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The Q initiative has established itself as an important resource for quality improvement in health and care, supporting members with skills, new relationships and self-confidence. However, to deliver change at scale there is a need to build on these achievements.
Q aims to connect people working in quality improvement across the UK health and care system, to make it easier for them to share ideas, enhance their skills and thus bring about a change that benefits patients. As of April 2020, it is led by the Health Foundation and supported by partners across the UK and Ireland.
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. An evaluation of the first Q Lab project was also conducted by RAND Europe and published in 2018.
Q provides a wide range of opportunities for members to access resources, take part in 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.
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.
Examples include 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.
When decision makers face hard choices about how to allocate resources or to deliver services in new ways, they do not instinctively look to Q members as a resource that might help them. 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.
Q was never designed to be a ‘sole provider’ of improvement support and has been largely successful at building relationships with other organisations that provide added reach, networking opportunities, and access to resources. However, 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.
The Q Lab pools the best available evidence about an issue and draws on the ‘hive-mind’ of Q to draw out practical wisdom from patients and practitioners. 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.
Overall, the infrastructure of Q has been remarkably resilient, supporting a tenfold increase in membership and significant expansion of activities and resources. However, 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.
While members appear to appreciate the range of resources available, it is less clear whether doing more of some things and less of another would result in greater value. 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.
