Healthcare Improvement Scotland (Scottish Intercollegiate Guidelines Network)

HIS logo

Healthcare Improvement Scotland (HIS) are the national healthcare improvement organisation for Scotland and part of NHS Scotland. HIS work with staff who provide care in hospitals, GP practices, clinics, NHS boards and with patients, carers, communities and the public. The work of HIS drives improvements in the quality of healthcare people receive by:

  • supporting and empowering people to have an informed voice in managing their own care and shaping how services are designed and delivered
  • delivering scrutiny activity which is fair but challenging and leads to improvements for patients
  • providing quality improvement support to healthcare providers, and
  • providing clinical standards, guidelines and advice based upon the best available evidence.

The ScottisSIGN logoh Intercollegiate Guidelines Network (SIGN) was established in 1993 to produce evidence-based clinical practice guidelines for the National Health Service (NHS) in Scotland. Originally part of the Royal College of Physicians of Edinburgh, it is now a key part of HIS.

Since its beginning, SIGN has been at the forefront of developments in guideline methodology. Its methods have been adopted or adapted by many other guideline developers around the world. Current methodology is set out in SIGN 50: a manual for guideline developers. This can be accessed, along with the complete range of the work of the organisation, at

SIGN was a founder member of, and remains an active participant in, the Guidelines International Network (GIN). Their main current contribution is towards developing a standard for evidence tables that will facilitate sharing of evidence between guideline developers in different countries. SIGN is also a participant in the GRADE group and has recently committed to adopting the GRADE approach to developing evidence-based recommendations.

Collaborator's Profiles

 Duncan Service

Mr Duncan Service
Quality & Duncan Service is the Evidence Manager at SIGN. He is responsible for IT support to SIGN, website and database design. He is also responsible for systematic literature review for clinical guidelines and advising group members on SIGN methodology and critical appraisal. He has worked on 13 different guidelines while at SIGN the most recent being the Management of early rheumatoid arthritis. Duncan Service is currently a Non Executive Director on the Healthcare Improvement Scotland Board.

Photo of Karen Ritchie

Dr. Karen Ritchie
Head of Knowledge Management, SIGN.  Karen Ritchie originally trained in the biological sciences and worked in cancer research before developing a career in health services research. Following research posts at the University of Glasgow, and the MRC Institute of Hearing Research she joined the NHS in 2002 and has lead a team of health services researchers in the synthesis of evidence to support a range of activities including production of health technology assessments. Development of this role has led to her current role in Knowledge Management within Healthcare Improvement Scotland.

Photo of Mr Robin HarbourMr Robin Harbour (retired 2014)
Formerly Quality & Information Director of SIGN. A librarian by training and background, he has worked on evidence-based medicine for the last 15 years, 14 of these working for SIGN. Mr Harbour's responsibilities included the systematic review process used by SIGN and the development of evidence appraisal and the grading of evidence for guidelines. He was one of the lead developers of the SIGN grading system which was introduced in 2001, and has been a long term member of the GRADE group. He has a personal interest in patient involvement in evidence-based medicine. He is a member of the Guidelines International Network (GIN) Evidence Tables Working Group, which is seeking to develop standard evidence tables for use by guideline developers worldwide.  Mr Harbour is a contributing author to two Cochrane Reviews on osteoporosis.