This paper discusses the emerging concept of Continuous Improvement in Healthcare Support to Operations (CIHSO) recently introduced within NATO. It starts by summarising the developments in NATO policy regarding clinical governance and how this has evolved into CIHSO before examining the operational aspects of CIHSO within the Plan-Refine-Execute (PRE) process of operational planning process. It then looks at the components of a CIHSO system as it might apply to the deployed military healthcare system covering the functions of medical and tactical evacuation, deployed hospital care and executing medical operations. The last stage of PRE should include assessment through the tracking of key performance indicators of the military medical system. The UK and American systems of assurance for the deployed trauma system are reviewed as part of the clinical aspect of CIHSO, as well as consideration some of the emerging issues in the management of CIHSO in a multinational environment.
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