The Q health framework

Developed to support leaders in planning and delivering large-scale improvements across health systems, this framework (image accompanying this post; Q, 2024) was a collaboration with a broad range of British medical sector leaders.

The framework falls into two halves: the first half is focused on sustainable development and creating the conditions for a sound health/wellness system; the second half is on how that service should be delivered, via service and outcome transformation. Within each half are thee sets of activities: collective vision and leadership; an aligned operating model; capability, connections and culture in the sustainable development half. In the service and outcome transformation half there is: system and pathway redesign; continuous quality improvement; and targeted innovation. Around these six activities are 18 key considerations which all stakeholders must address for this type of system change to work and to stick (Q, 2024). They are:

• Co-creating a vision and narrative for change
• Building leadership support
• Understanding together the nature of the system
• Engaging with all partners and communities
• Redesigning management systems to enable improvement 
• Aligning resources and incentives
• Agreeing priorities and mediating expectations
• Developing goals and the ability to measure progress
• Enabling productive cross-silo connections and reflections
• Creating collaborative learning habits and structures
• Building skills and space for everyone involved in the change

And in the second half:

• Understanding the context, needs and assets of those served
• Diagnosing and redesigning end to end pathways and service models
• Delivering multi-strand 'transformation' programmes
• Incrementally improving hundreds of processes with service users
• Adapting roles, ways of working, metrics and linked systems
• Ongoing monitoring, adaptation and control of service performance
• Testing, experimenting, scaling and embedding innovations
• identifying priority gaps and/or innovations
• Understanding the current situation and desired futures

In order to create the right conditions, the framework emphasises building a collective vision, prioritising transformation efforts, and developing sustainable change through culture and capabilities. These elements rely heavily on engagement with partners and communities, shared understanding, and strong leadership support across organisations (Q, 2024). The delivery aspects focus on three key areas: system redesign, continuous improvement, and targeted innovation. These require deep understanding of local context and population needs, iterative testing with real-time data, and identifying promising innovations that can be scaled effectively across systems. This will need programmes combining pathway redesign with changes to funding, IT, and infrastructure. Tools for reviewing and planning large-scale change is built into the system. This is not easy work, but will require investment over multiple years, and a government committed to making change. I am not sure than any government on the planet is realistically in that space right now... and as for making cross-party long term funding commitments... well. I think that too is a wait and see thing.

The framework is a partnership between the Health Foundation, the Q community, and NHS Confederation. It will be nice if it works, and if the UK government actually fund it and back it. 

Sam

References:

Q. (2024, August 29). Improving across health and care systems: a framework. Q, The Health Foundation. https://q.health.org.uk/resources/improving-across-health-and-care-systems-a-framework