Evaluating the Q Initiative for UK Healthcare Quality Improvement

the health foundation

The Q initiative is led by the Health Foundation and supported and co-funded by NHS Improvement, that aims to connect people working in quality improvement across the healthcare system throughout the UK. During 2015, the first year of Q, the Health Foundation recruited 231 members to join a founding cohort to help design, refine and test the initiative before the wider recruitment process commenced in 2016. As part of this, the Health Foundation appointed RAND Europe to undertake an independent, embedded, real-time evaluation of Q to inform its future design and implementation.

Key Findings

Members of the founding cohort reported a range of views on what quality improvement is, what the barriers to its effectiveness are, and what they expect from Q. Members also expressed a series of benefits and challenges of the initiative.


  • Members of the founding cohort were optimistic that there was benefit to be gained from the creation of a national initiative like Q.
  • Members were positive about their involvement in Q’s founding cohort, especially its impact on connecting them with other participants and developing key aspects of the Initiative.
  • The vast majority of participants who were interviewed stated that they would like to remain involved with Q in some capacity. Overall, the levels of commitment and loyalty expressed by those interviewed at the end were high.


  • Members of the founding cohort reported that they face significant barriers in implementing quality improvement, which was mainly due to lack of time and financial constraints.
  • The large size of the founding cohort made co-design of Q challenging, but did help members buy into it.
  • Members agreed that Q was a promising but unproven initiative. Members of the funding cohort and project team members agreed that Q did not make as much progress during the first phase as might have been hoped.

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