Cover: Strengthening the contribution of improvers to UK health and care?

Strengthening the contribution of improvers to UK health and care?

An evaluation of the Q Initiative 2016–2020

Published Jul 13, 2020

by Lucy Hocking, Jennifer Newbould, Sarah Parkinson, Katherine Stewart, Amelia Harshfield, Tom Ling

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Research Questions

  1. How effective is the ongoing governance, design and management of Q (see Chapter 5)? How has Q Lab progressed during the period of this evaluation?
  2. How well does the Q community and infrastructure meet the needs of members?
  3. To what degree is Q providing support, enabling connections and the development of expertise, and mobilising members to lead and undertake improvement more efficiently and effectively?
  4. What impact has Q had on the wider health and care system across the UK?
  5. Is Q achieving or contributing to sustainable improvement in health and care across the UK and, if so, how?

Q aims to connect people working in quality improvement across the UK healthcare system, to make it easier for them to share ideas, enhance their skills and thus bring about a change that benefits patients. It is led by the Health Foundation and supported and co-funded by NHS England and NHS Improvement. As an embedded but independent evaluator commissioned by the Health Foundation, RAND Europe has been a 'critical friend' of Q from 2016 to 2020. The first two years of this evaluation were primarily formative in approach, focusing on how Q was designed and established, and feeding the data back to the Q team to support and inform the ongoing design and management of Q. The later stages of the evaluation took a more summative approach, focusing on the impact of Q on its members as well as on its wider contributions to healthcare improvement. The study has involved nearly 200 interviews and focus groups, 13 surveys, several case studies and deep dives of Q in different areas of the UK, citizen ethnography, review of key strategic and improvement literature, observations at Q events and Q team meetings and a social network analysis of connections between Q members. RAND Europe conducted a separate evaluation of the first design year of Q in 2015 and an interim evaluation report for this study was published in 2018.

Key Findings

Q is a respected and appreciated home for improvers.

Activities, connect with each other and share learning. Q has established a positive profile among improvers in the UK health and care system and its members share a strong sense of identity and feel mutually supported. More widely, Q has helped raise the profile of improvement in health and care and strengthened the understanding of what it might contribute.

Q has helped build a community of improvers with confidence in their own knowledge and in their ability to deliver improvement.

The initiative has successfully supported this by connecting members to each other and bridging to a wider community, making it easier for lessons and good practice to spread. The connections made through Q have also been used to support ongoing improvement work and help create improvement projects.

Q supports practical knowledge mobilisation on the ground.

For example in changing patient experiences, resulting in fairer or more efficient care, or improving outcomes. Q members say that the collaborative nature of the Q Exchange funding programme and the financial support offered have led to a number of tangible impacts.


Engage organisational and system leaders more actively with Q.

Stronger connections with system leaders would help Q members to be given time and resources to use their improvement skills and give leaders access to a network that can support delivery.

Maximise opportunities to collaborate with different agencies across the UK.

Q will need to ensure that it is able to both respond to changes in the capacities and resources of other organisations and maximise the mutual benefits from these relationships.

Ensure that impact from the Q Lab is more visible.

The Q Lab process was often thought of as positive, however some participants were unsure about the impact it sets out to achieve, and whether this has been realised. Q Lab leadership need to continue to experiment in how to involve diverse expertise and build partnerships that can support delivery as well as understanding.

Review the Q infrastructure.

In the face of further considerable growth ambitions and scale, it is important to consider what is needed to preserve the quality of Q activities, its profile among health providers and policy makers, and its responsiveness to members.

Examine the use of resources.

Q could consider conducting a discrete choice experiment to more precisely understand how members trade off the benefits they perceive from different activities and resources.

Research conducted by

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

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