Conclusion: Where is Q now? Where next?

The value and experience of Q for members

Three years in, and with over 2,500 members and with a Twitter community approaching 10,000, Q has maintained its initial momentum, signalling the broad appeal of both what’s provided for members and the over-arching mission of a more joined-up approach to improvement across the UK.

A subset of members report that they are less actively engaged than they would like to be, suggesting they may be struggling to find the right ‘way in’ to Q or are yet to find opportunities that they are confident will help them achieve their priority objectives. A priority for those leading Q both centrally and locally will be to make it easier for members to navigate what’s available, with improved induction and clearer signposting. The Q website will see significant development over the year ahead, offering time efficient access to knowledge and people.

Q is voluntary, with no minimum level of engagement expected. Network theory suggests it is normal to have a relatively small proportion of all members who are proactively engaged at any particular point and there is more to learn about what will be reasonable to expect within Q. In order to increase engagement, the Q team recognises there is more to be done to help employers to understand the benefit that participation will bring.

45% of members in the first phase of recruitment reported having protected time to participate in Q activities, with some taking annual leave to attend events. This illustrates the restrictions on funding and time available for many groups of staff to participate in development activities, even when activities are free to attend. Operating in this context, Q needs to demonstrate that it offers practical and potentially resource-saving ways for organisations to access the expertise and ideas needed to deliver high quality, sustainable care.

Looking forward

Q has been conceived from the start as a long-term initiative, and over the coming months the central team and Q’s partners will lead a process to establish a funding and delivery model for Q fit for the long term. The aim is to deliver on the promise that Q becomes a stable platform that enables sustained momentum for improvement, despite the structural turbulence that often characterises the health and care sector. As described in Box 9, this will also explore ways Q can more explicitly and fully support work on priority issues.

Change at an increasingly ambitious scale

The major challenges facing the health and care sector in the decades ahead will require change at multiple levels. Arguably, the NHS is reasonably well structured to support change within individual institutions, such as acute hospitals. Far fewer mechanisms exist for the generation and exchange of knowledge between people, teams, organisations and sectors. This is particularly true when it comes to sharing knowledge about how best to design and iteratively improve processes of care. Q is designed to be an infrastructure that is flexible enough to support and help connect people doing the diverse range of work needed over the years ahead.

The outputs from Q Labs and Q Exchange are adding to a growing bank of tangible examples of Q enabling collaborative change. As Q attracts more people both at the front line and leading change at an organisational and system level, the scale and strategic significance of Q’s impact is likely to expand.

The evaluation includes examples that suggest Q adds value by providing a space where lessons are shared between people leading improvement to services – this is where ‘the rubber hits the road’ in terms of making a difference for those who use the health and care system. The learning from the evaluation and the insights from the Q team suggest that Q also has the potential to mature into a space that supports those engaged in more strategic work that seeks to transform care models and shift the focus to prevention.

Conclusion: ongoing learning and improvement

Ultimately, and as reflected in Q’s updated theory of change, the aim is that the improvement workforce in the UK becomes broader based and better supported, and that people leading improvement can operate more effectively across boundaries to understand what’s needed and speed uptake of what’s useful. Q seeks to bring together a critical mass of activity in individual local systems and on key topics, and in this way accelerate sustainable approaches to improvement all across the UK.

The potential of Q is only just starting to be realised. Learning, designing and delivering collaboratively with members and partners has been core to what has been achieved so far. This report, and RAND’s evaluation, reflects the generosity and passion that Q’s members and partners have brought to help establish and continually refine Q.

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