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Why Q?

Our health and care system is facing major challenges, with the need to improve at significant scale and pace and in the face of considerable financial pressures.

Q was established in response to a recommendation from Don Berwick’s 2013 report A promise to learn – a commitment to act: Improving the Safety of Patients in England, that we urgently need to enhance the ‘bottom up’ capacity of the health and care system to identify and respond to new ideas.

Improvement is happening in pockets around the UK, but a better connected approach is needed to enable the scale of transformation required. Too often problems are solved in one place at a time, without easy ways to tap into support and advice from those who have already been there. Great ideas spread painfully slowly.

So enhancing the ability of the system to make the most of innovative ideas is critical. Creating a diverse and well-connected community will encourage innovation and help develop solutions that have the buy in of different groups.

Over the past decades, thousands of people in health and care have been trained in, and are now delivering, structured approaches to improvement. Providing long-term support for people with improvement expertise makes the most of that investment already made.

We are creating ways to surface, support, develop, connect and mobilise people to help maximise their impact and accelerate improvement. It is providing a long-term ‘home’ for cross-boundary learning and change. Our ambition is that Q will contribute to an ultimate aim of improvement work being everyone’s responsibility.

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Where did Q come from? Is patient safety part of it?

Q began as an initiative to recruit ‘5,000 Safety Fellows’ following a recommendation of the widely respected 2013 Berwick report A promise to learn, a commitment to act.

Recognising those with improvement expertise was part of the report’s recommendations about how best to improve safety in the wake of failings of care at Mid-Staffordshire Hospitals NHS Trust. The report made the case for a system devoted to continual learning and improvement.

In 2014 NHS England approached the Health Foundation to lead the design and delivery of the initiative.

The Health Foundation’s UK-wide remit and funding means the initiative will bring together those committed to health and care quality across all four countries in the UK.

The decision was also made to expand beyond patient safety to cover all domains of quality in line with the Institute of Medicine’s (IOM) definition: safe, effective, patient-centred, timely, efficient and equitable.

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What is the difference between Q and other initiatives, networks or programmes?

Q is intended to complement and underpin other initiatives, networks and programmes, not compete with them. It is aimed at individuals and will provide a long-term infrastructure to support them throughout their improvement career.

Q will support other initiatives and programmes by:

  • making it easier to understand what improvement work is being done, by whom,
    and where UK-wide
  • providing resources and platforms to connect and support across existing
    networks
  • making it easier to collaborate on areas of shared interest
  • influencing the context of improvement.

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Who designed Q?

To ensure that Q meets the needs of those who will be part of the community, we collaboratively designed the initiative together with 231 founding cohort members in 2015.

In addition, throughout the design process, we have involved eminent leaders of improvement and wider stakeholders (more than 500 people in total to date).

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Who funds Q?

Q is co-funded by the Health Foundation and NHS Improvement. It was previously co-funded by NHS England. On 1 April 2016, the Patient Safety team transferred to NHS Improvement, along with co-funding commitments to Q.

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Are patients involved?

Patients are at the heart of Q: its mission is to deliver tangible improvements for and with patients, and the members include patient leaders. We describe patient leaders as people who combine commitment, understanding and experience of improvement with their perspective as a patient or carer, or as a leader within an organisation that represents patient or public perspectives.

There are many labels used with somewhat different emphasis to describe those active in wanting change, and who have substantial experience as patients or carers or as representing the perspective of patients and carers.

Terms include ‘lay members or representatives’, ‘experts through experience’, ‘system leaders from a patient perspective’ and ‘community leaders’. Q is open to all of these improvers.

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What are the benefits and opportunities of being a member?

Members will join a diverse community of other improvers – a ‘home’ to turn to for inspiration and support.

Q provides ways for members to learn, share and get advice from a wider network of peers, offering flexible development in ways that taught courses aren’t easily able to provide.

There is no membership fee or minimum time commitment to be a member. It is designed to help support busy people with their current improvement work and ongoing development, and to promote their visibility as a leader of improvement. Q should support members to tackle the challenges they are working on, rather than feel like an extra project.

Members are added to the online directory, hosted and promoted by the Health Foundation. They have access to online resources and subscriptions, such as the Institute for Healthcare (IHI) Open School online courses, BMJ Quality, ISQua and the LEAN QI app.

There will be opportunities for sharing ideas, enhancing skills and collaborating on improvement projects. These will include national and local networking events, expert-led knowledge sessions, and site visits both within health care settings and in other sectors.

Some of these activities are organised through a central team, while others are managed through regional improvement organisations or self-organised by members.

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How does Q support patients and the public?

Q aims to foster improvement in every part of the health and care system. The ambition is for people who use services to be more confident that the way they are designed and run is informed by best practice from across the UK.

Through Q, people who understand how to make health and care services better (including patients) are pooling their knowledge and energy, with a focus on achieving practical, measurable improvements. It gives those who bring the patient and public perspective a greater voice and recognition as equally-valued improvers, alongside those at the front line of care – managers, researchers, policymakers and others.

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How does Q support organisations?

Q will create time-efficient ways for its members to draw on the expertise of others to help accelerate work on improvement challenges. Having a member within the organisation will help ensure access to the best ideas and a range of experts from across the UK and, in future, internationally.

It will equip members with skills and resources to enhance their ability to act as leaders, role models and mentors for those they work with, encouraging a culture of continuous learning and improvement.

The online directory helps employers identify those with the skills and passion for improvement.

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How does Q support the health and care system?

Q will help promote improvement within the health and care system, encouraging and supporting a wide range of people to effectively lead improvement. Although members are expected to develop their own learning and skills, it is also hoped they will use this input to lead and develop others beyond Q – building capacity across the system.

We are proposing to establish a network of ‘Q improvement labs’ over the coming years, where people from across the UK will collaborate on improvement challenges, making it easier to pool knowledge and energy to enable faster and more sustainable progress on cross-system and complex issues.

The first Lab will be piloted from Spring 2017 and will focus on the topic ‘Empowering people to manage their own health and care needs’. Find out more and get involved.

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How can I join?

To ensure the community is grown in a manageable way, and to enable members to contribute to its evolving shape and design, opportunities to join are being phased across different parts of the UK. Find out more about joining.

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Why are there selection criteria?

We worked together with the founding cohort and others to develop selection criteria for joining Q. The decision to have selection criteria was made after much debate. It is there to ensure those who join share an understanding of improvement and are able to contribute equally and as trusted advisers.

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How much does it cost to join?

There is no membership fee to join, however travel and expenses are not covered by Q.

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Will those not in paid employment have contributions to expenses?

There will be times where we will cover the travel and out of pocket expenses in relation to Q activities for those who are not in paid employment. This will need to be pre-approved and in line with the Health Foundation expenses policy.

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