Q has a number of distinctive features and strengths that will need to be reflected in the governance model. These include:
- a lack of hierarchy and a commitment to involving patients, carers and diverse professions from within and beyond the health and care sector.
- a strong commitment to flexible, iterative learning, minimising bureaucratic processes, maximising learning between members and promoting a sense of shared ownership across the community.
- a desire to facilitate two-way relationships between national and regional activities, as well as relationships with other improvement organisations, and ensure these are well managed as the community grows in size and complexity.
As part of the next phase of developing Q, work is underway to consider what governance model will be appropriate in future, and an innovative ‘Commons’ model has been recommended.
The Commons model
The theory behind the Commons model of governance was developed by economist Elinor Ostrom, whose work demonstrated – in very practical ways – how people could co-produce, and make the most of commonly held assets and resources.
A Commons model has been proposed for Q on the basis that it is values-based and inclusive, as well as robust and accountable. The model will allow members freedom to work together and to make decisions locally, and to self-organise. It will hold individuals to account in ways that are proportionate to the task in hand, and provide an underpinning logic and framework for groups who choose to work together on projects.
What would this look like in practice?
It is proposed that there will be a loose structure bringing together a number of regionally located commons into an overarching National Commons Stewardship Group. The governance model will be trialled in three areas of the UK from early 2017.
We will eventually create these commons stewardship groups in each part of the UK – creating a platform for stewardship of Q activities at a local level. There would also be structure for facilitating collaboration and knowledge exchange within and between the different local commons.
We will identify a small group of people who are willing to take a more active stewardship and leadership role for Q, forming a National Commons Stewardship Group from representatives of the local commons groups. This group would effectively become a board with up to 18 members, chaired by a Convener. It would have some responsibilities for financial, strategic and performance oversight for Q.