Increasingly, quality improvement programmes are developed with an explicit mandate to involve patients, carers, and members of the public. A quality improvement and research programme in Northwest London has nearly a decade of experience in this field. This article provides an overview of how improvement initiatives supported by the programme have involved patients in the co-design of interventions within various clinical settings. Reflections on some of the challenges and facilitators are offered. Extending roles for patients beyond codesigning interventions to involving them in implementation offers new levels of engagement and transparency. Key Words Quality improvement; co-design; patient and public involvement BACKGROUND Over the last decade or more there has been a growing interest globally in the development of quality improvement (QI) programmes to support healthcare professionals and managers to improve the quality of services and associated health outcomes for patients. While many advocate the explicit involvement of patients, carers, and members of the public, the roles they