Through Q, we are redefining who and what counts when it comes to improvement. This is not as an academic exercise, but because it’s critical to keep pace with the creativity and breadth of the community’s work and what’s needed to tackle the complex challenges facing health and care.

This blog shares resources to support us on the journey across the broad improvement landscape of which we are part.

Who counts when it comes to improvement?

Before partnering with NHS England to found Q, the Health Foundation was funding fellowships for dozens of people. These programmes were hugely influential but didn’t reach many of those with improvement expertise, leading amazing work in the sector, who had built experience through specific courses, programmes or their day-to-day work.

Through Q, with 10-20 people joining each week through its consciously flexible criteria, we’ve radically expanded the number and range of people who are recognised for their experience and energy for improving health and care.

As we look forward to launching a new partnership with NHS Confed and the Health Foundation to support learning and improvement across systems in the UK, it’s great to think how far we’ve come in building a community that spans organisations, professions and backgrounds. We now have the opportunity to go further, to connect with those working in all parts of health and care, beyond the orbit of the NHS where courses and investment are often channelled to the acute sector and benefit some groups more than others. We have a duty to ensure a diverse range of backgrounds in our membership, not least because the improvement world needs to reflect the populations we seek to serve. We need your help in this: our recruitment campaign invites members to consider who else might benefit from joining Q.

What counts as improvement?

Q offers an amazing window into improvement practice across the UK and Ireland, and how it has changed over the years. At the opening session of this year’s Q community event, we had the opportunity to reflect on the breadth of ways that improvement ideas and approaches are being deployed.

Taking a helicopter view of the improvement landscape, we charted four broad modes of improvement work:

• First there’s the iterative quality improvement that’s been the basis for addressing so many quality and safety issues over the years.
• A second mode, that emerged as our ambitions have increased, seeks to transform pathways and care models.
• Third, there’s increasing interest in work that seeks to shift the whole operating model for organisations.  While sharing core improvement principles, there are additional ideas, methods and activities brought into this work, including from adjacent territories of operational development, leadership, for example.
• And fourth, there’s work happening in the community that’s targets a particular innovation, for example helping tech or other innovations scale more effectively or using social movement methods to generate energy around a particular need.

This is a simplified view on the world, I know. To stretch the analogy of improvement work as a landscape, there are many paths you can take, with disputed territories and no hard boundaries.

Improvement is broad and diverse, making it all the more important that we connect to learn from each other.

You can watch the recording of the Q community event session and access the slides to learn more and join the conversation.

While this is useful for us to reflect on, it’s as important to influence how improvement work is seen by those making decisions on how resources are used.  We want to bring home that improvement has come a long way as a movement, that it’s much more than small scale Plan-Do-Study-Act cycles and can bring benefits across all parts of health and care delivery.

Where next: embedding improvement approaches as mainstream business

Last week the Health Foundation has shared two publications: a briefing that sets out the strategic case for improvement as mainstream business and a quick guide. Both draw on what we are seeing in the Q community and our work with Q’s five country partners from the UK and Ireland. The briefing elaborates on the four modes of improvement I’ve sketched above. It makes the case that improvement approaches are indispensable, not just for incrementally improving care at a micro or team level but when it comes to tackling the biggest challenges that health care faces. It summarises the steps needed to overcome the barriers to embedding improvement across all health and care settings.

The accompanying guide helps us think broadly about the range of benefits that can be achieved through improvement work. It summarises compelling examples that can help you make the case for investing in improvement approaches. In a health sector attempting to solve the same entrenched challenges for decades, those of us working in improvement need to step up and point to methods that – with the right support – can achieve sustainable results.

Use these publications to reflect with colleagues and peers on the role of improvement approaches, and where else the benefits from these approaches could be felt. You can work with other local Q members to influence decision makers in your organisation to see the broad relevance of improvement ideas. If you’re looking for inspiration, the recent Health Foundation webinar shares the national context of more explicit support for improvement in England and learning from those on the journey to improvement as mainstream business.

As improvement evolves, Q will continue to be a place to come together, discuss and make sense of what’s happening.  We’re on this journey together: please share how you are starting conversations in your organisation with each other and the Q team.