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The reality gap: managing expectations and getting the most out of Q

Member Chris Tiley shares a candid insight into his his initial hopes for Q - and where improvements could be made to provide better opportunities for connection and collaboration across the community.

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The comedian Ben Elton used to talk about the reality gap – the difference between what you envisage something will be like and what actually happens – and this has been my experience of being part of the Q community so far. I joined Q after my wife sent me the joining link knowing I was looking for a new challenge. I applied largely looking to link with enthusiasts after starting to feel a bit isolated in my work as a GP in Cornwall.

To date, though it has made some made impact, I must admit that joining Q has not had the invigorating effect on my work that I had hoped. I recognise that this is partly down to me and is open to improvement. Without going part-time it is hard to find time in the day, and the evenings are generally given over to recovery time and family – something that many other Q members I’m sure can relate to.

What’s been helpful?

I’ve been a member since early 2017. I’ve attended events – including a joining event in Exeter, a regional meeting in Taunton and the 2017 national event in Liverpool where I presented a pecha kucha on health inequalities. I went on a Q visit to the NHS blood bank near Bristol​ in June of this year. I spoke to a number of interesting people enthusiastic about their work, and I’ve had some follow-up email conversations.

What could be better?

I’ve used the Q website to search for local members to meet but unfortunately numbers near me are low and my invitations went unanswered.

Threads in the SIGs that I joined showed interesting work being pursued on the GP and co-production streams, however, they often featured Zoom calls without any linked IT advice or occurring during business hours that I could never guarantee being free for. As a GP I have no protected time in the week apart from 2-3 pm on a Wednesdays when I am getting ready for the school run!

Posts on the sites did not generally result in a response. I engaged with some randomised coffee trials but latterly have had to abandon them for the same reason. One I had to cancel just as an urgent visit request was phoned through. After attending the national event I had a real go at twitter but the amount of information was slightly overwhelming and I couldn’t engage in a meaningful way.

This has led to a slight sense of detachment from the movement which feels like a result of my basic IT skills, my geography, the dense and unpredictable nature of my work. It’s also down to the attitude of my partnership, where I have tried to introduce Health Foundation principles to enable quality improvement work but find very little support among my peers – which comes full circle to why I joined Q in the first place.

So how can we get the best out of the community, knowing that we have limited time and other commitments?

If I had to make any recommendations they might be:

  • Check preferred communication method with all new members – email feeds have the advantage of being accessible at any time. If Twitter or Zoom is mandatory for the best results, offer training links on the website.
  • Advice on the best way to call small local meetings would be welcome, including scrupulous updating of the Q member map for this purpose.
  • Consider a mentoring scheme linking new members to more established ones as they find their feet.
  • Encourage each new member to consider an achievable but relevant project in their first year as a way of introducing how best to use connectivity and the undoubted resources that Q offers.

I’d be keen to hear from other members who have experienced something similar and have some advice on how they’ve overcome this. In recent weeks I have started deleting emails from Q on arrival feeling that I am unlikely to be able to take part or respond in a meaningful way but recognise this is too negative and will start at least to look at them afresh. I am reminded of the biblical parable of the grains of corn and hope that in time I may become more fruitful rather than risk withering away after an initial spurt of enthusiasm.


  1.  Hi Chris, I really appreciate that you’ve shared your reflections in this way. We have often talked about Q by breaking it down into time (what you can do if you have 5mins, 30mins and more). The reality is that for many people the commitments and pressures of the day job make discretionary effort feel challenging, and this community is voluntary.

    Zoom and Twitter have organically become two of our modes for communicating with members, and Twitter’s reach is beyond the community itself of course. Your points are a helpful reminder that we can provide better support in these areas. In response to some similar feedback we have developed a Tweet sheet (which new members now receive) and we are developing this into a digital format to make available to all. I will link you in with Matt our community manager on this and the groups.

    I think mentoring or a buddy scheme could provide that initial support to navigate Q. You may have seen that we have a number of Connectors across the different geographies, you may want to link with one of those in your area?

    It would be great to see other members responding to this and sharing experiences of how they have overcome some of these challenges. Also, if you'd like to have a chat directly at any point, please do drop me a line.


  2. Hi Christopher

    It is really refreshing to hear comments from an honest view of just being open about how you have found things, you are right there is a major gap between expectation and reality however the reality can be a wonderful thing also.

    I joined the randomised coffee trials when I joined Q and at least 50% of them fail to connect, I have had the privalidge of being involved in the first Q Lab which was both interesting and time demanding and yet I like others wait to see if the network will rise to the challanges that the lab posed.

    A network no matter how diverse is dependent on its members and participants to engage and help each other to succeed and with that in mind I would invite you to link up and see how together we can effect change for the better.

    Thanks agian for being so straight with us and I look forward to hearing from you.

  3. Hi Christopher

    Thanks for sharing your blog, it was really interesting to learn about your honest experiences of Q and I hope over the coming months you find things and people to engage with. As Jono mentioned, the Q Lab is open to people to get involved and may be of interest to you. The Lab works on a single challenge over the course of 12 months or so, providing a range of opportunities for Q members and non Q members to get involved. This year we are looking at ways to improve care for people with mental health problems and persistent back and neck pain. We are working in partnership with Mind on this topic, and we think the findings will be useful and applicable to those working in a range of settings to improve care for people with physical and mental health problems

    Depending on the time you have available involvement with the Lab could be relatively light-touch, for example if you only have 30 mins a fortnight you might join the conversation on the online group, or perhaps read or contribute to some light-touch research. If you had a more time available and the topic was of particular interest to you, you may wish to get involved in testing improvements on the ground, with the support of the Lab team and participants. You can find out more on the website (and this brochure may be of interest but if you’d like a chat about it feel free to drop us a line at If you’d rather a Q member perspective I’m sure Jono would be happy to share more about the Lab and the opportunities, and of course unknowns about how it might develop.

    All the best


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