SARAH: Sarah: Hi, I'm Sarah and I'm here with Becca. Between us, we run a lot of the West of England Academy sessions, including programmes around improvement, leadership, and change.
QualiTea is exactly what it sounds like. A cup of tea and a useful conversation. These are short, informal podcast sessions, usually around fifteen minutes, and focusing on one simple improvement tool.
We'll use real, relatable examples and talk about how you might use the tool in your day to day work. Not in theory, in real life. They're not training sessions, they're more like a friendly nudge in the direction of have you tried this? So grab a cuppa, get comfortable and let's get started.
BECCA: Hello and welcome back to QualiTea, the podcast where we chat through quality improvement methods in the time it takes to enjoy a cup of tea.
SARAH: Hello! Today we’re talking about that never-ending to-do list. And how on earth you decide what actually matters.
BECCA: But surely everything on that list matters? The problem is I don’t have the time, energy, or resource to tackle it all.
SARAH: Well that is often the thought process we all get trapped in, but the reality is that not everything on that list is a true priority. So let’s chat about MoSCoW.
BECCA: The city in Russia?
SARAH: No, in this case MoSCoW is a really practical prioritisation tool.
It’s an acronym. It stands for:
Must do
Should do
Could do
Won’t do (for now anyway)
At its simplest, MoSCoW is about sorting your workload when you’ve got more to do than you have time, capacity, or people — which, let’s be honest, is basically every NHS project.
BECCA: What it really does is force a conversation most teams quietly avoid — what actually matters here?
SARAH: Because we’ve all sat in those meetings where everything is “top priority”.
BECCA: And when everything is a priority… nothing is. You just end up busy, not effective.
SARAH: So let’s go through how it works…
BECCA: Starting with Must haves. These are your non-negotiables. If this doesn’t happen, the project doesn’t work. Full stop.
SARAH: Not “it would be a shame” or “someone might be annoyed”.
BECCA: Exactly. Think patient safety, statutory reporting, or critical deadlines. If you don’t act quickly, you feel it immediately. A really useful test is: would you delay the entire project for this?
If yes, it’s a Must. If you’d still go live without it, it isn’t.
SARAH: Then you’ve got Should haves. These are important, high-value things. You’d really want them in, especially early on, but the project could still function without them if it had to.
BECCA: These are often where the quality sits, but they’re not the difference between “works” and “doesn’t work”. They add value, improve overall quality, or prevent future problems. Things like staff guidance documents, training materials, evaluation plans, or improving the user experience.
SARAH: The danger is these often get squeezed out due to time pressures, even though they’re the things that actually make systems better.
BECCA: And that’s why the MoSCoW model helps because through sensible prioritisation you deliberately create the space for them.
SARAH: Then Could haves. These are your nice-to-haves. They improve experience, polish, maybe even staff satisfaction — but if they drop off the list, nothing breaks.
BECCA: They’re often the polishing tasks. The little tweaks people want to add to make something perfect. And those tiny additions are often what quietly overload teams.
SARAH: And finally Won’t haves. Which sounds negative, but it’s actually one of the most powerful parts.
BECCA: Completely. Because this is you explicitly saying: we are not doing this right now.
Not because it’s a bad idea, but because it’s not for this phase.
SARAH: It’s basically saying “great idea… just not today.” And in NHS work, where scope creep is almost inevitable, that clarity is gold. It protects your time, your team, and your delivery.
BECCA: This is where good leadership comes in — being able to say no, or at least “not yet”, is really powerful because, here’s the uncomfortable bit… if everything feels like a priority, it’s not just a capacity issue — it’s a clarity issue.
Let’s talk about how this works in practice…
SARAH: Yeah, so we have been using this a lot recently. With the expansion of our Academy work we are being asked to do lots of things, and you and I have so many ideas it’s given us a huge to-do list!
BECCA: Yes and everything feels very important.
SARAH: So we decided to practice what we preach and sat down and worked through MoSCoW together. And what was interesting was how much discussion there was at the start — things you saw as Musts were definitely Coulds for me.
BECCA: That’s the bit people underestimate — the conversation is the work. The grid at the end is almost secondary.
SARAH: Exactly.
BECCA: I had something similar on a project where I was redesigning a recruitment process. The group were so enthusiastic that we were getting ahead of ourselves with all the things we wanted to achieve. The “Won’t do for now” column was really useful then. It allowed people to park those ideas knowing they wouldn’t be forgotten, but that there was other work to tackle first.
SARAH: What’s useful is that once you strip everything back, the actual number of true Must Do’s is usually quite small. Which makes delivery feel much more manageable.
BECCA: Yes it really helps to get you on track, because suddenly things are broken up into bite-sized pieces and it becomes easier to see the order in which you need to deal with the different elements.
SARAH: Totally, and that helps to set timeframes and get started with a view to improving things, rather than waiting for perfection.
BECCA: Right, time for a practical tip. How do you use this in real life?
SARAH: Next team meeting, take your task list and ask: “If we could only do three things this week, what would they be?” That’s your Must do list.
SARAH: Then ask: “What would we do next if we had more time?” That’s your Should Do.
BECCA: Then honestly ask: “What’s a good idea, but not essential right now?” That’s your Could do.
SARAH: And finally: “What are we not doing this week?” That’s your Won’t do.
BECCA: Are there any pitfalls or things people need to watch out for?
SARAH: The big one is Must-have inflation. Everything creeps into Must because people are nervous about leaving things out.
BECCA: And then you’ve basically undone the whole exercise.
SARAH: Exactly.
BECCA: A helpful sense-check is volume. If more than about 60% of your list is Musts, you probably haven’t been strict enough.
SARAH: You need to push yourselves a bit. Have those discussions and make decisions.
BECCA: Yes remember this isn’t set in stone. You need to revisit it regularly because as you get through the Must do’s, you can move things up from the Shoulds and Coulds. And the reality is that in the systems we are working in, priorities sometimes change, so you need to change too.
SARAH: Yes that’s important to remember because another thing people often ask is: when do the Shoulds and Coulds actually get done?
BECCA: Yes, that’s such a real concern.
SARAH: And the honest answer is: they only happen if you intentionally plan for them.
Either you schedule time for them, or they become the starting point for your next cycle.
BECCA: Yes revisit it. This isn’t a one-off exercise. Priorities shift.
SARAH: Today’s Won’t could absolutely be tomorrow’s Must.
SARAH: So, quick recap before the tea goes cold —
BECCA: Which mine nearly has.
SARAH: MoSCoW gives you four categories: Must, Should, Could, Won’t. It helps you prioritise honestly, manage scope, and make decisions as a team.
BECCA: Must dos are non-negotiable, Should dos are important but not urgent, Could dos are nice ideas, and Won’t do protects your time and capacity.
SARAH: Use it with the right people, be disciplined about your Musts, and don’t treat it as fixed.
SARAH: And remember — your Won’t dos aren’t the bin.
BECCA: They’re your backlog. Good ideas, just waiting for the right moment.
SARAH: So next time your list is growing and everything feels urgent, pause. Ask: what are our actual Must do’s this week, and what are we consciously choosing not to do?
BECCA: Good teams don’t try to do everything at once.
SARAH: That’s us for today. If you’ve used MoSCoW in your own work, we’d genuinely love to hear how it went. You can find the link to this and others in the show notes.
BECCA: And if there’s a tool you’d like us to cover in a future episode, send it our way.
BECCA: Now go wash up your mug, be ruthless with your priorities… and we’ll see you next time.
SARAH: See you next time.
