HIS grades each of the 3 key focus areas, Direction, Implementation and delivery, and Results, as Exceptional, Good, Satisfactory or Unsatisfactory. Exceptional asks for everything Good does plus continuous self-directed improvement, external assurance or benchmarking, and stakeholders involved in improving the service.
The four grades
HIS's inspection methodology sets out generic grading principles that apply to every service.1 Each grade adds to the one below it.
| Grade | What HIS looks for |
|---|---|
| Unsatisfactory | No evidence of appropriate systems, policies, procedures and processes having been developed or implemented |
| Satisfactory | Systems developed and implemented, and evidence of impact and outcomes |
| Good | All of that, with positive impacts and good outcomes, and self-directed improvement of the systems and their results |
| Exceptional | All of that, with continuous and sustained self-directed improvement, involvement in external assurance or benchmarking, and stakeholders involved in improving the service |
Reports print the grade beside each key focus area's question. An Edinburgh independent hospital inspected unannounced in May 2026 was graded Exceptional for Direction and Good for Implementation and delivery and for Results.2
What HIS's guidance lists for Exceptional
The methodology gives eight areas of guidance for an Exceptional grade.1
- Strong and transparent leadership, leaders honest about performance, clear on strengths and where to improve.
- A positive organisational culture, staff who feel valued and speak up.
- Good oversight of care, leaders engaged in the service and aware of the real issues.
- Driving change through effective systems and processes, governance, workforce planning, training, and learning from complaints and adverse events, with results that are easy to demonstrate.
- Open to challenge and change, open with inspectors and receptive to feedback.
- Effective collaboration with partners, NHS boards, local authorities, the third sector and others.
- Engaging with those who use the service, feedback used to change and improve the service.
- Continuous improvement, change identified, implemented well and sustained.
Limits on grades
Improved grades from a follow-up inspection are capped at Satisfactory, because a follow-up looks only at the requirements and recommendations already made. Higher grades from the previous inspection stay as they were.13 Grades can also change after a report, for example after enforcement action or an upheld complaint.2
- Find your weakest key focus area. Read your last report's findings for each area and the requirements made under it.
- Meet every requirement. Outstanding requirements hold a grade down, and HIS's Service Risk Assessment scores inspection outcomes and enforcement activity.
- Show the impact of your systems. Satisfactory needs systems in place with evidence of impact. Good needs positive impacts and good outcomes for patients.
- Show improvement you started yourself. Good and Exceptional both ask for self-directed improvement. Keep the record of what you chose to change and why.
- Benchmark outside the service. Exceptional asks for external assurance or benchmarking, such as a third party accreditation scheme or comparison with peers.
- Involve patients and partners. Exceptional asks for stakeholders involved in improving the service. Minute it when it happens.
- Key focus area ______ Last grade ______ Date ______
- Requirements and recommendations open ______
- Systems in place ______
- Impact on patients, with a number ______
- Improvement we chose to make, and its result ______
- External benchmark or assurance ______
- Stakeholders involved, and how ______
How grades set the next inspection
Inspection outcomes are one of the five indicators in HIS's Service Risk Assessment, scored on the post-inspection grades, performance between inspections, enforcement activity and how well the service engaged with inspection. The total score sets when HIS next inspects, from within 3 to 6 months to within 5 years.4 The guide to writing an HIS self-evaluation shows how to present that evidence between inspections.
Questions
Is there one overall HIS grade?
Inspection reports grade each of the 3 key focus areas separately and show the three grades side by side. HIS keeps a grading history for each service on its website.
Can a follow-up inspection raise my grade to Good?
No. Improved grades from a follow-up are restricted to no more than Satisfactory. A full inspection is needed for Good or Exceptional.
Can a grade change between inspections?
Yes. HIS says grades may change after an inspection due to other regulatory activity, such as enforcement action or an upheld complaint.
Sources
- 1Healthcare Improvement Scotland, 2024Independent healthcare regulation, inspection methodology, July 2024Read source
- 2Healthcare Improvement Scotland, 2026Unannounced inspection report, an independent hospital in Edinburgh, August 2026Read source
- 3Healthcare Improvement Scotland, 2026Announced follow-up inspection report, an independent clinic in Glasgow, July 2026Read source
- 4Healthcare Improvement Scotland, 2024Independent healthcare regulation, provider handbook, July 2024Read source
Written by the wai team from Healthcare Improvement Scotland guidance, checked on 15 October 2026. This is guidance, not legal advice. HIS does not endorse wai or any software.