Modern Outpatients and Whole Systems Patient Flow - Two improvement delivery programmes sponsored by the Scottish Government, was launched in 2017, aiming to reduce the number of hospital-delivered outpatient appointments by 400,000 by 2020 including reversing the year-on-year increase by developing a ‘Modern Outpatient’ model which avoids the need for routine planned care by predicting risk, enabling self-management, providing support and intervention only when necessary. The aim of the programme is to improve the quality of care for patients by distinguishing between natural and artificial variation. The strategy is to reduce or eliminate artificial variation and optimally manage natural variation, focusing care on the patients’ needs.