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Q Exchange enables people to develop and refine funding proposals with input from other knowledgeable improvers across the UK. It is piloting a radically more transparent and participative process than most other grant giving programmes.

The Q co-design process felt tough but also exhilarating

People seem to be really inspired by this, with lots of great comments appearing within a few days of the first project ideas going up. The vast majority are positive, with people pointing out where they are doing similar work and ‘competing’ bidders reaching out to each other to share reflections.  And there are some comments that are suggesting how the ideas could be improved.

Whilst it’s easy to agree that two heads (or even a whole community of heads!) are better than one, it can still be hard to take on board comments that are challenging. The experience of leading the co-design of Q taught me a lot about that, and I thought it might be timely to share some reflections.

The co-design of Q: probably the largest example of co-design in the history of healthcare improvement

The initial co-design phase of Q was hugely valuable, yet it was also often challenging for the team and probably the most professionally risky and exposing thing I’ve done. Over six months, we invited over 50 organisations and our 231-member founding cohort to co-develop and give feedback on every part of what we were proposing.  And people didn’t hold back – we collected thousands of post-its, survey responses and participated in passionate discussions, often played out publicly and often telling us contradictory things.  We also have our evaluators embedded in the team, explicitly encouraged to critique what we were doing.

Two years on, my commitment to collaborative development of ideas is as strong as ever, and we’ve accumulated a range of methods for doing this well [see Creative Approaches to Problem Solving toolkit and Liberating Structures in healthcare Q special interest group]. I’ve also got better at responding to critical or unhelpful comments and I’ve reflected on how to understand and make best use of such feedback.

Three ways to get the best from large-scale co-design and feedback processes 

  1. Make space to reflect on what you’re hearing 
    It’s natural to become very personally attached to your idea and so react strongly to feedback you receive. We found it helpful to create space as a project team to make sense of what we were hearing. Pay attention to how you’re responding emotionally as well as intellectually, as this can give you signals about what’s really important to you.It can be hard to receive comments where people misunderstand what you’re planning and harder still when they manage to put their finger on fundamental flaws or contradictions in what’s proposed.  At those moments, I often feel embarrassed not to have seen it beforehand.  Especially when the idea put forward is one you’ve developed with others, the urge to defend and avoid exposing your partners can be particularly strong.Yet, how you respond to comments will set the tone and influence whether others will give you their thoughts.  How do you make sure you make the most of the opportunity and avoid being defensive?
  2. Reflect on what sits behind the comments you receive
    Keep in mind that people give feedback in different ways and this is often influenced by the norms of their profession.  To generalise, I’ve noticed that clinicians and academics, for example, often show their engagement in an idea through more forceful critique than would feel culturally normal in other sectors.  Patient leaders, many of whom find themselves marginalised in other discussions, may adopt an adversarial tone that can be confusing without appreciating their context.Words mean different things in different quarters of the wonderfully diverse Q community.  Especially in an online environment, the tone and nuance can be lost in translation.
  3. Be open and appreciative, but not afraid to be selective
    In large-scale collaborative processes, project owners get lots of suggestions, including many from people who are relatively distant from the content, and have had little time to think through their input. Sometimes, these fresh perspectives are gold dust – but there will also be other inputs that don’t add a lot to your thinking. Sometimes we hope to find people who are the perfect collaborators, but we may also get invitations to work together that stretch beyond what we can authentically embrace. To my mind, the ideal is to engage thoughtfully with whatever feedback and opportunities you receive, but allow yourself to dismiss some things or use them as a springboard for a further creative development in your idea, rather than feeling you need to adapt what you’re proposing in line with every comment.To help maximise the change of getting useful contributions, we encourage bidders to spell out the types of input they would find useful. We have also developed this guide to help people contribute in fruitful ways.

Q Exchange: developing ideas for success in a multi-stakeholder world

The Q Exchange process encourages bidders to respond well to feedback and show their ideas developing in response. We haven’t just designed it in this way for the sake of it: we’re trying to create a space that aligns with what’s needed in the real world so people aren’t just doing work to feed the process and get funding.

Especially working as we do in complex multi-professional systems, evidence suggests that projects often fail to gain traction because they make perfect sense to the group who originally developed the concept, but don’t work for others who need to participate to make it successful.  Whether feedback changes your approach fundamentally or helps you communicate your idea better, we hope getting early input from many quarters will help set projects up for successful delivery – and wider uptake.

What I hope you’ll take from this blog, is that the team managing this process (and the wider Q community) understand the relational complexities involved with inviting honest critique.  This process is not aiming to find the perfect projects about which nobody has anything bad to say – many of the best ideas may be controversial. Those of us shortlisting recognise the trade-offs you’ll be balancing and look well on people engaging with the feedback they receive without expecting you to agree with it all.  We’re confident the Q members making the decision about who gets funding will appreciate that too.

The Q co-design process felt tough but also exhilarating. Our up-front commitment to stress testing ideas is still giving back. We also built a lot of momentum and credibility thanks to the story we can tell of an initiative built with input from many people from different backgrounds.  How much further might your idea go by coming through this process?

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