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What is the challenge your project is going to address and how does it connect to your chosen theme?

A fundamental precept of improvement science is to understand & influence human behaviour (Deming). However improvement literature & training often focuses on its technical aspects, neglecting its psychological or ‘people’ factors, despite improvement in healthcare being “20% technical and 80% human” (Godfrey).

Human Factors has attempted to do this, but does not draw from the wider psychological theory base to support key improvement activities such as communicating and influencing staff, building the resilience of the improver and the staff teams they work with and overcoming organisational and cultural barriers.

By building a network and drawing on a range of multi-disciplinary expertise we hope to develop resources to make improvement activity more effective and help to overcome some of the challenges of scale and spread, resulting in systems that are more likely to sustain improvements.

What does your project aim to achieve?

This project aims to bring together the hitherto disparate worlds of psychology and improvement, crossing theoretical boundaries to make improvement more effective.

We want to connect people across organisations that are interested in the human side of improvement & form a Q special interest group. Over the course of a year we will co-produce:

>> A body of curated knowledge about the psychology of improvement;
>> Practical resources that use psychological concepts to support change & are free for people to use & evaluate;
>> 3 networking events across the UK to disseminate resources and spread impact.
The work will draw on the evidence base from Human Factors and Behavioural Economics, as well as the wider psychology research and theory base.

We are inspired by the IHI’s ‘Psychology of Change’ paper (2018) which draws on the learning from Marshall Ganz about grass roots community organising, co-production and distributed leadership. The author, Kate Hilton, is supportive of our project.

How will the project be delivered?

We want to create a special interest group in Q and over the course of the next few weeks start to work up and craft our application to the Q Exchange. We would love you to join us on this exciting journey.

We are hoping to deliver this work using some of the distributed leadership & community organising techniques we are interested in. So we are looking for Q members who would not only join us out of interest, or show that they like this work, but who are also willing to undertake an operational role in the project and be in charge of a part of the budget to help us deliver our goals.

We will assign a proportion of the budget to the special interest group to enable members to take on specific tasks to help curate and disseminate knowledge, develop and test materials and plan and deliver the learning events.

We will use a commons stewardship approach to support a distributed leadership model, seeing our uniting purpose as the wish to create something useful for the Q community and beyond.

What and how is your project going to share learning throughout?

We will host a 4-6 weekly virtual meeting for active participants to share experiences, ideas, successes and failures to shape the learning resources, and this will be summarised as a written update for all Q members to enable the work to be influenced by a wider community of improvers and practitioners with psychological expertise.

We will continue to reach out to the Q Community throughout the duration of the programme to ask for support and input. We will let people know when we have created materials to test. We will ensure that all the resources we create are open access and encourage active feedback and evaluation via the Q twitter space.

We will hold three learning events to bring interested people together, to network and grow the community, to share knowledge and resources and to help improve and refine materials.

We are keen to write up our final learning and disseminate through a peer reviewed journal.

How you can contribute

  • We are a warm & friendly group of folk who are looking to find other people who are interested in this area. We are looking for people that want to take part in three distinct ways:
  • >> As a person with an active interest in this area who wants to keep in touch with how we are getting on and can sign post to resources, be a champion for the work and act as a critical friend
  • >> As a person with expertise and/or enthusiasm who would take a lead in helping to develop resources, thinking, materials etc
  • >> As a person who loves to plan, design & run learning events and be willing to help us or find us a free venue
  • We are also seeking your support at this early stage to tell us what you think of our idea and what we could improve. Please let us know if you’d like to join the group and help us make this happen or if you have ideas about how best to embrace co-production and ensure we ground this work in the best way possible

Plan timeline

30 Sep 2019 Set up P4I Special Interest Group on Q Community website
15 Dec 2019 Virtual meeting - plan virtual / site meetings for P4I team
31 Jan 2020 P4I team site meeting 1 - planning network/resource/events
31 Mar 2020 P4I virtual meeting - position update & support/events
15 May 2020 Draft P4I knowledge & practical resources developed
15 Jun 2020 P4I team site meeting 2 - finalise resource/event planning
30 Jun 2020 Knowledge bank/practical resources complete and signed off
1 Sep 2020 P4I virtual meeting - event planning (may need site meeting)
15 Dec 2020 3 national events delivered between Oct-Dec 2020
31 Mar 2021 Learning shared via Q Community & peer reviewed journal

Project updates

  • 14 Jun 2021

    Hi everyone,

    The P4I: Psychology of Change session with Kate Hilton Blog and recording are now available! Please click the link below to access these:

    We hope you enjoy it and we would welcome you to leave a comment or like on the video/blog. We’d also encourage you to spread the word and share the blog with others.

    P4I Project Team

  • 4 Feb 2021

    Hi everyone,

    You are cordially invited to the Psychology 4 Improvement (P4I) Psychology of Change session facilitated by Kate Hilton (31st March, 2021). This session forms part of the Q Exchange Psycholgy 4 Improvement winning bid 2020 which is about building psychological and relational understanding amongst the improvement community to support more effective improvement work.

    ‘The rate at which improvement spreads relies on the people who are implementing the change in practice. Psychology4Improvement helps leaders at all levels equip people to commit to improvement work: the way that we think and feel, what motivates us, and how we behave when we encounter change. This one-day workshop features real time improvement examples concerning COVID-19, health equity and joy in work and engages participants in applying methods to activate their own – and other people’s – agency.  ‘

    For more information and to Register your place (limited spaces available), follow the link below:

    This workshop will be advertised more widely, later this week.

    Take care and we hope to see you there,

    P4I Project Team

  • 3 Feb 2021

    Hi everyone,

    You are the first to be cordially invited to the Psychology 4 Improvement (P4I) Psychology of Change session facilitated by Kate Hilton. This session forms part of the Q Exchange Psycholgy 4 Improvement winning bid 2020 which is about building psychological and relational understanding amongst the improvement community to support more effective improvement work.

    ‘The rate at which improvement spreads relies on the people who are implementing the change in practice. Psychology4Improvement helps leaders at all levels equip people to commit to improvement work: the way that we think and feel, what motivates us, and how we behave when we encounter change. This one-day workshop features real time improvement examples concerning COVID-19, health equity and joy in work and engages participants in applying methods to activate their own – and other people’s – agency.  ‘

    For more information and to Register your place (limited spaces available), follow this link

  • 14 Dec 2020

    Psychology 4 Improvement (P4I) Update December 2020

    The P4I team have been through a journey over the last year, many of us were strangers creating new relationships with each other, but all passionate about using psychological principles to improve improvement.  The P4I team have originated from across the North, East & West of England and Wales.  This has meant that for much of the last year the work has been about linking in with each other, sharing and developing ideas, learning loads  but increasingly it has been about creating a connected community that supports each other.  This work has been led by a small core team reaching out to others within and beyond the Q Community to co-produce and deliver on our aim, which is:

    “To develop a Psychology for Improvement community to lead, develop and role model the importance of Psychology for Improvement in delivering human-centred, sustainable improvement in health and care.”

    And to deliver on our original objectives:

    • A body of curated knowledge about the psychology of improvement
    • Practical resources that use psychological concepts to support change and are free for people to use and evaluate
    • 3 networking events across the UK to disseminate resources and spread impact

    However COVID 19, with all the restrictions that it brings have meant that, whilst we were absolute in keeping to the objectives we originally set, we had to think creatively in the ‘how’ and ‘when we deliver.  This means that the work of the Q Exchange P4I project carries on, the project being complete by April 2021 – so watch this space for the juicy stuff to come.


    We started the journey as an exploration, trying to understand why each of us has come to think that psychology is such an important component in quality improvement and what exactly does Psychology for Improvement mean for the core team and the wider community.  We set up different mechanisms to capture this information including: the use of different platforms, listening spaces, literature reviews, surveys and tweet chats.  We also set up connecting structures to help us to reach out to a wider community beyond the Q Community and these included:

    In addition the P4I reached out to form partnerships with others including:

    Much of the initial learning has been expressed through blogs that have been published throughout this time.

    And tweet chats:


    As a result of this exploration into the evidence plus ideas and perspectives from the P4I community, the P4I core group developed a model for the delivery phase of the Q Exchange work and beyond.  This is represented by the P4I Dynamic Model:

    QI Journey of Emotions

    • To share the emotional journeys that are peculiar to improvers, with a view to building a library of QI Project Personas and map emotions to different parts of the QI Journey

    Body of Knowledge

    • To build a body of knowledge around psychological principles linked to QI – mapping evidence to experiences expressed in the tweet chats

    Community of Practice

    • To start building a community with an interest in incorporating psychological principles into QI work.

    Psychological Safety –

    • Developing practical ways to create environments where individuals feel safe to express ideas and learn from failure


    The P4I Journey is nowhere near over.  Even as the Q Exchange project comes to a close in April 2021, this work will continue.  The P4I Steering Group invited representation from the Evaluation SIG to be a member and to help evaluate the impact of this work.  A framework of measures to understand the following has been developed:

    1. Have we achieved our three P4I goals by 31.3.21?
    2. What impact have we made so far in the Q Community and beyond?
    3. What have we learnt along the way about how best to develop and role model the importance of Psychology for Improvement in delivering human-centred, sustainable improvement in health and care?
    4. What could we do even better in the future?

    Whilst some of the P4I Events have been to build community and to explore what psychology 4 improvement means to people – the events have also had an impact on the participants, illustrated in the preliminary data below:

    • P4I Tweet Chat impact – 89% of participants said that they found participating in the tweet chat useful, especially around learnt new things, connecting with new people and encouraging further reading to learn more about P4I
    • QI Journey of Emotions Tweet Chat impact – Participants of the QI Hour welcomed the space to reflect, connect, and share experiences and ideas. Improvers also felt it reminded them of purpose and passion, feeling refreshed, enthused and energised.
    • Community of Practice session impact – over 35 people attended the community of practice, many of which took part in a subsequent survey around the meaning of P4I.  Some feedback across almost 200 comments included:

    ‘I loved the speakers input but also all the attendees, and the organiser who made this happen, thank you from the bottom of my heart’

    • Twitter @Psychology4I– 678 followers, >4k visits, >150k impressions, 1012 mentions, 157 tweet
    • Psychology for Improvement SIG  – steady growth to include 114 members


    The learning continues but for those that might want to do similar work there are a couple of take-aways from the team.

    • Relationships are key – spending time to get to know each other and understand differing points of view.  We did this through non-randomised coffee trials and thinking spaces.
    • Enablers – seek out and take advantage of all the tools, methods and technology that are on offer
    • Virtual Working – can and does work and is great for working across national boundaries,  but you need to plan and work at it to get the best out of the experience

    Next Steps

    Whilst several events and resources have already been set up, for instance COP, Blogs including recorded presentations and tweet chats, the journey is not over and please watch this space early 2021 where there will be further:

    Curated P4I knowledge:

    • P4I evidence mapped to improver experiences

    Practical resources posted online:

    • Improver stories and videos
    • Recorded sessions
    • Tools for improvers such as ‘Spaces for Listening’

    P4I Community of Practice events:

    • Psychology of Change one day session run by Kate Hilton – 31st March 2021
    • Series of ‘Spaces for Listening’ for improvers to share their experiences of QI in a psychologically safe space – run by Charlie Jones

    If you would like to get involved you can either join the Psychology for Improvement Special Interest Group, follow us @Psychology4I on twitter or contact Rachel Trask or Samuel Thornton.

  • 19 Jun 2020

    P4I Tweet Chat – We had a great Tweet Chat yesterday focusing on Psychology for Improvement, check out the hashtags #Psy4I and #QIhour. Many thanks to Lou Waters and the team at Gloucestershire Safety & Quality Improvement Academy (GSQIA) for organising this. The richness of ideas and conversations were incredible, in one hour there were:

    • 555 tweets from
    • 60 participants with almost
    • 900k twitter impresssions

    The P4I team will be analysing this information with a view to incorporating it into the P4I work in a true co-productive way

    P4I COP Blog – Check out the update blog describing the first P4I Community of Practice meeting in April.  the blog includes presentations from Kate Hilton (author of the IHI Psychology of Change White Paper), Anna Burhouse and Benna, Matt & Rachel from the ABCi Team at ABUHB.

  • 1 Jun 2020

    P4I – May 2020 update

    Psychology 4 Improvement – what’s it all about? We know that Deming talked about a profound knowledge of human behaviour being key to any endeavour that is about changing things, making things better for staff and service user’s alike…but what does that actually mean?
    This is what the Psychology 4 Improvement Q Exchange group is starting to explore, finding what works for people, curating a number of resources and sharing these with the quality improvement community.
    So how far have we got? – The P4I group are spread across the country to firstly we needed to get together to get to know each-other, share ideas and plan our next steps. We wanted this work to be as inclusive as possible, about people connecting with others to co-produce resources that are of real practice use to those improving their services. We not only want his experience to be productive, but also fun!

    Here is a little of what we have done so far –
    P4I Special Interest Group – In September 2019 we set up the P4I Special Interest Group to share thoughts, ideas and experiences around P4I.  We have 80 members and would love you to join, sign up here.
    @Psychology4I – Soon after we started to tweet out about the work inviting participation beyond Q Community members.
    Zoom Meetings – we have been meeting via Zoom since January just to get things going
    Blog 1 – P4I: Let’s Introduce Ourselves. We wanted to share the founding group stories, illustrating our different journeys towards psychology for improvement – check out the blog here
    Blog 2 – What has changed to make change happen so quickly? Freddie shared his reflections on how the pace and ease of change has increased since the start of the COVID pandemic – check out his blog here
    P4I Community of Practice – Since the COVID pandemic hit, we have had to change the way we work, so our initial P4I Community of Practice meeting planned for Bristol became a Zoom call at the beginning of April 20.  We had brilliant presentations from Kate Hilton (Author – IHI Psychology of Change), Anna Burhouse and the ABCi team plus a virtual Thinking Round giving each participant space to share their reflections of P4I and what it means to them – (we will share these presentations as part of the P4I COP Blog in the next week or so).
    P4I Survey – we carried out a brief survey exploring the content for P4I
    Steering Group – We invited members of the P4I COP and SIG to become P4I Steering Group members. We are extremely pleased that we have great representation from across the UK to lead the P4I work, including representation from the Evaluation Special Interest Group.
    Next Steps – In the spirit of Psychology 4 Improvement, we are spending a little time getting to know each other, finding time to have a virtual coffee and a chat. We are setting up workshops to explore P4I content and how we evaluate this work, in addition to setting aside time to plan our sharing events later on this year or early next year.

    Plus watch out for the P4I Twitter Hour – taking place between 8-9pm on 17th June #Psy4I #QIhour – let’s have a conversation about P4I.

  • 24 Apr 2020

    P4I Blog #2 – Read Freddie Johansson’s great blog – ‘What has changed to make change happen so quickly?’. Freddie reflects on the rapid change COVID-19 has brought and the shift in mindset that has come with it.

    P4I Blog #1 – Let’s Introduce Ourselves

  • 8 Apr 2020

    Hi everyone,

    The first P4I blog is now available on the Q Community; introducing some of the founding members of the Q Exchange project and how their interest in this area, brought them together to form this piece of work.

    P4I: Let’s introduce ourselves – Blog #1

  • 17 Mar 2020

    Covid 19 – P4I Community of Practice inaugural planning meeting.  This meeting will now take place as a virtual session via Zoom and will no longer take place in Bristol.  Those who have booked onto this session have been contacted.

    Whilst the P4I team intend for this event to go ahead as planned. Please note – the developing COVID-19 response may result in the event being cancelled at short-notice. The P4I team will inform all registered attendees as soon as possible in this eventuality.

    If you would like to register for this event please book by clicking the link below

  • 24 Feb 2020

    Hey P4I…ers – You are cordially invited to the first get-together of the Psychology 4 Improvement (P4I) Community of Practice (COP).

    The inaugural P4I COP get-together is open to all who have an interest in this area, and both Q Community and non Q Community members are welcome to attend.

    The P4I Q Exchange project will have two phases, a planning phase and a delivery phase.  This initial meeting forms part of the planning phase and is the first of a series of P4I COPS meetings/virtual get-togethers that will seek wide input into P4I resources to be shared with the wider Q Community during the delivery phase.

    However, this get-together is also all about getting to know each other, sharing ideas as well as planning the next steps of this work…albeit alongside a bit of fun, reflection and lots of coffee and cake.

    To sign up please follow the link below –


  1. Hi everyone,

    The first P4I blog is now available on the Q Community; introducing some of the founding members of the Q Exchange project and how their interest in this area, brought them together to form this piece of work.

    1. Great to read P4I's first blog and so delighted this project is going strong -  it's much needed. I first became interested in the psychology of human behaviour when working clinically.  As an advanced clinical practitioner, I was always intrigued by patients labelled by other healthcare professionals as 'uncompliant'.  Usually, after time spent listening to their experience, exploring their anxieties, hopes and needs, together we would agree a way forwards based on a shared understanding, with renewed self-belief and hope for the future.  I often use a similar approach in improvement work and find it very frustrating when QI training focuses mainly on tools rather than the really important stuff - the psychology of change.  Really looking forwards to learning more and contributing to this important work.

  2. Hi everyone,

    In light of the COVID-19 response: The Psychology-4-Improvement (P4I) team have decided to cancel the face-to face Get together in Bristol and instead to host a Virtual – Get Together! We are sorry that we will not be meeting in person just yet and hope that you are still able to join us virtually for this event. The event will be hosted on ZOOM on the 3rd April – Weblink and timing details will be shared once confirmed. We look forward to speaking to you all!

    Please ensure you’ve signed up via Eventbrite to confirm your attendance, via the link below:

    Disclaimer: Whilst the P4I team intend for this event to go ahead as planned. Please note - the developing COVID-19 response may result in the event being cancelled at short-notice. The P4I team will inform all registered attendees as soon as possible in this eventuality.

    *If you have any ideas or suggestions to support this event, please comment below. We are interested in your thoughts!

  3. WATCH THIS SPACE - Details of the first 'P4I Community of Practice - get together' to plan our next steps will be provided soon!

  4. Thank you for your interest in Psychology 4 Improvement.  If you are interested in the progress of this bid please join the special interest group (, where updates on developments and future events will continue to be posted.

  5. HI am very interested in this project as I have been experimenting with blending psychological approaches into improvement work. Worked as a psychologist in physical health in acute hospitals for many years, now doing community health work and mental health at BEH MHT and interim Clinical Director for Community Health. Actively involved in our improvement team as Faculty. Keen to be involved - looks like a much needed project.

  6. Hi, great idea. This is a much underdeveloped and recognised aspect of QI that does not lend itself very well to measurement or particular tools so I would love to see this supported.

    1. Hi Juliette, I’ve noticed that you have joined the P4I special interest group, brilliant. We are hoping this is going to be the start of a lively conversation! Watch this space...

  7. Great idea, love to be involved with this. Good luck all, you've got my vote.

    1. Hi Paul, it would be great if you could join our P4I special interest group. We want to pull together a community of evidence and ideas!

  8. Best wishes

    Inder Singh

  9. Congratulations on your shortlisting.

    Such an important project idea to help understand why so many improvement ideas fail, or don't gain the traction needed to be scaled up.

    I will follow with interest- Primary Care background, where our core organisations (Practices) are small, but we are getting more used to working together at cluster level; numerous cross- boundary challenges to be overcome. You haven't chosen the ' soft' side of improvement here at all!


    1. Hi Sue, you are cordially invited to join our P4I special interest group to take part or even just listen to the conversation.

  10. This is a great project and I have joined.  It is the people that make projects a success!

    Looking forward to being involved and hearing more

    Good luck


  11. Guest

    Lorna Stewart 2 years, 7 months ago

    This is a wonderful idea. I am a consultant clinical psychologist and improvement leader, working in an improvement team. Really keen to join the conversation.

  12. Great idea.  I gained my degree in Organisational Behaviour at Lancaster University in 2000. I have spent the last 16 years working in the NHS - the best place to learn and study organisational behaviour in my opinion!  I've recently worked with an engineer who was doing QI using Deming approach.  I was very happy to have the opportunity to share my knowledge and to add in the people factors.  The key to success is recognising the value of teams; you need a group of individuals with very different skill sets collaborating to deliver QI.  Count me in!

    1. Hi Corrina, it will be great to include your thoughts and experience in this work.  I notice you have joined the  P4I special interest group, brilliant!

  13. Hi Debbie and Anna,

    Great to put coproduction at the heart of this. If you want to hear from one of the pioneers of coproduction, Prof Glenn Robert, please join the lunchtime video call this Friday.

    More info/to register:

    He'll be sharing a major international copro research project to solve some of the big coproduction challenges.

    1. Hi Matthew, is this call going to be recorded?  I’m not around on Friday but would like to be able to listen in afterwards if possible.

  14. Dear all,

    if you would like to get discussions going on twitter then do follow us at @Psychology4I and if you would like to join our special interest in Q then do join and also feel free signpost non Qs that you think might be interested to the group via

    Please also spread the word amongst your community about the vote :)

    best wishes



  15. Fascinating idea. I'd love to know more!

    1. Please join us Stephen, we are trying to pull together a new community of practice to debate what we should do to develop some great resources and experiential learning opportunities for Qs.

      A :)

  16. Excellent Idea. There’s such a load of twonk with little evidence or even provenance peddled about in the space between psychology and improvement. It would be great to get as diverse a group as possible together to gather the good stuff and more importantly have some fun exploring its application in the real world. I’ve run a dozen multidisciplinary CoPs so can help with that, worked on leveraging a litte cognitive science within all sorts of improvement malarkey and have spent 20 years researching, developing and implementing concepts, methods and tools to help people understand the decisions they make.

    Be warned, I have a tendency to bang on about Unconditional Positive Regard. Already having a geekout at the prospect of this 🤓🤪

    1. Dear Matt,

      so glad you joined us! I totally agree about trying to make this space as diverse and inclusive as possible. We want lots of opinions, models, ways of thinking and creative ideas about how to collate, curate and evidence this work.

      PS please do keep banging on about unconditional positive regard :)

  17. Sounds like a really interesting project - such an important part of change to consider so any learning that can be shared will be great for the whole Q community,

    1. Thanks Nicola, hope you will bring all your great experience to the table to help us make this brill. A:)

  18. Is there a chance for service user/patient/carer involvement in this?

    1. Absolutely, coproduction surely has to be at the heart of this, don't you think?? We are keen to think about the importance of human relationships and so all perspectives will be important. Please join us

      A :)

  19. Really keen to see this develop further, and have already followed on twitter!

    1. Brilliant Jenni! Fancy joining the group too?

      thanks A :)

  20. Hello everyone, it's really exciting seeing this evolve with so much energy and interest. I loved reading through all the comments. Kate Hilton at IHI is a real inspiration with her Psychology of Change Framework, it makes so much sense. Feels like there's a massive opportunity here.

  21. Very keen to see this idea develop.  I'm in the process of working up a PhD research proposal around this very topic, so would love to contribute and support.

    1. That's so exciting Anna :) would love to have a catch up call and hear how you are doing. The group is here if you fancy joining?

      A :)

  22. Congratulations on articulating the need for some thinking, networking and co-ordinated activity in this area.  I would be very interested to participate in the proposed work and Special Interest Group given my interest, expertise and experience in relational and psychological processes that contribute.

    1. Thanks Craig,

      It would be great to have you involved and hopefully you'll join our specialist interest group when we set it up.

  23. Hello team

    I think this sounds a really interesting project and congratulations on being shortlist. There are some similarities between this and the Yorkshire and Humber Improvement Academy Achieving Behavior Change (ABC) for Patient Safety

    Worth taking a look. I have done the training and put it into practice once and had some very positive results.

    I will join your virtual group because I'm very interested in how this project progresses.



  24. Really excited by the possibilities in this project.  My sense is that it has the potential to help unlock improvement opportunities in areas where we typically struggle to gain traction / operationalise despite lots of good intentions.

  25. Hello

    The key I think is in defining Improvement. How would you measure it?

    Have you considered/used the Behaviour Change Framework and the Behaviour Change Wheel ( COM-B) model by Michie et al.,?  It allows you to systematically identify and select behavour change ''techniques'' that may be most effective in changing an specific behaviour and then allows for evaluation of the behaviour change.




    1. Hi Michaela,

      three of us did a presentation on this just two weeks ago. I find Susan's work so very helpful.

      Have you used it a lot?

      Anna :)

  26. What an excellent project.

    I am interested in being more involved & be delighted to contribute where ever I can be helpful

    I have a Behavioural Science qualification &  background and plenty of QI experience in and outside the NHS.

    1. Thanks Jude, sounds like you would have loads to contribute to the thinking around Psychology 4 Improvement.  We’d like to keep in touch if that’s ok, and it would be great if you would like to be a member of the special interest group when we set it up.

  27. The whole team are really excited to be shortlisted for the Q Exchange this year. This topic is close to our hearts. Also, watch out for a new P4I special interest group we plan to set up soon. Q members join the conversation! looking forward to hearing your ideas...

  28. Hi Rachel, Anna and team,

    This sounds really interesting. I work in the Psychology team at Oxford university, with colleagues working in improvement and in human factors, including at a new centre called Oxford Health Improvement, I'd be interested to hear how things develop and will spread the word amongst my colleagues.


  29. I’d really appreciate being a part of this discussion. No amount of improvement tips, tricks or tools will work without the ability to take people on the journey with you. Understanding the psychology of change is crucial to success.

    1. We’d love to welcome you on board Alison. It’d be great to have your support and ideas. We hope to involve lots of Qs in this work and share our knowledge and skills.

      Thanks Anna

    2. Alison, I absolutely agree with you and it looks like the conversation has already started with some great thoughts and ideas already being posted.

  30. Guest

    Sharon williams 2 years, 10 months ago

    This is a great project and an area that definitely requires further exploration.  Looking forward to see how the conversations and the project develops. Very happy to support in anyway I can.

    1. Thanks Sharon, so pleased you want to join in. We’d love help to spread the word and also to share your ideas about what you’d like to see us develop. We want to get as many Qs involved as possible.

  31. It's great to see this project - not least as it's a topic I think is crucial for successful and transformative QI.

    A Q founder member, Claire Kenwood, and I had actually been talking about getting a blog series going about psychology and improvement and how "the 'soft' stuff is the hard stuff!" We just never had the bandwidth to kick it off...

    She's done great work around Psychological Safety and Relational Coordination - two fabulous ways that the 'soft' stuff is proving to be both crucially important, and actionable. (NB Amy Edmondson has said she'll do a Zoom session with Q on Psychological Safety).

    There's also growing interest in the role of leadership maturity/'vertical' psychological development and quality improvement - it could be both a major blocker and crucial enabler of change. This interest has come from people like Helen Bevan and the NHS Horizons team, the Faculty of Medical Leadership and Management and others. Indeed, Q itself has hosted two Zoom sessions around adult psychological development/leadership maturity and quality improvement - with Prof Sofia Kjellstrom from Jonkoping and Jennifer Garvey Berger. (They'll go up on YouTube at some point).

    I'm not sure if it's psychology or not - but the crucial role of Adaptive/Invisible leadership in enabling innovations in healthcare is at the heart of Prof Mary Uhl-Bien's model:

    And the 'Systems Convening' that Etienne Wenger is finding to be crucial to enabling change across a complex landscape no doubt has many psychological/relational elements to it.

    Both Mary and Etienne have said they'll do Zoom sessions for Q later in the year (a second one for Mary!).

    Etienne and Beverly Wenger are actually coming to the UK to set up a community of practice for 'Systems Conveners' later this year - it's not hosted by the NHS, but I do hope some NHS people will be able to get involved.

    I'm not sure we'll ever get to the collaborative, cross-boundary ICS-world without 'Systems Convening' becoming a recognised discipline!  ;-)

    The Wengers will be writing a handbook on it soon, to try to launch it as a discipline! The NHS should get involved with them, as a case study! And get to start using the tools and approaches asap.



    1. How exciting Matthew!! So pleased you’re keen to get involved and link this up with your other work.

      Thanks for all the helpful links too.

      Thanks Anna

    2. Thanks Matthew, there’s some really interesting stuff here that contributes to our understanding of how the psychological aspects of how we work with each other affects improvement. It would be so great if the Q Community could learn from Amy Edmondson herself!

    3. That s exciting news Matthew, I love Amy Edmondson's fearless organisation and yes your right on vertical development. One of the book I read few months back talked about why charismatic leadership isn't the solution because personalities of a leader is such a random collection, on the other hand, vertical development or 7 stages of adult development of leaders is a linear development which is more predictable vs random nature of charismatic leadership. Loving this idea, psychology of the livewares in the system was not consider in the past and better understanding is the first step to improve. Happy to help whenever I can.


  32. Guest

    Louise Probert 2 years, 10 months ago

    The human side of improvement is fascinating and I really look forward to seeing how this project progress. More than happy to help where I am able.

    1. Thanks so much Louise, we would love you to join us and get involved.

      Thanks so much

      best wishes


  33. I think this is a critical and underdeveloped area of improvement learning - great to see it here!  It may help to bring the our OD and improvement practitioners closer together.  Happy to add perspectives to this, particularly seeing our systems as socio-technical and what this means for creating environments that are more inclusive and more supportive of improvement/innovation.

    1. Dear Liz, we’d be delighted to have your support and to gain from your valuable experience. Please feel to share your ideas and send us any links or resources you think would be helpful.

      Thanks so very much

      best wishes


  34. Fascinated by this, and would love to join in this Q project.  Bring it on!!

    1. We’d love to have you join us Brian! It’d be great to have your knowledge and experience in this area helping us to form the next steps.

      Can you spread the word and let other folk that you think might be interested know about it. We will form a special interest group and connect everyone that way.

      Exciting times!

      speak soon

      best wishes


  35. What about the human side of work as well? A really important aspect of 'standard work' design. It would be good to collaborate with my idea if funded. See

  36. Hi,

    This is a subject I'm keenly interested in. I've an OD background and bringing that into my current improvement role. Happy to get involved.


    1. This is great. Thank you Lisa!

  37. Hi all,

    This looks like and sounds like an excellent project. I have loved seeing this idea grow from an initial conversation into what it is now. Cant wait to see how it develops.

    As always, happy to support :)

    1. Thank you Jonathan, this is great!

  38. What a fantastic idea. I recently facilitated an afternoon with registrars who are a year away from starting consultant jobs, with the theme of relational leadership, connection and influencing. It was really well received and highlighted a huge gap for many of our healthcare professionals, as they develop their careers. Would really love to support this work!

    1. Hi Seema - psychology of change principles can be applied to such a wide variety of settings like your work with senior trainees shows. Speaking to our SpRs in September so would love to hear more detail about what resonated with your group and how you approached this topic which can for many medics seem a bit "fluffy" - we need to make it clear how essential to good leadership understanding on this topic is.

      Speak soon!



  39. This is a great idea! More than happy to help and look forward to conversations to develop this further

    1. Fabulous and thank you Becky!

  40. Guest

    Andrea Davies 2 years, 10 months ago

    Fantastic idea- look forward to conversations to develop these ideas further.

  41. Hi more than happy to help if I can.

    1. Thanks Paul, help to spread the word would be wonderful and we would be so grateful for any ideas.

      Brilliant to have you on board.

      Thanks Anna

  42. Hi all,

    As a Q connector for Wales, Q Exchange connector last year, and behavioural psychology enthusiast, I'd be happy to support this project.

    I've studied some Behavioural economics and drawn into fractal nudging. Very much interested in application of Cynefin and the liminal spaces.

    My colleagues and I have delivered workshops and have the slides I'd be happy to share to put 'behavior change into practice'. A few different versions.

    The Bevan Comission also work with the Psychology department at Bangor University, as I am sure they would be interested too.

    Involving Gareth (already commented) would be a great idea with his approach using HSD.

    Anything I can do to help, give me a shout.




    1. Thanks Andy and Gareth

  43. Hi all,

    This looks like an excellent project...

    Happy to share any info on Human Systems Dynamics if that's helpful (can also share my perspective and experience using Dave Snowden's Cynefin framework and Mary Uhl-Bien's Adaptive Space model) as well as the work I've recently starting doing in leadership development using Marshall Ganz's work...

    All the best, Gareth



    1. Thank you, Gareth!

      This is very thoughtful and generous of you.

      Your Webinar on Human Systems Dynamics was terrific.

      It is also terrific to hear you’ve recently starting doing work in leadership development using Marshall Ganz's work. I’d be really interested to hear more about this.

      I am one of the Coaching Fellows with the IHI’s Leadership and Organising for Change Course (led by Kate Hilton). I therefore have the privilege and joy of seeing, hearing and supporting Health Professionals (across the Four Nations, Europe, Scandinavia and Africa) learn and apply leadership and community organizing knowledge and skills (drawn from the teachings of Ganz) to transform the health care systems and communities in which they live and work.

      Just to echo Anna, could one of us be in touch to find out more?

      Very best wishes,


    2. That would be wonderful Gareth. Thanks so much. Could one of us be in touch to find out more?


  44. Great idea. We had a really interesting webinar on Human Systems Dynamics for the Complexity approaches SIG. We were introduced to their approach to complexity within systems - tapping directly into the psychology/improvement interface.  We had lots of interest in the webinar, so I think your idea would fit well with members growing interest in the human/relational side of improvement

    1. Gareth and Emma, I'm interested especially in your thoughts around complexity and it's relational aspects in terms of quality improvement. Looking forward to taking this conversation further.

  45. Thanks for starting the conversation Isabel - I havent come across this model before.  It would be great if you could share it

    1. Loving the concept of Decency Quotient, good leadership being a combination of IQ + EQ + DQ.

    2. Ah...think the idea of add decency decency quotient to traditional IQ and ED is also worth considering

    3. Hi Rachel just realise I forgot the E, environment in C-Shell

    4. Hi Rachel sorry for the slow response,  this comes from human factors -Culture software hardware liveware (patients) and liveware (practitioners). I really like the model and have also discussed with Andy Ware. I think the livewares, either patient or staff,  can be put in the centre of the model depending on the improvement context. Psychology of change,  behaviour science would support and help us better understand hardwired and acquired human behaviour so the society can be benefited from the potential greatness we all have within and offer without traditional boundaries . Happy to support this idea even I m only a novice on this subject.


  46. How about using the C-SHELL model? It captures the essence of all mechanical and psychological (biological) elements in QI. Embed culture of psychological safety needs to go hand-in-hand so a mix of scientific disciplines - thro' lens of complexity science?

    1. Great idea Isabel. Thanks for sharing. 😊

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