Appendix: Recruitment

The recruitment process

Reaching ‘first base’ by attracting and recruiting people to the Q community has been a major undertaking. The 48 organisations that nominated the founding cohort of Q members have continued to help promote Q and this evaluation pays credit to the collaboration between the central Q team and 18 regional partners who oversaw a near 10-fold increase in members between November 2016 and April 2018.

Some applicants found the process overly onerous, though others felt that the time spent considering why people want to join Q and what they would bring was important to build commitment. With each round of recruitment, incremental improvements were made in response to the evaluation and member feedback, with the current process reflecting a more substantial redesign and streamlining process.

‘I think that being part of a selection process means that you value membership more highly when successful. It requires more active rather than passive engagement with the opportunity.’

Quote from RAND evaluation of Q

In general, the recruitment process was seen as well managed and fair. Encouragingly, most unsuccessful applicants felt that they understood why they had been unsuccessful and would consider applying again.

Debate about recruitment criteria

Recruiting large numbers of people is not just an operational challenge. From the start, the fact that people need to apply to join Q has divided opinion. Following substantial debate and consultation in the design phase, applicants need to demonstrate experience of playing an influential role in efforts to improve health or care that spans more than one team and to demonstrate some reflection on approaches to change. The criteria are designed to include those supporting improvement from a range of professional or lay perspectives. Those operating at a local, regional or national level to create the conditions to enable front-line improvement work are also able to apply. Q is not just for those who have been part of improvement projects at the point of care.

While some feel that the participatory ethos of improvement is at odds with a selection process, there is a strong case, broadly accepted by many, that having an initiative that recognises those with established expertise is valuable. In this way, Q seeks to complement rather than compete with open networks that exist locally, and reflect the evidence that leading improvement successfully requires relatively advanced skills and knowledge. Given that peer learning is core to the appeal of Q, having a selection process appears important to establish a common baseline of understanding and shared language.

There has been particular interest and debate regarding the involvement of service users within Q. As part of the design phase of Q, workshops were held with people who identified as patients or patient advocates to explore the recruitment criteria. There was a targeted opportunity for patients to apply in 2016 and the peer support focus of the first Q Lab project helped to bring Q to the attention of people with long-term health needs. The Q team has developed a policy for working with patients in the community, and was selected to share the work Q has done on patient involvement as part of the International Forum on Quality and Safety in Healthcare in 2017.

As the Q community grows and it is possible to show how a growing number of people from different backgrounds, including patients, have been able to demonstrate they meet the criteria, there appears to be broader acceptance of the chosen selection process. The data being generated through Q can support further work about both how to attract more people to join Q from diverse backgrounds, and how to target development to ensure people have the opportunity to develop the skills and experience to meet the criteria. It is encouraging that Q Exchange has stimulated a number of project proposals focused on building the improvement skills of people with lived experience.

A priority for the next stage will be to more actively encourage and demonstrate how Q members are reaching out to support and develop others within their organisations, demonstrating how a community of people with established expertise can help catalyse widespread engagement in improvement.

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