By Yvonne Sawbridge, Senior Fellow, University of Birmingham Health Services Management Centre

Q is an initiative, led by the Health Foundation and supported and co-funded by NHS England, connecting people skilled in improvement across the UK. Q will make it easier for people with expertise in improvement to share ideas, enhance their skills and make changes that bring tangible improvements in health and care.

At our second design workshop in Glasgow in September, this was the question the founding cohort of Q were all asking. Whilst we reflected on our mission statement, and reviewed our approach/theory of change in terms of HOW we might develop this initiative, there were a range of views about WHAT it could be. How could we describe it to those not there in the room? A network of connected communities, with a shared purpose of improvement; a repository of skills, tools resources and expertise; a think-tank to test ideas, or none of the above?

There was no shortage of enthusiasm and energy for the strategic aim- a response to Berwick’s report (2013) calling for the NHS to become a learning organisation with quality improvement embedded into processes and patient safety a clear focus. What we were all grappling with was describing exactly how we could contribute to this agenda as a collective community, in a meaningful way.

At some stage in the discussion I began to frame the approach using Gladwell’s “Tipping Point” (2001) as my point of reference. I recalled his description of the three agents of change: “the law of the few; the stickiness factor and the power of context” and this began to help me with my own sense-making.

“The law of the few” describes the need to have a collection of three types of people engaged in the endeavour. Connectors- those who know an amazing number of people and can make connections for many others (“the social glue”); Mavens- have all the facts, figures and information on the topic at hand (“the data banks”)and the salesmen with the skills of persuasion. They don’t need to possess or exert hierarchical power rather a command of high level inter-personal skills and oodles of influence.

I met all three types of people in the workgroups, on tables and in breaks- with the connectors being the most visible- I had so many speed dates I was exhausted!

“The stickiness factor” relates to the message itself, and the way it is presented. For me, this is the part of the initiative which we are clearly co-designing, and grappling with to achieve a coherent message, if not consensus. This is work in progress.

Finally comes “the power of context. If post Francis; post Winterbourne and any other recent care failings, we are not able to create the right context and focus on improving patient care, then when will we? However the tension between the financial constraints; performance pressures and quality are real and the Q community are no idealists. Managing to address this as part of the initiative is a given- and one that will take some careful thinking and testing.

So - what IS  Q? We are continuing to explore this at the third design event in November, ahead of wider recruitment of next year.

Watch this space….


Berwick, D. (2013) A promise to learn-a commitment to act. London.

Gladwell, M. (2001) The tipping point -- how little things can make a big difference. Abacus.  London.

This was first published on the Health Foundation website