The power of Q – hear from three community members

Dan Beale-Cocks, Expert by Lived Experience, West of England

For me, improvement involves an ongoing process of small changes. You keep doing what works. You stop doing the things that don’t work. And you share your learning.

Service-user involvement in improvement is crucial. I’ve used a few services over the years, and I find it weird that no one ever sat me down and asked ‘If you could design a service, what would it look like?’ Instead, I’ve been expected to fit my entire life into their service-shaped hole.

Q was recommended to me by a colleague. It sounded like an opportunity to learn more about quality improvement alongside a wide range of people. All my previous experience was with statutory mental health services in England.

I was involved with the first Q Lab, which asked ‘What would it take to make peer support available to all who need it?’ It’s tricky to balance ‘freedom to create the thing’ with ‘guidance about how to create the thing’. I think staff facilitating the event got the balance right, making sure the workshop sessions were structured enough to produce something useful, but free enough for people with diverse experience to provide innovative ideas.

I find it very hard to talk to people, and the idea of ‘making connections’ fills me with creeping dread. Despite this, through Q I’ve been able to talk about ideas with people who are doing interesting work locally. 

My priorities for future work are learning from deaths – especially around suicide prevention – and making coproduction a core part of people’s work at all levels of their organisation. Q has given me some tools for creative problem solving and skills in presenting ideas to different audiences. 

Dominique Bird, Head of Capacity and Capability, 1000 Lives Improvement, Public Health Wales

Improvement is about patients and professionals working together to bridge the gap between where we are now and what is possible, using various structured methods. I’m particularly interested in two areas: how we connect, across professional groups, organisations and sectors; and how we use the power of patients through shared decision-making.

The real strength of Q is in its diversity. Q spans specialties and sectors, it’s UK-wide and it feels like more of a movement than a top-down structure. People join because they feel passionate and want to connect and collaborate with others. That’s a real power in this because we can sometimes find more in common as individuals than organisations.

Overall, I think our efforts are best focused on prevention and population health. Improvement can add a lot to that – focusing upstream [looking earlier in the progression of needs, to prevention and earlier intervention], across mental and physical health. In Wales we’re starting to focus on communities, through community assets or footprints, spanning all sectors, including education, housing, and environment factors. That’s where we can have the biggest power, and improvement can have a huge impact on bringing those sectors – including the third sector – together. 

Through Q, I’ve made connections with people in similar roles in parts of the UK facing similar challenges so we don’t have to reinvent the wheel. I’ve also adopted facilitative approaches, tools and techniques that I’ve learned at the events. In the future, I’d like to see the Q community become a collective voice to advise on areas of challenge and inform research ideas. 

Dr Mark Vignesha Roberts MPH FRCP, Clinical Director, HSC Safety Forum, Public Health Agency, Northern Ireland 

To me, improvement is more an attitude than a science – being continually open to doing things differently and better, and embracing change rather than fearing it. It’s also about enfranchising common sense in a methodological way, to provide clarity to what can sometimes seem insurmountable, complex problems. 

I work half-time as a physician and half-time as the clinical director for our regional improvement body, so I like trying to make improvement tools as democratic and accessible to people working at the front line as possible, but also stepping back to look at the effect of systems on culture.  

Initially, I was a bit hesitant about joining the Q community but I’ve been encouraged by its spirit of inclusiveness. In Northern Ireland, we need outward connections – with colleagues in the Republic of Ireland, Scotland, England and Wales – to make sure we are correctly confident of what we are doing well and aware of areas we need to improve on. I’ve already used some of the Q offered tools, such as TRIZ – a playful approach that encourages you to think what ‘terrible’ would look like and then identify elements of that in your own service or organisation.

One of the big challenges for improvement is to broaden its appeal and relevance. In the next 10–15 years I’d love to see the most sober leaders, such as the finance directors, routinely asking ‘How can we use improvement methods to address this problem?’