Improving complex systems with improve-mentation: challenges and solutions

The fast-changing environment for healthcare in all countries calls for new approaches to achieving improvements. This article proposes that improve-mentation is one such approach. Improve-mentation synergistically combines elements of implementation and improvement sciences, as well as experience to carry out change in different settings. One feature is the iteration of the change so as to adapt the change to the evolving context for private and public healthcare in different countries. The article addresses challenges posed by increasing complexity and describes the methods used in four different improve-mentation frameworks, using case examples to illustrate different resolutions to generalisability and other issues.