The student identified the need for service improvement by observing accidental needlestick injuries in the community. To demonstrate and understand the process involved, the student will create a service improvement plan that will reduce the number of needlestick injuries. The student service plan includes the introduction of needle removal (see Appendix 1). To implement change in a healthcare context, a PDSA concept will be used. Langley developed the PDSA cycle to describe the importance of changing and developing these crucial changes which will hopefully help lead to improvements (Langley et al., 2009) (see appendix 2) for details. The National Health Service uses the PDSA and will implement necessary measures to improve services for the public (NHS Institute, 2006). When change is implemented, it can come from a top-down approach or a bottom-up approach. With top-down change, the change will be made by the most responsible person who will build a plan and nurture it so it can be implemented. With a bottom up change, the plan comes from the staff/employee, this comes from the people working together and the workforce comes together to make a collective decision, this decision is for the workforce to act on and is called “bottom-up approach”. Quality improvement methods offer many benefits, and there are many models to use for quality improvement. These models and characteristics have features in the updated version of total quality management practice models and have numerous benefits, with models such as Six Sigma and Kaizen utilizing these characteristics (Royal Charter, 2011). The PDSA cycle will be used to manage improvement efforts in the health service....... middle of document ......a). Retrieved from http://www.clinicalgovernance.scot.nhs.uk/section2/pdsa.aspSuccesful Methods, . (2006). The art of kaizen. Retrieved from http://www.successmethods.org/kaizen.html Nursing and Midwifery Code of Practice (2008). Retrieved from NMC website. www.nmc.uk.orgRoyal Charter, . (2011). Total quality management (tqm). Retrieved from http://www.thecqi.org/Knowledge-Hub/Resources/Factsheets/Total-quality-management/BMJ, . (2008). Darzi review: . Rewarding hospitals for quality improvement, says Lord Darzi, 1163(10), Retrieved from http://www.bmj.com/content/337/bmj.a642.full doi: 10.1136/bmj.a642Wright, J. ( 2004, January 1). Model to be improved. explains the improvement model and how to take the next step in redesigning your radiology service., 1, Retrieved from http://www.improvement.nhs.uk/diagnostics/LinkClick.aspx?fileticket=lWoFbYq9RnM%3D&tabid=63