How we’re responding to the independent evaluation of Q

In February 2026 Picker and their partners, Researching People (ResPeo) and Healthcare Priority Solutions (HPS), published findings from their independent evaluation of Q. 

The insights they have generated arrived at a time of change for Q. After 10 years, we moved from The Health Foundation to our new home at the NHS Confederation. The context for Q, as with the wider healthcare sector, is one where funding is being increasingly constrained but the vision we aim for is as important as ever. This means our work needs to be focused, so that we can collectively achieve the greatest possible impact, despite the economic climate.

With learning and improving at the heart of everything we do, we have been actively considering how we adapt to both the evaluation and our new context. This a real opportunity to refresh how we work so that we can maximise our impact going forward.

Here we summarise the key themes and lessons from the report and how we are responding. 

Through the evaluation we heard that some members and others were unclear what Q is here to do. And because an increasing number of our events, programmes and content are now open access some felt unsure who can be part of Q and how they could further benefit by joining. [ref]Recommendation 13 and 17[/ref]

We have now more clearly articulated Q’s vision and purpose so that people in health and care understand how we can help them and the unique contribution that Q can bring to the health sector: 

We have published our vision and purpose on our website, alongside our core areas of work and the four values. These are underpinning everything we do going forward.

Welcoming members and others to our events and groups aligns with our inclusive values and our desire to support and connect with a diverse range of people trying to improve care. In light of the evaluation findings we will refresh and be more explicit about the benefits of membership over the coming months.

The evaluation showed that, for some, being a member of Q adds to their own professional identity and confidence, as an extension of Q’s own reputation for expertise in quality improvement. Their membership also increases the visibility of their improvement work.

With ongoing support from the Health Foundation and partners from across the UK and Ireland in our new home at the NHS Confederation, we plan to continue to build on our reputation while being further embedded in the NHS. 

We are retaining our own identity as the Q community. Our recent move gives us stronger connections to organisations and systems and makes us better placed to influence and support change. We will use our platform and position within the system to raise the voices of our members and help ensure your stories and experiences are heard by decision makers and system leaders.

Some members, and potential members, described our application and assessment process as off-putting, meaning that some people who we’d love to have as part of the Q community haven’t joined. 

We also heard that Q sometimes felt England-centric or wasn’t fully meeting some members’ needs. For example, those who work in primary care or social care, those who bring lived experience, as well as Q members with high levels of improvement experience. 

The evaluation therefore recommended changing our application process and working to increase diversity within Q’s membership.[ref]Recommendation 16[/ref] It also recommended making sure the content we produce and the events and programmes we run better meets the needs of all our members, including those with different levels of improvement experience. [ref]Recommendations 9, 10 and 11[/ref]

We have reviewed our approach to membership with a view to making Q more inclusive and easier to join. We hope to share more on this soon and are grateful to members who have helped us to shape what this will look like going forward. We’re also improving communications for new members to help them make the most of their membership as soon as they join.

We are reviewing how we best meet the needs of the whole community. For example:

• We will continue to operate and support members across England, Wales, Scotland, Ireland and Northern Ireland.  We are refreshing how we will with our partners in each nation to ensure we understand and reflect the needs and priorities in each part of the UK and Ireland. 
• We’re expanding how we support members working in primary care. We already host the primary care online group and have been seeking member experiences so we can gather insights to help influence the future of neighbourhood health.
• We are broadening our focus to support more people with varied skills and welcoming those with experience of a wide range of change, improvement and transformation approaches.
• Involving those with lived experience is essential for ensuring improvement efforts are effective and sustainable. Patient leaders with experience of improvement were part of our founding cohort and are an important part of Q’s membership. These members make key contributions across Q, for example our Q Lab programme, our co-production group, and a range of Q projects. We will continue to advocate for the central importance of fully involving patients in improvement work and will continue to seek opportunities to involve those with lived experience in our own work.

Q has focused on strategic themes to help focus the work we do (e.g. technology and digital; reducing waits; improving across systems). Although these themes were chosen with our partners to be relevant across sectors, the evaluation highlighted that some members felt that some of our content aligned more with the priorities for acute settings, and that if it did not feel relevant, they would stop taking part in Q activities for a period. 

The evaluation also showed us that when our events, content and programmes have a clear topic, offer practical tools and support with real-world challenges, they deliver the most impact. 

The team therefore recommended we make sure our content is relevant to the pressing challenges our members are facing, and balances different needs, including those working in different settings. [ref]Recommendations 15 and 6[/ref]

Some of our events (such as our online workshops and webinars or our local and regional events) were shown to have impact at individual, organisational and system levels. The evaluation suggested that increasing these would increase Q’s overall impact. [ref]Recommendations 1 and 2[/ref]

Reflecting on these insights, going forward:

• Our content and events will continue to respond to sector needs across all five nations. 
• We will ensure our work remains relevant to sector priorities, making the most of connections through our new home. This includes the shift from hospital to community; digital transformation, data and AI; productivity; waiting lists; quality management; cross-system improvement as well as responding to other pressing areas as they emerge. As examples:
  • We are hosting an event with NICE, supporting the shift in diabetes care from treatment to prevention.
  • We’re curating existing insight and evidence on key topics to help members and decision makers. Our recent briefings include: an effective approach to change, innovation to adoption and managing quality during change. We’ve also curated resources and member perspectives on Artificial Intelligence, Maternity, and neighbourhood health.
• We will continue to offer a range of opportunities so members can choose what suits them best. That could mean reading resources on our website in your own time, connecting with other members in our topic-focussed groups, attending webinars and events or taking part in a programme that requires ongoing commitment.

The evaluation showed that Q programmes and activities that offer opportunities to directly collaborate on improvement work have the greatest perceived impact for individuals, organisations and systems. This was clear in some of our most substantial programmes, such as Q Lab and Q Exchange. The evaluation recommended that increasing member collaboration opportunities could help us increase our impact. [ref]Recommendation 8[/ref]

Sharing learning and experience was identified as a key mechanism for delivering impact – this includes between Q members as well as with colleagues and peers. The evaluation therefore recommended encouraging and supporting members to share more. [ref]Recommendations 3 and 12[/ref]

Learning from these key insights, we will be seeking to create more collaboration and sharing opportunities going forward, supporting members to create change.

With Q Lab being one of the programmes we already deliver that offers collaboration opportunities, we are exploring how we can build from this. This already includes:

• Setting up a new Lab with Macmillan Cancer Support
• Creating more spaces and events to support members with practical tools, methods and resources to work through different elements of the Lab process. For example, our regular partnership and skills map events. 

Our community began more than 10 years ago with our 231 founding members. For it to keep thriving, we commit to continuing to create spaces for members, across settings, sectors, roles and hierarchies, to connect and share with each other. We encourage all our members to get involved, sharing their own ideas and experiences too – whether that’s with an opinion piece or a resource for our website, an event for members, or new group discussions on a topic of interest.

To support members to share what they have learned at Q events and programmes with colleagues, we will seek opportunities to create practical takeaways that can easily be passed on, so others can benefit too.

The evaluation highlighted examples of Q’s ultimate impact (i.e. improvements to patient care) from projects that we supported through our funding programmes. The evaluators made some specific recommendations as to improvements that could be made to our collaborative funding programme Q Exchange. [ref]Recommendation 4[/ref]

We are delighted to see the impact that these programmes have had. However, like so many others in the sector, we are now unfortunately operating with a lower level of funding. This means that we will not be able to continue with Q Exchange or Supporting Q Connections grants going forward. 

In light of our new financial position, we are considering different ways to build on what we have learnt from the programmes we have run to date and how we may best support our members to have impact in the future. 

We will continue to share learnings and examples from the work we have supported and funded to help spread knowledge and experience that others may benefit from. 

By working in partnership with others, we’re also creating new opportunities for members to apply for funding for their work, such as the Lab we are delivering with Macmillan Cancer Support. We’re also continuing to advocate for the resources needed to support improvement work through our influencing and thought leadership work. 

The report highlighted a need to improve how we share information and opportunities with members as well as greater clarity on the purpose and value of our programmes, events and services. The evaluation recommended improvements to our website and a refresh to our communications approach, to make things timely and relevant for members and other stakeholders. [ref]Recommendations 7, 14 and 18[/ref]

We know that our old website was very difficult to navigate – we’d heard feedback on this previously and were already taking strides forward while the evaluation was ongoing. We co-designed our current website with members and launched it at the end of 2024. 

The new website also brings new technology for our Q groups, allowing members to connect and collaborate. Members can control discussion forum notifications according to their own preference – real time, daily, weekly or not at all.

Redesigning our website and group spaces was just the first step. We know there’s more we can improve and we’ll keep listening to our members to make it better. We regularly share opportunities for members to take part in user testing so that we can learn what changes we need to make next.

We also plan to create a new communications strategy. We’ll be doing this once we’ve confirmed our new approach to membership and clarified the different activities and opportunities we’ll offer to our members going forward, so that we can factor this in.

Currently, the culture and conditions in many organisations present a key barrier for improvement work to thrive. Members are often juggling many different demands on their time and attention. If their organisation perceives improvement work as a luxury, members can struggle to prioritise time and energy to engage with Q. 

The evaluation highlighted that Q provides members with connections and skills, and that some members value what they gain sufficiently to share with their colleagues. However, the wider culture and conditions in their workplaces can limit the impact that this knowledge sharing can produce. 

The evaluators therefore recommended we undertake further work with senior leaders to shift organisational culture and made specific recommendations to help us learn from our 2024 Learning and Improving Across Systems peer learning programme. [ref]Recommendations 19 and 5[/ref]

They also recommended work to influence policymakers to help create the right conditions for improvement efforts to flourish. [ref]Recommendation 20[/ref]

In recent years Q has broadened its activities to include programmes specifically for senior leaders – that includes our Learning and Improving Across Systems programme (co-delivered with the NHS Confederation); Provider collaboratives: Improving equitably (with NHS Providers); our National Improvement Leaders programme, as well as support for board development. Some of this work was in its infancy during the evaluation. 

We will continue to create bespoke programmes and content for senior leaders across health and care, helping them to create the conditions in their own organisations and systems that enable change and transformation: 

• We’ve built on the learning from our first programme with NHS Confederation, and are now co-delivering our system improvement support – a new tailored opportunity for health and care leaders and their teams, helping them transform services and achieve sustainable cross-system improvements. 
• We remain committed to our work across all the UK and Ireland. This includes continuing to invest in and develop our National Improvement Leaders programme. It brings together national leaders in the UK and Ireland to develop shared insights and strategies for influencing and embedding improvement at a system level and across nations. 

Over the last year we have leveraged our position as being both ​‘of the sector’ and independent, to elevate member experience and make the case for improvement to be embedded in policies and practice, at a time of change for all our nations. 

We will continue to seek insight and experience from our members and use this to influence policy makers and leaders across organisations and systems. We will build on our work to date sharing what we’re hearing from our members, amplifying our members’ voice and experience, and exemplifying the culture and conditions needed for improvement. This could include activities such as: 

• Convening members for workshops and roundtables around policy challenges (such as the implementation of the 10 Year Health Plan and the upcoming quality strategy);
• Synthesising learnings from our programme participants;
• Publishing case studies or using our regular podcast to showcase best practice and key lessons;
• Presenting at national events;
• Seeking opportunities to directly engage decision-makers. 

Our partnerships with the NHS Confederation and NHS Providers have created many opportunities to strengthen this aspect of our work and we look forward to taking this further now we are together in one organisation. We are actively seeking further projects and opportunities to influence the culture and conditions across organisations, systems and the sector as a whole.

The evaluation team’s final recommendation was to further embed monitoring within Q’s activities so that we can evaluate rapidly and assess changes over time. [ref]Recommendation 21[/ref]

With learning as one of Q’s core values, we have invested heavily in evaluation since our inception. We have recently reviewed our approach to ongoing evaluation to make sure it provides timely insights on our work and is meaningful and proportionate for participants to engage in. This will include rapid monitoring across Q’s activities and, where budgets allow, more substantial evaluation of some of our newer programmes, services or events.

With such a large evaluation there’s lots to consider, learn from and adapt to. We hope this page explains where we’ve already made progress and where there’s more for us to do. We will keep drawing on this evaluation and member feedback as we design and iterate our future programmes and services. 

With the health system continually evolving around us (and exciting changes in our host organisation, following NHS Confederation’s merger with NHS Providers), we’ll keep this insight in the forefront of our minds as we consider how best to apply the learnings in our ever-changing context. 

We appreciate your support as we continue to adapt so that we can best meet the needs of our members and the sector as a whole.