Cover: An evaluation of the first phase of Q

An evaluation of the first phase of Q

Engaging the founding cohort in a co-designed approach to health care improvement

Published May 9, 2016

by Bryn Garrod, Josephine Exley, Emma Harte, Celine Miani, Jennifer Newbould, Catherine L. Saunders, Tom Ling

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Research Questions

  1. How did Q evolve during the first year of the initiative?
  2. How could the design process be improved?
  3. Who was selected for Q, what did they learn, how did the network function, were there any unintended consequences, and how did Q meet expectations?
  4. How effective was the recruitment process?
  5. What different roles, barriers and links to other initiatives emerged?
  6. How valid was the theory of change and how likely is Q to be effective at executing it?
  7. How could Q be designed and implemented following the first year?
  8. How could Q be monitored and evaluated following the first year?


Q is an initiative, led by the Health Foundation and supported by NHS England, designed to connect people skilled in quality improvement across the UK. The Q founding cohort comprised 231 members who attended three two-day 'design events'. We carried out an independent, embedded evaluation of the first phase of Q, to look at both the success of the design process and the potential for success for Q, while providing continuous findings to the Q project team.


The evaluation used a multi-method approach, including a social network analysis and a novel method that we have called 'citizen ethnography'. Evaluation team members attended fortnightly project team meetings and design events.


Q founding cohort members came from a variety of backgrounds. The size of the founding cohort caused difficulties with the co-design of Q. At the end of the year, members were much more connected with each other. Less progress was made with the design of Q than might have been possible, but members were enthusiastic about Q's potential success and determined to help it achieve its goals.


Q is a promising approach to a critical problem currently facing health and care in the UK. The first phase was successful in building good will and loyalty amongst the founding cohort. Q's success depends on individual components that the Q project team and founding cohort have designed in outline but whose details are still being fleshed out. Q remains unproven but has the potential to bring significant benefits.

Key Findings


Q members reported a range of views on what quality improvement is, what the barriers to its effectiveness are, and what they expect from Q.

Members conceptualised quality improvement as a spectrum from a mind set to a discipline in its own right. Members reported that they face significant barriers in implementing quality improvement, principally lack of time and financial constraints. Interviewees were optimistic that there was benefit to be gained from the creation of a national initiative.

Implementation of a co-design process

The size of the founding cohort made co-design challenging but catalysed member buy-in.

The large size of the cohort limited the extent to which all members could engage in the co-design process. Members felt that the events were well organised and that the products and brand were of high quality. The levels of commitment and loyalty expressed by most Q members interviewed at the end of the process were high.

Mechanisms of change

Q has connected founding cohort members.

Members provided a multitude of positive examples of the beneficial impact that participating in the Q founding cohort had had on the 'connecting' and 'developing' strands of the central part of the theory of change.


Q is a promising but unproven initiative.

Q founding cohort members and project team members agreed that Q did not make as much progress during the first phase as might have been hoped. The vast majority of interviewees stated that they would like to remain involved with Q in some capacity.


Next phase of Q:

  • Focus early on bringing substance to Q's features.
  • Make clear the relationship between leadership and membership.
  • Avoid confusion over the recruitment strategy for members.
  • Stick with the current theory of change for now.
  • Harness diversity through a shared core of values supporting a wide variety of activities.
  • Transition from a formative to a summative evaluation.

Future initiatives similar to Q:

  • Be clear about the founding cohort's role and recruit accordingly.
  • Ensure that events and activities fit within an overall vision.
  • Make sure that accountability and processes for decisionmaking are clear.
  • Maintain the strengths of Q.

Research conducted by

The research described in this report was prepared for the Health Foundation and conducted by RAND Europe.

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