Key points

  • Q needs to be first and foremost about connecting people involved in improvement. During 2015, members were supported to build many new connections and relationships with people from other professional backgrounds and geographies. There are early signs to support the hypothesis that these connections can boost the effectiveness and confidence of those doing improvement, enable innovations to flow more easily across the system and allow new collaborations.
  • Multiple enablers need to be in place for people to be able to design, implement and measure improvements effectively. These include time, access to information and resources, and support in a system that is often fragmented and turbulent. Members supported the idea that Q should provide a long-term infrastructure that will offer development opportunities and make members more visible to each other, encouraging connections and helping people work together to support each other.
  • The scale of the co-design process enabled broad-based engagement in shaping Q. Collaboratively designing Q with such a large and diverse range of people was complex and challenging. Members were very engaged in debates around what Q should deliver, but with many divergent views synthesising and deciding how to move forward was often hard. However, the scale of the process enabled a broad-based community of improvers to be established. A significant majority of founding members report a positive attitude to Q, perceive the initiative as important and want to stay involved and shape the strategy further. Q is now broadly at the stage intended, with an agreed operating model that will now be tested in practice on a larger scale as the community grows.

This report looks at the first year of the Q initiative and the extensive co-design process used to create it.

Q is a diverse and growing community of people, with experience and understanding of improvement, committed to improving the quality of health and care across the UK.

To ensure Q meets the needs of those in improvement, the Health Foundation worked in partnership with 48 organisations to recruit 231 founding members to help design and test Q during 2015. The Health Foundation believe the process to design Q is the largest collaborative design process of its type undertaken in improvement in health care.

The report identifies lessons for anyone seeking to support improvement work across organisations or through networks, as well as those engaged in designing initiatives with many diverse stakeholders. It draws on a variety of sources including the independent real-time evaluation of Q undertaken by RAND Europe.


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Q is an initiative connecting people with improvement expertise across the UK.

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