Proposal for Q improvement labs

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Purpose of this document

This document sets out early plans for a new way of supporting health care professionals to tackle complex problems in health care: Q improvement labs.

Q is an initiative connecting people with improvement expertise across the UK. The Q community is made up of a diverse range of people including people at the front line of health and social care, patient leaders, managers, researchers, policymakers and others.

Q’s mission is to foster continuous and sustainable improvement in health and care. To achieve this, we are creating opportunities for people to come together and form a community – sharing ideas, enhancing skills and collaborating on improvement projects.

An ambitious and exciting idea – Q improvement labs - was generated within the collaborative design process for Q. The Q improvement lab concept is an attempt to find new ways to collaborate on complex, systemic issues that affect multiple parts of the health sector. The ideas for Q improvement labs are at an early stage. If labs progress, they can offer a space, whether physical, virtual or both, to bring members and others together to work on such problems.

This document sets out the story so far in their development and the next steps. A number of design questions have been identified and these will form the basis for further conversations and research over the coming months to establish if there is a strong case to progress Q improvement labs. If so, a business case will be developed and funding will be sought for a pilot lab to test the idea in practice.

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Contents

Introduction The Q initiativeQ improvement labs

What is an improvement lab? The seed of an ideaLearning from other labsImplementation focus in Q improvement labs

The development of ideas for Q improvement labs Design events with Q participantsEmerging principles

Design questions

Next steps

Appendix 1

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The Q initiative

Right now thousands of people across the UK are working to improve health and health care. Some are leading large-scale improvement initiatives spanning multiple organisations with major financial investment. Others are making small, regular changes to practice in a single team. Many improvers are enrolled in taught courses to develop skills and knowledge about improvement techniques and many more are learning on the job. For years we have known that successful improvement work is happening all over the UK. We have also known that more often than not, improvements are happening in isolation with problems being solved one organisation at a time.

Into this environment the Q initiative emerged. Q is being led by the Health Foundation and co-funded by NHS Improvement.

Q is a long-term initiative aiming to support individuals and their improvement work. Through this, Q benefits members’ employing organisations and the populations they serve. It has been designed to complement and enhance other initiatives and networks. People in the community pool together their knowledge, insights and connections – encouraging collaborative ways of making improvements.

The community is growing – over the coming years we envisage Q will become a community of thousands of people. There is no membership fee to join. People in the community have the flexibility to commit and participate in ways that fit with how they work and which best benefit their improvement work.

It is not a taught programme, but a learning network of support for those already knowledgeable in and undertaking improvement work. The model for Q was designed with 231 founding members during 2015. This has helped ensure Q is genuinely helpful to the diverse range of people leading improvement. Q will continue to evolve – being shaped as the community grows.

The hypothesis underpinning Q is that there are huge opportunities that could be realised by connecting those people who are working on improvement initiatives across the health sector, making it easier for them to learn from and support one another.

Introduction

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Introduction | The Q initiative

The Q community is made of up a diverse range of people including people at the front line of health and social care, patient leaders, managers, researchers, policymakers and others. This boosts the power of Q as a source of innovation and practical problem solving with a wide range of perspectives. Where there are existing networks, Q will complement these, providing long-term connections across the whole of the UK and, in time, with international organisations and agencies.

PeripheralThere can be limited time, space, resources and support to conduct effective improvement work. Rarely is improvement seen as part of the day job.

FragmentedImprovement work is often done in pockets of localised activity. Many groups and individuals are working on similar problems, repeating mistakes and reinventing the same solutions.

ExpertiseMany people working in improvement would benefit from further development and connections. A survey with Q members in July 2015 showed that only 58% believe they have all the skills and knowledge needed for the improvement work that they would like to do.

TurbulentOrganisational structures and individuals’ employment base can change often, disrupting progress and connections between collaborators.

Rate and scaleimprovement often happens at a slow pace and/or is not spread or sustained. The Q founding cohort cite a pressing need to build the quality improvement capabilities of front-line teams.

InvisibleImprovement work often carries on unseen, and it can be hard to identify potential collaborators and sources of expertise and knowledge. A survey with Q members in July 2015 showed that only 46% find it easy to access the information and/or resources they need to improve the quality of care.

Challenges facing efforts to improve

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Q improvements labs

Through the process of co-designing Q an exciting, ambitious, idea emerged. The community, and others, felt there was an opportunity to capitalise on the collective expertise of members to make progress on complex, system wide issues – challenges that require innovation and coordination across the system (beyond single teams or organisations).

The idea for Q improvement labs is based on our early hypothesis that by bringing people together to work on a complex but bounded problem, creating space to work on the problem, and supporting their work with insight and analysis from topic experts and a small labs team, real progress could be made to spread and sustain improvements in health and care. We know that the story of improvement in health and care in the UK is complex. There are multiple hard-to-control factors influencing which ideas are adopted and implemented across the system. 1 Q improvement labs will not be the ‘silver bullet’ to fix all problems. However, our early research and indications from an independent evaluation of Q conducted by RAND Europe suggest there are some promising signs that labs could make a difference to how innovation and improvement is socialised, generated and spread across the health and care sector.

1 Berwick, D. Disseminating Innovations in Healthcare. Journal of the American Medical Association. 2003; 289(15): 1969-1975

Introduction | Q improvement labs

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The seed of an idea

We are currently witnessing something of a global trend in the public sector – the proliferation of ‘labs’ aiming to generate innovation and change to make progress on intractable challenges. These labs are attractive – bringing people together with a range of skills and creating protected time and space to work collaboratively and creatively on issues that require system-level coordination. They adopt a highly inclusive way of working and are philosophically different to the ‘command and control’ way of doing things which has traditionally been prevalent in public services. 2

In the context of Q, we landed on the term ‘lab’ for our initial ideas from early conversations about bringing together a number of different ingredients for success. During the co-design events held in 2015, the idea of ‘Q improvement labs’ was tested with the founding Q members. We discussed what labs could be and do, and simulated a ‘lab-like’ workshop with members (a mini prototype).

Early feedback suggested there was strong support among members for exploring the idea further. 3 Following this we have been exploring how labs work in other sectors and gathering intelligence to design something that could work for Q.

2 Twitter, 17 June 2016. Available from: https://twitter.com/La27eregion/status/743718645533007872 (At a recent conference among the ‘labs’ community of practice, a French public service innovation lab leader described the lab theoretical mind-set as a blend of ‘pragmatism, empowerment, evidence-based policy, serendipity and abductive reasoning’). 3 Uscreates’ report on Q Improvement Labs for further background on prototyping the lab proposition with Q members. Available to read on request.

What is an improvement lab?

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Learning from other labs

Systematic learning from labs in other sectors is difficult. This is partly because of their newness and emergence: the majority of the hundreds of labs that exist worldwide are no more than a few years old, and therefore evidence on sustained impact is still sparse. Labs represent a community in the process of forming and defining itself and there is no definitive list of labs.

There is no established orthodoxy, or neat definition, of exactly what a lab is. The term is applied to a plethora of processes and organisations, often with quite different goals and employing distinct methods and approaches.

There do however appear to be some defining features that make a lab a lab. Nesta have characterised labs as ‘prototyping the future’.4 Frances Westley et al from the Waterloo Institute for Social Innovation and Resilience (WISR) describe labs as:

‘offer[ing] a place for creative, cross sector and cross disciplinary decision making and innovation. The process is supported by careful design and facilitation and is resourced by research geared to the decision makers’ need. The focus is on those “wicked problems” that seem insoluble.’ 5

When thinking about how labs tackle these wicked 6 problems there are clear variations from lab to lab in terms of the specific methodologies or tools used. However, Westley has compiled a list of defining characteristics that successful labs have in place, which we paraphrase on the following page.

4 Nesta. World of Labs. Webpage. 2015. Available from: http://www.nesta.org.uk/blog/world-labs5 Westley F, Goebey S, Robinson K. Change lab / Design Lab for Social Innovation. Waterloo Institute of Social Innovatoin and Resilience. 2012. Available from: http://sigeneration.ca/documents/Paper_FINAL_LabforSocialInnovation.pdf6 Rittel H, Webber M. Dilemmas in a General Theory of Planning. Policy Sciences. 1973(4): 155-169

What is an improvement lab? | Learning from other labs

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The use of the word ‘lab’ in the context of Q does not represent a commitment to copying other labs. We are exploring whether the term ‘lab’ is helpful in articulating what we are developing within Q, as we know we need to learn from other organisations and institutions that go beyond labs.

However, irrespective of terminology, our early research confirms that there is some common ground between the concept for Q improvement labs and other successful labs. We will continue to learn from other labs and over the summer of 2016 we will undertake further, targeted research with organisations working in a similar environment to help inform our ongoing design.

Frances Westley principles of labs

What is an improvement lab? | Learning from other labs

Broad based research Labs do not rely on a single research methodology but instead bring together a variety of information sources to build a holistic understanding of the problem space.

Specialised physical environment Labs operate within a space conducive to creativity (this doesn’t mean every lab has its own, dedicated space).

Rapid prototypingLabs model elements of the problem space and solutions to problems. These prototypes provide tactile models that can help participants quickly think through the implications of a wide variety of system interventions.

Co-creation of solutions Labs work across sectors and silos, seeking to encourage diversity.

Clear process design and facilitationLabs provide participants with a sense of where their workshops are going and how the work they are currently doing researching, sense-making or prototyping will fit into the broader system change.

Multi-disciplinary support (or core) staffLabs have staff in place to provide research and prototyping support for participants. Chief among the expertise involved are: design skill (technical and process), facilitation skills, ethnographic skills and political/collaborative skills.

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Implementation focus in Q Improvement labs

Many existing ‘social change labs’ or ‘innovation labs’ are focused on innovating and generating new ideas, rather than on implementation, scaling and spreading of solutions (see figure 1). 7 This is one reason why we need to look beyond existing labs when designing Q improvement labs (see figure 2).

We think that the ultimate measure of success for Q labs will be in catalysing change that improves the quality and safety of care of patients. In some cases this may require collaborative innovation for new ideas. In some cases it will require systematic review of existing good practice and collaborative work to spread these ideas into different environments and contexts.

The mechanisms and expertise required to innovate are different from those required for implementation and spread.8 Bringing these capabilities together to design solutions that will really work in practice will be a key challenge for Q improvement labs.

We know that the quality of an innovation or idea alone is not enough to support its uptake. Rather it is the interaction between the innovation, the intended adopters and the organisational conditions that influence uptake. 9 . Through Q improvement labs we hope to bring people together to contribute to the development of a deeper understanding of the challenge, developing solutions in a way that constantly keeps in mind the real world context in which they will need to work. The Q community will provide opportunities to connect to all parts of the health and care system to encourage adoption of ideas generated through the labs. By involving key stakeholders in individual projects, and though our Q members, we also hope to be able to have influence over the organisational conditions that will be required for the solutions to be successful.

7 The Bridgespan Group, Roes partners, the Rockefeller Foundation. 2014 Innovation Labs Survey. Available from: http://www.bridgespan.org/getmedia/d9f734ae-c4f8-4f36-a842-c03b75e4f668/Innovation-Labs-Survey-Data-Summary-2014.pdf.aspx 8 Grint K. Wicked Problems and Clumsy solutions: the role of leadership. Clinical Leader 2008 (1) 2. Also Hartley J, Martin J, Benington J. Leadership in healthcare: a review of the literature for health care professionals. Institute of Governance and Public Management and Warwick Business School. 20089 Greenhalgh T. Robert G. Macfarlane F, Bate P, Kyriakidou O. Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations. Milbank Q. 2004;82:581–629

What is an improvement lab?

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What is an improvement lab? | Implementation focus in Q improvement labs

Q improvement labs will achieve impact through a combination of (a) explicit and concrete actions, such as implementation or a change in policy and (b) more subtle mechanisms such as organisations choosing over time to change their local policies or way of talking about a problem as a result of the work.

As we undertake further research and conversations over the coming months we will further develop our theory of change, setting out in more detail how innovation and large-scale adoption happens in complex systems and the ways in which labs will support this.

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Labs will draw on diverse sources of expertise and fields of learning

What is an improvement lab? | Implementation focus in Q Improvement labs

Social franchises

Hackathons

Simulation centres

Tech incubators

IHI

Design-led thinking

Data science

Psychology

Human factors

Behavioural insight

Quality improvement

Organisational change

System thinking

Ethnography

Q improvement labs

Figure 2 Ideas generated at May 2016 design events about sources of expertise labs could draw on

Figure 1 Image taken from ‘Innovation labs survey 2014’, a survey of 76 labs globally

82%

56%

16%

0%

13%

4%

What type of work do labs engage in most often?

Developing and testing a new solution

Mobilizing multiple stakeholders to drive solutions

Scaling a solution

Optimizing existing solutions

Developing a portfolio of solutions or opportunities

Implementing a solution

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Design events with Q participants

In May 2016 we held two strategic design sessions with members and prospective members. The purpose was to share emerging ideas about how Q improvement labs could operate and to test and challenge those ideas.

The following two diagrams represent the ‘straw man’ proposition as presented in May – the labs network and the people likely to be involved. They are a snapshot in time of emerging thinking about Q improvement labs, which we are using to prompt and generate feedback and input.

The sessions generated useful insight about members’ initial reactions to the proposals through a series of high level questions and conversations between the project team and members. Feedback from these sessions is summarised in Appendix 1, and this has been used to shape the design questions described later in this document.

A lab – A core team – A physical space – Project funding – Access to specialist expertise

and facilities

Sharing and support network – Labs online presence – Bank of associates – Evaluation – Cumulative learning – Lab team and method

development – Building new labs – Community of practice with other

labs/ experts

Q members – Anyone in Q can join any

lab project – Involved at various degrees

of intensity

The development of ideas for Q improvement labs

Note: locations on the map do not reflect intended locations

Lab time will likely be split between running long term projects and more flexible support for improvement work taking place within the Q community

Q improvement labs network

Figure 3 Illustration of Q improvement labs network shared at May 2016 design events

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Stakeholders that might be involved in Q improvement labs

The development of ideas for Q improvement labs | Design events with Q participants

• Pick topic, get mandate

• Contribute to sense-making

• Commission evaluation

• Connect to other labs

• May have additional expertise and facilities

• Provide sponsorship for topics

• Sense making• Help to pick topic• Contribute knowledge• Engage with findings

• Testing and reporting

• Participate in ideation

• Contribute knowledge

• Help pick topic and

comm

unicate learnings and

adopt recomm

endations

Host institu

tionQ m

embers

Fund

ers

Labs support netw

ork

Topic experts

Public

Topi

c sp

ecifi

c st

akeh

olde

rs

• May contribute to specific testing scenarios

Increased number of participants

Core team• Manage project

resourcing and infrastructuring, and work with all these groups to design and deliver the Q lab activities

Figure 4 Illustration of stakeholders that might be involved in Q improvement labs shared at May 2016 design events

• Sense-making• Provide insight

about topic

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Emerging principles

Although we still need to develop more concrete aspects of the Q improvement labs proposition, we are starting to establish some core principles about what we think they will do and how.

• They should offer dedicated space to bring people together, supported by a core team with a range of skills and expertise. Whether this means a fixed dedicated space and/or a more flexible mobile or pop-up space is still an open question.

• They should operate across the UK working on challenges that have relevance to multiple population groups.

• There should be a clear set of principles and strong value base that will guide how they work.

• When tackling a challenge, labs should draw on tools and techniques from within quality improvement as well as expertise from other sectors or disciplines that are less commonly used in the health and care sector.

• They should pull together knowledge on topics, drawing on research, best practice and good ideas from across the health and care sector in the UK, as well as from other sectors and countries when applicable. They will not seek to reinvent where good practice is proven.

• What constitutes success should be different depending on the nature of the challenge: in some cases it might mean influencing policy through the generation of new thinking, in others it might mean changes to practice through the wider adoption of successful ideas.

• They should focus on designing solutions in ways that can be sustained and spread, seeking a deeper understanding of the organisational conditions that may be necessary for particular interventions to be successful and the elements that can and should be customised.

• They should seek ways to support lasting change beyond the life cycle of a lab project. This may include leveraging the support of lab sponsors for post-project funding.

• They should be evidence based and objective. This will include recognising that for many complex problems detailed evidence may be lacking.

• They should be rigorous in their evaluation and assessment and willing to challenge traditional forms of evaluation. For example, if trying to measure multifaceted social changes, the ‘gold standard’ of a randomised control trial is unlikely to be applicable.

The development of ideas for Q improvement labs | Emerging principles

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This overarching vision has been broadly supported and gives us a good starting point from which to build. However, we quickly need to translate this into a tangible proposition that can be tested. There is a range of directions that labs could go in and a number of structural or operational decisions to be made.

The development of ideas for Q improvement labs | Emerging principles

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As with any project that deals with innovation and uncertainty, there is a fine balance to strike between gathering evidence, best practice and views to guide the project, and iterative learning through testing and prototyping. We have identified six design questions that we will need to make progress on in order to develop a business case seeking funding to develop a lab.

Under each design question we have briefly outlined our current thinking. A series of conversations will take place with members and other stakeholders throughout summer 2016 to discuss these further.

Design questions

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1. How will Q members connect and interact with labs?

Our diverse range of members is integral to the success of Q improvement labs. We envisage they will help select the topics, contribute through research and idea generation, and take forward and disseminate outputs from the labs projects. We imagine that different members will be involved at different points and to different degrees depending on the topic that is being worked on.

During the May design sessions, members identified a number of ways they would like to be involved in labs, illustrated by figure 5. However, they also raised concerns about how much time they felt able to commit to labs due to other work demands. We need to develop thinking about what would make involvement in labs feel like a time efficient priority for professional development and progression of improvement priorities, as well as what support is needed to be able to fully participate.

Figure 5 Feedback from May 2016 design events about possible levels of involvement in Q improvement labs

Design questions

Minimal Lots

Vote on a topic

65 participants

55 participants

57 participants

Send in examples of good ideas

Pecha Kucha (20 minute presentation)

to test ideas with colleagues

Be interviewed or respond to call for

evidence

Take part in a twitter chat to

rate ideas

Take part in a prototyping workshop

Interview people in your own organisation

Review/ critique ideas in person

Help connect labs to places where ideas can be

prototyped and tested

Take part in analysis workshop

Join insight-gathering visit (for example to

another industry)

Take part in a centrally organised idea

generation sprint

Prototype an idea in your own organisation

and report back

Organise/ host a site visit

Run your own idea generation workshop

and report back

Take part in full testing of an idea

RESEARCH AND DEVELOPMENT

IDEA GENERATION

SIMULATION AND TESTING

8%

9%

14%

6%

20%

21%

11%

14.5%

19%

14.5%

4%

20%

42%

42%

38%

17%

Levels of involvement in labs

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2. What principles will labs be founded on?

The principles or values labs are based on should be clear and consistent, even though the specific techniques and skills they employ will vary from challenge to challenge. We propose that labs should be committed to:

• Working across boundaries without hierarchy or bureaucracy

• Open and objective evaluation

• Testing and iterating ideas

• Learning through failure as well as success

• Creativity and nurturing of new ways of working.

We need to test these principles and create a strong value base for labs, which will guide how labs develop.

3. How will labs catalyse change?

Our hypothesis behind Q improvement labs is that certain complex challenges will benefit from new conditions, collaborations and techniques coming together, with space to innovate and test ideas across traditional boundaries. Through the work labs do with members and their networks, lab projects will develop an understanding of key issues and support implementation of practical solutions across the UK. This broad impact, together with the developmental benefits of participating in labs projects and specific outcomes lab generate, will combine to produce more effective and efficient progress on a large scale in relation to complex problems.

Labs will seek to develop a toolkit of methods which can be used flexibly and according to the needs of the topic. We need to develop this toolkit in tandem with developing our hypothesis of how lab activities will lead to change and what we expect to see as a result. We should invest in sophisticated evaluation, learning from the experience within Q, to shape the way labs develop.

Design questions

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4. How labs connect with existing improvement initiatives, organisations and local work?

Labs should bring something new to the health and care landscape, but this uniqueness could be as much about how labs connect with existing initiatives as about any new techniques they employ. We do not need to map every organisation and describe how labs will connect with each of them. We should be able to describe the way in which labs will support the great work that is already happening across the UK and be clear about the unique opportunities Q improvement labs can offer. We feel labs should seek to support local improvement work as well as working on system-wide issues and we want to explore what this element of labs work could look like.

5. Where does the ownership for labs rest?

We need to be able to describe how and by whom labs will be owned and practically managed, as well as a governance model for labs. For example, we need to decide how topics are chosen and which findings and conclusions are promoted widely. We will need to make decisions with enough detail to commence work on the first lab in 2017. As with many aspects of labs design, we may need to take some pragmatic decisions about how this takes place in the early stages with a view to testing different models.

6. How much will labs cost in year one and what options exist for long term funding?

Indicative funding for Q to 2019/20 has already been agreed between the Health Foundation and NHS Improvement. However, in addition to this, further investment will be required to establish Q improvement labs and enable them to operate across the UK. In the first instance we will seek additional funding from the Health Foundation in late 2016. The business case we present will need to include the budget for the establishment and running costs for year one and beyond.

We want to establish a long-term and sustainable funding model for labs, based on the expectation that if the idea is proven and results are forthcoming, we expect a range of organisations will be interested in investing in the core labs infrastructure as well as specific projects labs tackle.

Design questions

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We will seek to develop responses to these six design questions by autumn 2016. We will do this through a series of conversations, focus groups, a small number of development workshops with stakeholders and desk-based research. We will not seek ‘perfect’ or complete answers but instead, in the spirit of innovation, they will be as evidence based as possible while recognising that we should not seek to design labs on paper alone.

We wish to progress quickly to the next stage of development and begin prototyping. We will ensure the prototype lab meets the triple needs of desirability, viability and feasibility (decision making criteria commonly used in design processes and product development). 10 This prototype will then develop into a fully resourced first lab in 2017.

Next steps

ViabilityWhat can be

financially viable?

Innovation

Figure 6 Viable, feasible, desirable framework

Viable, feasible, desirable frameworkThis framework is a way for evaluating potential solutions against the three success criteria that are critical for making sure any idea is going to be a success.

10 IDEO, Our approach: Design thinking. Available from: https://www.ideo.com/about/

DesirabilityWhat do people desire?

FeasibilityWhat is technically and organisationally

feasible?

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Q is about building a community of people with knowledge, expertise and commitment to improving quality in health and care. Labs offer the opportunity to bring improvers together, supported with some resources and expertise, to make progress on complex issues to improve care for patients and the public across the UK.

We are looking forward to working with members and others over the coming few months to take this proposal to the next stage.

Next steps

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Summary of feedback from May design sessions with founding members

Appendix 1

Category Key themes Number

Innovative and collaborative approachTaking part in a genuinely innovative and collaborative model. Opportunity to do things differently 17

Making progress on problemsRe-igniting passion, being able to identify, reframe and make progress on problems 14

Time to reflect and create in a safe space

Time to reflect, focus on improvement in a facilitative environment, as a safe space to innovate and trial 14

Breaking down barriers - role, org, sector

Being inclusive - a chance to work with different people, beyond, role, org, region or sector, in a collaborative way for constructive problem solving

13

Community involvementContributing and sharing as a community with energy, passion and enthusiasm 11

Learning opportunityLearning something new, and being able to apply to other areas of work. Personal challenge and development 8

Patient involvement Starting from a patient’s perspective with them at the heart 3

What are you most excited about?

Table 1 / based on 80 responses, 35 from Leeds and 45 from London

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Appendix 1 | Summary of feedback from May design sessions

Category Key themes Number

Ways of workingHow to get consensus, cultural barriers in health and risk of group think. Skills and ability to diagnose problems 16

Community involvementHow to get involved, level of commitment and resource required, and crucially how to sustain involvement 15

Implementation and achieving outcomes

Doing rather than talking, how to implement, making a difference and then sustaining it 15

Engaging the right peopleHow to ensure labs are grounded in the reality on front line and involve a wide spectrum of people - not just usual suspects. How to sustain momentum

11

Topics - working on the right ones Choosing the right topics - size, importance, relevance to members 8

ScopeFocusing too much on healthcare/ acute instead of health and community, starting too big and not using a QI method of small tests of change

8

Business model Funding model, who is in charge, whether central model is right 6

Linking to current work and AHSNLinking to what’s already happening, at regional and national level, adding to the complexity and risk of taking resource from other activities 6

Language Labs terminology and concepts are not accessible enough 5

USP and how it’s different Lack of clarity of what we’re doing and why 5

Labs network Proposed network is small, risk of exclusivity 4

Patient involvement and impact Not having an impact on patients 4

Evaluation Evaluation and allowing time to see whether they make a difference 3

Spread challenge Producing good ideas that we aren’t able to spread 3

Miscellaneous 1

What is your biggest concern?

Table 2

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Category Number Category Number

Ways of working 29 Topics - working on the right ones 8

Community involvement 27 Scope 8

Implementation and achieving outcomes 18 Patient involvement and impact 8

Linking to current work and AHSN 14 Evaluation 6

Business model 13 First lab - when and where 6

Engaging the right people 11 Language 5

USP and how it’s different 11 Examples from other labs 4

Choosing topics 11 Spread challenge 3

Labs network 10

Grouping: questions and areas of concernThis table shows the grouping of the biggest areas of concern and where people had questions.

Table 3 / based on grouping together the themes from questions people raised and areas of concern

Appendix 1 | Summary of feedback from May design sessions