking Failure Demand (demands created by the system, not patients) and demands driven by the social determinants of health.
  • Kaunas Klinikos (Lithuania) – Senior Management Leadership Weekend Facilitation

    For the leading university teaching hospital in Lithuania I was the keynote speaker and facilitated four bespoke workshops to senior managers and executive team during their annual educational retreat. The workshops were on Failure Demand, Quality Improvement, Measurement for Improvement and Demand / Capacity. Feedback was very positive with participants enjoying the highly applicable learning ...
My Work
Areas of Expertise

Areas of expertise

Offered through consulting, coaching, workshop, training or bespoke publications:

Large scale improvement programmes

Learning capture

Process improvement

Measurement for improvement


Professional development programmes

Community of practice

Quality improvement

Failure demand

Theory of Change

Organisational development

Learning events and workshops

Lean thinking

Demand and capacity

Bespoke improvement publications

Areas of Expertise
Areas of Expertise

Lean and QI Training for Health and Social Care

Delivered face to face or online

In addition to consulting and programme design assignments, I design and deliver bespoke Lean and QI masterclass courses.

These courses are completely customised for each client to reflect their work and challenges – see my blog on the limitations of standardised Lean / QI competency frameworks.

Clients include:

Central improvement organisations

Mental health trusts

District general hospitals

Foundation trusts

Teaching hospitals

General practices

Medical device and pharmaceutical companies (including Lean for market access teams)

Community teams

Areas of Expertise
Contact Nick
Contact Nick…
Contact Nick
Improvement Insights

Improvement Insights

Quality Improvement Traps

Using the English NHS as an example, this article focuses on the weaknesses of much current Quality Improvement (QI) thinking and application within healthcare settings.

Read More

Improvement Insights

Contact Nick