Participants in a Q Lab discussion at the Barbican
Photo by Q Lab, used with permission
The Q Improvement Lab is an initiative led by the Health Foundation to connect people working in quality improvement across the UK healthcare system. It is distinctive not only for its focus on improvement but also for its concerns with UK health and social care issues.
An evaluation of the pilot Q Lab found that the Q Lab approach is distinct from other health and social care improvement efforts; participants valued the varied engagement approach and networking opportunities; and that the Q Lab consolidated learning and knowledge on, and raised the profile of, peer support, and motivated participants to take action.
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, funded by the Health Foundation and NHS Improvement, was launched in the spring of 2017. The Q Lab is distinctive not only for its focus on improvement but also for its concerns with UK health and social care issues.
The Health Foundation and NHS Improvement wanted to know whether the Q Improvement 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.
The Health Foundation commissioned RAND Europe and the University of Cambridge to answer this question by collecting real-time, formative, evaluative evidence to support the Q Improvement Lab pilot. The 15-month evaluation, which began in May 2017, aimed to identify usable lessons for future decisions from an analysis of the culture, roles, activities, enablers, barriers and engagement of the pilot Lab along with an explanation of why these approaches evolved and with what consequences.
The team's specific evaluation questions were:
Through the formative evaluation, RAND Europe and the University of Cambridge aimed to develop an empirically rich and analytically informed account of how the pilot Q Lab works in practice.
The research team examined the resources required for an effective approach, the value for stakeholders, how the work mobilises change, and how it fits with other approaches aiming to achieve similar ends. Key methods applied included ethnographic observations, interviews and focus groups with key stakeholders, surveys and document review.
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.
In its pilot year, the Q Lab team developed and implemented an approach to addressing challenges in health and social care that hinged on developing a holistic understanding of that challenge, creating momentum around addressing the challenge, convening participants and stakeholders and empowering them to generate and act on ideas that are potential solutions. This is likely to be an effective and valuable approach for challenges where past efforts have been hampered by too narrow or too hurried an understanding of the problem, where not all the perspectives needed to develop solutions have been involved, and where securing collaboration across organisational and professional boundaries is key to success.
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.
However, 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.
Elisa Liberati (University of Cambridge)
