The turn of the year is a natural point to look ahead.  In Q, we’re taking some time to look beyond 2019, to think about how the world of improvement might be different by 2025 or 2030. This blog shares some early thoughts on possible trends: hopefully useful when you’re thinking about your own work and professional future. We’re hoping this will provoke challenge, questions and additional ideas that we can use to inform future plans for Q.

As you’ll see from the comments below and debate on twitter, the blog has already prompted some good discussion about the importance of co-production as a key future theme in improvement – a discussion which we hope there will be opportunity to explore further in 2019. 

Why now?

We’re doing this because we’re in the process of developing proposals for Q beyond the initial funding period, which runs to April 2020. Q was set up with an ambition that it would be here for the long-term.  As part of our future strategy, we need to understand how the world within which Q lives may change so that we can ensure Q develops to stay relevant for members and the health system.

Initial conversations with leaders from Q’s partner organisations in each country in the UK identified 6 high level ways in which the world of improvement appears to be evolving.

The Health Foundation is embarking on wider work on approaches to foresight and we’re learning this is not about trying to predict the future – instead it’s about exploring trends to help stretch thinking about how your work might need to adapt to thrive in different potential scenarios.

Having reviewed a set of global trends, initial conversations with leaders from Q’s partner organisations in each country in the UK identified 6 high level ways in which the world of improvement appears to be evolving.

Expanding change ambitions

The task lists of improvers are increasingly likely to consist of work that is inherently cross-boundary and systemic in nature. From redesigning care pathways and improving health in communities, to integrating health and social care, the level of ambition for improvement has been expanding for some time and that seems set to continue. The widespread interest in IHI’s triple (or quadrupal) aim suggests this is global. Improvers are needing to develop new connections and methods to tackle these bigger challenges. And in this new world, being able to work effectively across professional and organisational boundaries is likely to be just as important to success as any specific improvement methods.  We think that means the skills and links people build through Q will feel increasingly valuable.

Ongoing need for incremental quality improvement

This trend to larger scale ambitions is not to say that incremental improvement in service quality at the point of care will no longer be important. With little sign that the pressures on public services will abate over the years ahead, it sadly seems likely we’ll see further crises, calling for action on specific aspects of safety, service user experience and perhaps increasingly equity. Organisations will need to manage a portfolio of activity, with appropriate capacity and skills matched to iterative service development and more transformational service change – the latter of course needs to be underpinned by ongoing iterative redesign as new care models get into the detail.

Technological innovation

There seems set to be growing attention paid to introducing new technologies. Making the most of technological and information advances requires process change and often role redesign and different model of working with service users. Might Q help bring together the people with the skills and experience in these different fields?

As technological change will come both through incremental improvement by current providers and disruptive innovation, NHS providers may need to be able to navigate choppier waters in the years ahead. Could Q be a place that increasingly bridges the (sometimes imaginary?) divide between the ‘innovation’ and ‘improvement’ camps, so we can make the most of the methods and instincts of both.

Demand for scale

The evolving improvement agenda will be set against a financial reality that is likely to continue to be tough for many years ahead.The recognition of the size and urgency of the financial and other challenges facing health and other public services is likely to fuel increased pressure to secure adoption of new practices on a larger scale more quickly than has been achieved to date. In parallel of course, we’re learning how complex the process of adoption can be. As we look ahead, we’ll be asking what more could be done to develop Q as a flexible conduit for organic and more purposeful adoption of new ideas and practices. Q Lab can play an important role in understanding how we tackle shared challenges in a collaborative way to lay the ground for wider uptake.

Funding for improvement

The evolving improvement agenda will be set against a financial reality that is likely to continue to be tough for many years ahead.

We anticipate there will continue to be investment in structured approaches to making health and care better and responsibility is likely to continue to be distributed across multiple organisations. When thinking about the future, anticipating regular restructuring of these organisations is sadly one of the safer bets. The hope is that Q will make it easier to sustain the human connections between those involved in improving care, whatever fluctuations continue in the organisations around us.

Financial constraints

The financial pressures on the health and care sector are set expected to continue to be significant, notwithstanding additional funding for the NHS in England accompanying the long-term plan. This influences the work plan and environment for many of those involved in improvement. Financial constraints should mean what Q offers in terms of pooling resources and making the most of existing knowledge and skills is increasingly recognised as business critical. Yet, however strong the strategic case, people being able to take a few hours away from operational priorities is likely to continue to be hard. In this context, Q needs to ensure the relevance and flexibility of what’s available to members and that we’re helping members describe the value of participation to their employers.

Share your thoughts

What do you think?  Are these the key things that you see ahead?  What are we missing?  This is pretty much today’s agenda rolled forward, yet a key idea from the world of foresight is that major priorities are first felt as ‘weak signals’ from the margins of current activity. What are the things you’re noticing that you think could be rising priorities, worthy of greater attention now? Please share your thoughts as comments in response to this blog, or feel free to blog in reply.

Your thoughts will be fed into the work to shape Q for the future. And hopefully the insights we share will help us all be better equipped to prepare for what lies ahead.