To create better health and care for people across the UK and Ireland, we need to embed improvement capabilities at every level of the system.

Most of our work to date has been supporting and enabling members to bring positive change in your work, teams, and organisations. As the community has now grown to over 5,000, it’s time for us to focus on how we can influence the conditions that members operate within too. We want to create a desire for improvement methods at system level.

We know that for members and improvement to thrive, we need to support and influence senior and system leaders to create better conditions for improvement work.

There are two levers for Q to pull to increase the visibility and credibility of improvement: spreading and implementing ideas and interventions, and creating a more joined-up system.

The principles and methods of improvement are just as applicable at a system level as they are at an organisational and team level. So, encouraging improvement through work with senior and system leaders should help set the conditions for Q members to work with more organisational and system support.

We’ve brought system leaders together

Over the last 12 months, we have been working with senior and system leaders across the five nations of the UK and Ireland. Together we co-designed a peer learning space to explore embedding improvement at a system level.

We know that providing space to engage with like-minded people, who have very different perspectives, can re-energise, and reignite enthusiasm for improvement. And this works at all levels of the system.

Because of the nature of the work across nations, it’s much harder for system leaders to work on one thing together. But there is value in sharing approaches, and information, supporting and inspiring each other. We’ve provided space for peer support and exchanging information. Participants acknowledged this has been as helpful as, if not more helpful than, collaborating.

‘Coming together with people from the five nations was immensely useful. There were some things, where people were talking about things, and you were thinking, “Ah, actually we’re doing that, we are there” and there were other things where you go, “Hmm, okay, right, we need to think about how we adjust that” and “we do that differently.”’

Through talking openly with peers about the challenges they face within their systems, they found that quality improvement was being approached in similar but also quite different ways across the five nations. And each nation has a very different context for their work.

‘It’s easy to underestimate how important it is, though, as a leader, to get stuff in perspective, and realise, “It’s not me, it’s not my leadership style, it’s not something to do with my country; this is the nature of the work.” … I come away … inspired that I’m doing the right things, and I need to carry on.’

In providing this space, we’ve enhanced international connections and relationships between systems across the five nations. Which is helping to advocate for improvement methods in response to system issues. It is having a ripple effect.

“It has moved us forward. It has given us new thinking. It’s giving us documents, and pitches, and approaches to make cases for things.”

“These discussions have influenced some of the messaging I’m giving to our politicians and policy leaders in government around some of the challenges we’re currently dealing with.”

What’s next?

Our work in the last year has shown the value of creating peer learning spaces and the changes that they can bring to the way people work. And it has shown us that collaborative peer learning is a key route to embedding improvement in systems. In 2023 we will continue to work with system leaders, both at national and local level, to bring them insight and challenges from the community, so we can work towards creating better conditions and cultures for improvement across the health and care system.