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Independent evaluation of the Q Improvement Lab

Final Report

by Elisa Liberati, Megan Sim, Jack Pollard, Tom Ling

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Research Questions

  1. What are the distinguishing features of the Q Lab approach, and what are the mechanisms through which Labs work?
  2. What resources, stakeholders, conditions and infrastructure are required to deliver a Q Lab effectively?
  3. How does the Q Lab engage participants? How valuable have participants perceived their participation to be?
  4. How does the Q Lab fit within Q more widely, the Health Foundation and the broader health and care system?
  5. Does the Q Lab make a valuable contribution to achieving change alongside other approaches?

Around the world social labs are being established as a way of tackling complex challenges. The aim of these labs is to work creatively and collaboratively to formulate and test new ideas. Most commonly the labs claim to support innovation (a step change in delivery and performance) in policy or delivery rather than improvement (incremental change in performance), but in practice there is considerable overlap. Labs use various approaches, often rooted in the disciplines most relevant to their work, for example design or behavioural science.

The first Q Improvement Lab ('Q Lab'), funded by the Health Foundation and NHS Improvement, was launched in the spring of 2017. The aim was to test whether the Q Lab approach is likely to become an effective, valuable way of developing ideas or interventions to support positive change at multiple levels of the health and care system in the United Kingdom. The Q Lab is distinctive not only for its focus on improvement but also for its concerns with UK health and social care issues.

RAND Europe and the University of Cambridge were commissioned by the Health Foundation to undertake a real-time, formative evaluation to support the Q Lab pilot. The evaluation addressed the overarching question: 'Is the Q Lab approach likely to become an effective, valuable way of developing ideas or interventions to support positive change at multiple levels of the health and care system?' Starting in May 2017, the evaluation was conducted over 15 months.

Key Findings

The Q Lab approach is distinct from other health and social care improvement efforts

  • The Q Lab's mechanisms, particularly its convening function, and its combination of principles of collaboration, creativity, time-boundedness and topic-specificity, distinguish it from other improvement approaches.

A dedicated Q Lab team and a range of stakeholders contributed to effective delivery

  • Having a dedicated Q Lab team was likely essential in creating the momentum around the generation of ideas with the potential for impact. Engaging a range of stakeholders contributed to achieving a holistic understanding of the peer support challenge.

The varied engagement approach and networking opportunities were valued by Q Lab participants

  • The Q Lab team successfully maintained engagement throughout the pilot Lab. Participants had different motivations and faced different barriers to engagement, but valued the relationships nurtured through the Q Lab.

There were benefits as well as the potential for tension in the links with Q, the Health Foundation and NHS Improvement

  • The tight link between the Q Lab and Q benefitted the former, though there is a potential for tension given that membership for both initiatives is not directly linked. The financial support from the Health Foundation and NHS Improvement was vital to the Q Lab.

The Q Lab consolidated learning and knowledge on, and raised the profile of, peer support, and motivated participants to take action

  • Notwithstanding these achievements, participants and stakeholders felt that the Q Lab may not have been able to achieve impact and spread locally and nationally in its pilot year.

Recommendations

  • The Q Lab should retain many of its core elements, as well as the tools and techniques that support the development of psychologically safe spaces for a wide range of stakeholders to meaningfully interact.
  • The Q Lab team may consider changing the scope of its goals; the topic selection process; when and how it engages with different groups of stakeholders; and how to communicate what success looks like.
  • Going forward the Q Lab can contribute to the evidence base, both of ideas and interventions that emerge from the Lab, but also of the effectiveness of the Q Lab approach itself.

Table of Contents

  • Chapter One

    Context, aims and methods of the evaluation

  • Chapter Two

    The Q Lab approach: origins, phases and programme theory

  • Chapter Three

    Findings

  • Chapter Four

    Reflections and recommendations

  • Annex A

    Overview of data sources

  • Annex B

    Interviewee selection approach

  • Annex C

    Interview and focus group topic guides

  • Annex D

    Survey 1 instrument

  • Annex E

    Survey 2 instrument

Research conducted by

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

This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.