Impact and evaluation

The Q community is a thriving network of people sharing their improvement experiences. We support the community to learn and spread knowledge within and beyond the membership. 

Our theory of change joins the dots. It describes how what we do at Q is expected to enable a culture and practice of improvement which leads to better health and care for people across the UK and Ireland. 

It shows how the activities that we deliver or support create two key outcomes:

1. Thousands of Q members being better equipped to deliver positive change and amplify this impact through their networks.
2. Senior leaders creating better conditions and cultures for improvement and boosting capacity for improvement work across organisations and the health and care system.

If you’d like to be sent an accessible version of our theory of change, please email qcomms@nhsconfed.org

Importantly, our theory of change describes a set of measurable outcomes at individual, organisational and system levels. This helps us to assess the value added by individual activities, as well as the difference we make overall. It informs the choices we make about what we work on and the approach we take to deliver. 

Our theory of change was developed in the early days of the community by reviewing existing evidence and working closely with members. We review and update it periodically, informed by emerging evidence and priorities.

We are committed to monitoring and understanding our impact. We invest in high-quality internal and external evaluation to stay accountable and guide our ongoing development. 

Between 2023–25, we commissioned Picker and their partners to undertake a two-year independent evaluation of our impact. 

Building on earlier work [ref] RAND EUROPE. Strengthening the contribution of improvers to UK health and care? An evaluation of the Q Initiative 2016–2020 [/​ref] [ref] The Q community. Realising Q’s contribution to improving health and care. Impact and learning report. August 2023 [/​ref], this evaluation aimed to provide a precise and granular understanding of Q’s impact and the factors that enable and inhibit it. This was ambitious, especially given the many challenges in evaluating networks like Q. 

The aim of this evaluation was to inform future strategic decisions by understanding: 

• The impact that the Q community and its activities have for individual members, organisations and the wider health care system.
• What factors create this impact and how they interact.
• How could Q’s impact be increased beyond 2025.

Around 700 people fed into this evaluation, including many Q members and senior leaders within the health and care system. A small number of individuals who have engaged with Q activities or considered joining but are not members of Q also contributed their perspectives. 

The data was collected through multiple surveys as well as one-to-one interviews, group workshops and case studies. Data collection took place between July 2023 and February 2025. It was followed by detailed analysis to understand what’s working, for whom, in what context, and why. 

Picker’s work was supported by an Evaluation Advisory Group, chaired by Jennifer Egbunike and which included Q members.

• Q’s perceived impact was strongest at the individual level. For members who reported impact, being part of Q led to increased motivation, skills, knowledge, confidence, a growth in their personal networks and career development. 
• At the organisational and system levels, the perception of impact was more limited and difficult to attribute. Where identified, this impact included: 
  • organisational upskilling, supporting changes in organisational culture and changes in practices when delivering improvement work. 
  • enhanced spread and scale of improvement ideas and innovation across systems, breaking down silos and increasing the visibility of quality improvement. 
• The evaluation identified a number of barriers to engagement, which consequently limit Q’s impact. These barriers often overlap and interact. 
  • Some barriers were due to context, for example an individual’s lack of time and capacity, or organisational culture and lack of support for Q or improvement more generally. 
  • Additional barriers included a perceived focus of Q’s activities and content towards acute care, perceived exclusivity of membership and activities, and technical and communication issues. 
• The events, programmes and services which had the most impact often focused on a theme, provided practical steps and advice for addressing real-world challenges and helped members to collaborate effectively and grow in capability. The deep dive into Q Lab found particularly positive impact. 

This latest evaluation is informing the evolution of our events, programmes and services.