What is the Q Improvement Lab?

In 2017, the Health Foundation and NHS Improvement launched the Q Improvement Lab (Q Lab) – an initiative working across the UK to test a bold new approach to making progress on health and care challenges.

The video below gives a summary of the Q Lab:

Behind the headline challenges facing health and care – such as winter pressures, workforce issues and meeting the needs of an ageing population – lie many layers of other, knotty issues. These include issues such as considering how to develop genuinely shared medical records, design new services that are environmentally sustainable, or support vulnerable people to live at home for as long as possible.  Thousands of people across the health and care system are grappling with these challenges that have many moving parts, making it hard to understand their causes and how best to solve them. The complexity of health and care means that there are rarely single solutions that can be easily identified and rolled out.

The health and care system has a wealth of assets from which to draw: knowledge, expertise, evidence and examples of effective practice. But those in the midst of tackling tricky issues often lack the time and space to fully review what’s already known and what might be possible. Trying to solve similar challenges in relative isolation, making sense of interventions that need local adaption and balancing the views of many different people who have a stake in any change – it’s easy to see how progress can stall. In the context of financial constraints, rising demand for services and changing demographics, new approaches are needed to ensure that all those involved in health and social care can make the best use of the resources and ideas available to improve services for people in the UK.

The Q Lab is an exciting opportunity to bring together organisations and individuals, to pool what is known and uncover new insights and ideas on challenges that many face.

For change to happen at scale we believe people need to be equipped not only with a rounded understanding of the issue at hand, but with skills, connections and opportunities for applying insights and testing ideas in practice. The Q Lab builds momentum through a participatory, creative and purposeful 12-month process to achieve this.

This essay gives an overview of what the Q Lab initiative is and our journey through the first project which explored what it would take for peer support to be more widely available.

As an introduction to the Q Lab, this essay is a good starting point before going on to read the other essays in this collection.

Designing the Q Improvement Lab

The idea for the Q Lab emerged from work to understand what would be genuinely helpful to those seeking to improve health and care. Q – a community of people with experience and expertise in improving health and care – has grown from a concept to over 2,000 members over the last three years, bringing people together to share ideas, enhance skills and collaborate. During Q’s co-design phase in 2015 the idea for the Q Lab surfaced as a way of bringing together both Q members and others to work on specific, shared challenges.

We drew inspiration from the growing number of ‘innovation labs’ that use a variety of creative techniques from different disciplines to make progress on complex social issues.1 Drawing on that learning, and the heritage of improvement methods that are well established in the UK health care system, we worked with Q members to develop what a ‘Q Improvement Lab’ could look like.

Features of the Q Improvement Lab

Through the design process, core features of the Lab were developed. These are characteristics that have  shaped the Lab’s activities throughout the first project.

• Working collaboratively: The Lab works across geographical, organisational and professional boundaries to bring together a diverse set of people with relevant experience and expertise. Those who collaborate with the Lab are well placed to adapt and apply the insights and ideas that they themselves have helped to create.
• Creating spaces: The Lab creates the conditions for people to explore data, evidence, lived experience and real world examples. Together with Lab participants and partners, that insight is used to test ways in which we can make progress on the topic. This can happen face-to-face (for example, at thoughtfully designed workshops) and online (for example, through an online group). Whether face-to-face or online, attention is given to designing spaces that support inclusivity and creativity and have a productive mix of structure and flexibility.

As a workshop participant, I have a lot of freedom about my participation… If you’ve only experienced consultation style involvement you may find the freedom mildly disconcerting at first. But as the workshop progresses you’ll appreciate this freedom. You’ll see your contributions in the product, and you’ll know that you haven’t been pushed into agreeing with something that you disagree with

Lab participant

January 2018

• Drawing on a range of approaches and tools: Using approaches from quality improvement, and disciplines such as social innovation and design, means that we use methods that are best suited to the outcome that we are trying to achieve.
• Developing skills and connections: Through accessing new  information, methods and connections, Lab participants are well equipped to not only apply learning from the Lab process, but use those skills in other complex challenges they encounter.
• Working at pace: Although the challenges that the Lab focuses on are complex, we work at pace and build up momentum for change. It is easy for something to appear so complicated that either nothing happens or we over-simplify the situation and miss vital parts of the puzzle. The Lab aims to develop a shared understanding and find opportunities for iterative testing and improvement so that we can move forward and make progress on the topic.
• Thinking about scale from the outset: We draw on principles from the latest research about how ideas can be best shared, adapted and adopted and design those approaches into our ways of working2 . The learning is shared with those in health and care looking at how innovation spreads to contribute to developing that research further.

The ‘Ways of working’ essay (to be published October 2018) discusses these features in more detail and what we learned from doing them.

The first project: What the Q Improvement Lab did

Starting in April 2017, the first project explored what it would take for effective peer support to be more widely available, to help people manage their long-term health and wellbeing needs. The topic for the pilot project was chosen with the Q community.

While the first project is on peer support, the Lab has been designed to work on a range of topics in health and care and so future Lab projects will focus on different challenges.

The Lab broadly works through three phases of work:

1. Research and discovery: Investing time upfront – drawing on the best evidence and bringing new voices and perspectives to bear – to dig deep and understand the root causes of the challenge.
2. Developing and testing ideas: Using the findings from the ‘research and discovery’ phase to pinpoint key opportunities for impact and create momentum for change. This may involve developing a new idea and testing it with Lab participants, or through other vehicles, such as Q Exchange. Alternatively, there may be an idea that is already in development where the Lab can help speed up the pace and move it on to be scoped, tested and adopted.
3. Distilling and sharing learning: Collating what the Lab has learned and how the new insights can be practically applied. Learning is shared widely and people and organisations are supported to adapt and adopt insights and ideas.

For the peer support project, each of the three phases consisted of various activities, methods and approaches, including ethnographic interviews, workshops and data analysis to name but a few. Below is a Lab timeline which gives a broad account of what we did during the first project and when.

Who the Q Improvement Lab worked with

• The Lab team: The Lab is led and facilitated by a core team – seven  people based in King’s Cross, London, with varied expertise, an understanding of the health landscape and an ability to use a range of different methods.
• Lab participants: People with varied backgrounds and expertise in peer support, and health and care more broadly, who volunteered to collaborate and get involved in the Lab.

• The Q Community: A UK-wide community of thousands, with expertise and experience in improving health and care, that helped design the Lab. Q members participate and help to share widely the learning that emerges.
• Funders and partners: The Q Lab is led by the Health Foundation and co-funded by NHS Improvement, both of which have extensive knowledge, networks and expertise that we use and build on.
• Other experts: Exploring a problem from multiple perspectives requires a diverse range of skills, some of which we develop within the Lab team, and others we bring in as needed. For example, Christina Pagel, a mathematician at University College London, supported the design and analysis of our survey on decision making in peer support.

The ‘Ways of working’ essay will include further details on how we engaged and worked with Lab participants (to be published October 2018).

What the Q Improvement Lab wants to achieve

Through the first project – which was supported by an independent evaluation led by RAND Europe – our understanding of what we think the Lab can achieve has been refined. As explored more fully in the Impact that counts essay, the Lab seeks to enable change by:

• developing a deep and rounded understanding of key challenges and opportunities in a topic area
• generating ideas with potential to catalyse improvement
• equipping people with enhanced understanding, skills and connections to translate ideas into action
• sharing ideas widely, nationally and locally

We have seen promising, early signs of success during the first project. One example is ending the project with a diverse group of 200 Lab participants who contributed time and energy to a pilot project that was testing a new approach and way of doing things. Lab participants have also rated their experience very positively.

I have found the Q Labs on peer support to be a useful, valuable, experience. I can point to things that I’ve taken away from the Q Lab and talked about locally, and I can point to things in the Q Lab that came from me

Lab participant

January 2018

There are examples of Lab participants making new connections, some of which have already seeded joint projects. The online group is increasingly active; its 102 members (and growing) are sharing learning and asking for advice and information from one another.

The Lab’s learning is already being used as Q members improve their peer support project proposals for Q Exchange. New insights have also been generated from a large scale survey on how people make decisions on peer support.

Finally, as a result of this first Lab project a grant has been awarded to support the development of a new Evidence Hub for peer support – an idea developed during the Lab process in collaboration with the charities National Voices, Mind and Positively UK.

However, the true test of the Lab’s impact will be long-term. Although the peer support project officially ended in April 2018, Lab participants applying the learning, taking forward their ideas and using their new collaborations will take place over many months beyond the lifespan of the project. The Lab’s impact will also be enhanced as the team itself adapts, improves and explores how the Lab can feed into other vehicles for implementing change.

The first project was a pilot and so we have learned a lot about what worked well and what we need to improve on (we delve in to this in the Learning from the Lab’s approach to evaluation essay and the Ways of working essay which will be published in October 2018). This learning will be applied to future projects and will be shared with the Q Community and others.

The Future

The Q Lab has funding to run a second Lab project, starting in September 2018 with a partner organisation.

The long-term ambition is to set up a small network of Labs across the UK.

Next steps

• Discover what we learned about peer support during the Lab process in the Learning and insights on peer support essay.
• Learn new insights about peer support as a result of our large-scale survey in the How do people make decisions in peer support? essay.
• Connect with others who were involved in the Lab and join the online group 
• Know someone who might be interested in this essay? Share it!