Over the past 10 years, the Health Foundation has supported the development of the Flow Coaching Academy (FCA) programme, led from Sheffield Teaching Hospitals NHS Foundation Trust. The programme trains health care staff in the coaching, technical and relationship skills required to deliver continuous and sustainable improvement in health care services. 

This week, the Health Foundation published a new learning report on the work of the FCA. Tom Downes is Consultant Geriatrician at Sheffield Teaching Hospitals NHS Foundation Trust and Central FCA Clinical Lead, and Laura Semple is Assistant Director of Improvement Programmes at the Health Foundation. We spoke to them about the programme, and how its methods are already being applied to COVID-19 challenges.  

What’s special about the methodology you use? 

Tom: Back in 2010, early work on flow identified that a core challenge in Sheffield was in the journeys of older people through the health care system. We looked for a methodology that would enable us to redesign something as complex as care pathways that involve several different organisations and services.  

We looked at how Toyota uses ‘Obeya’, which roughly translates as ‘Big Room’, and we saw parallels with the complexities of car design and care pathway design. In a car, to design individual elements in isolation doesn’t make sense and we saw the same in older people’s care – we had to bring people together.  

Patients and carers were at the core and we needed them in the room with administration staff, nurses, doctors, social care staff, community staff and GPs. We put in two trained improvement coaches and we started a weekly Big Room meeting. We started with a patient story each week to remind us of our shared purpose for improvement and we enabled the team to assess the system, diagnose problems, test changes and measure improvements.  

The Sheffield Frailty Big Room has its ninth anniversary this year and has had a significant impact on care for older people across the city. Our second Big Room for respiratory care also resulted in clear improvements.  

From these experiences we recognised that we had something successful here and there was a discussion with the Health Foundation about how to codify it and turn it into something that could be scaled nationally. This is where the concept of the Flow Coaching Academy came from – training people over a year, while they put their skills into practice coaching Big Room meetings. 

Laura: For me, what’s unique about the Flow Coaching Academy is the combination of robust quality improvement methods with the human element of coaching. It’s based on an understanding of how people from different backgrounds can come together, understand each other and value each other’s contribution to the improvement. The methodology of flow coaching is very widely applicable and that’s demonstrated in the diversity of clinical specialisms where it has worked effectively and produced strong results. 

What have been some of the key successes from the Flow Coaching Academy programme so far? 

Tom: Over the nine years since that first Big Room, the length of stay in geriatric care in Sheffield has reduced consistently. It’s not all down to the Big Room, because great work has been done by our social and community care colleagues. The Big Room has been the engine for testing and designing new processes.  

At its core, this programme is not about improvement projects though, it is about people. We are developing people to be improvement coaches, and in parallel it develops their leadership skills. For me, this is important in how we think about improvement in the NHS. 

Laura: A key success has been the way the Flow Coaching Academy has been able to develop into a national network. Interventions such as this generally find it difficult to achieve national spread. Thanks to the universal applicability of this method to the whole gamut of clinical and system problems, this has landed well in a very diverse range of hospitals in England. It has been equally effective in Scotland and Northern Ireland, which have different health systems.  

In the first five years, the programme was scaled up to establish a UK network of ten local Flow Coaching Academies, training nearly 400 coaches, from over 30 NHS Trusts and Health Boards, and establishing over 150 Big Rooms.  

How has the Flow Coaching Academy responded to the challenge of COVID-19? 

Laura: The programme involved a lot of face-to-face interaction so it was amazing to see how effectively the delivery was moved online due to COVID-19 restrictions. In some Big Rooms progress has sped up, because rather than trying to find a meeting time which everyone can make, it’s easier for everyone to jump on to the digital platform. It has been easier to involve patients and other clinicians from outside the hospital, like GPs, in Big Rooms. I’m very optimistic that this wider system reach we’ve achieved during COVID-19 will be sustained. 

Tom: Behind the scenes the Central FCA team did an amazing job of the digital transformation. Digital has improved the programme in three core ways. The first is by delivering an environment where people can connect and collaborate across organisational and regional boundaries. The second is that the course has moved into digital modular form and that is really exciting because it dramatically reduces the cost of delivery, lowers the carbon footprint, and makes it more accessible, regardless of geography. The course comprises a series of e-learning modules and virtual discussion sessions which train participants to become a flow coach.  

The third is the actual intervention, the Big Room. If you’d asked me a year ago, I’d have said it’s essential that it’s face to face. Now I know I was wrong! The virtual Big Room works beautifully. We’re also seeing the potential to accelerate improvement work. When we’re designing a test of change, we would usually do the first iteration of planning in one meeting and then it would be a week before we refined it. Now we can discuss a test of change in a meeting, post on our digital platform that day, and I’ve seen it get to version four within 48 hours. 

I’d like to share with you just one of many examples of FCA coaches making a real difference at the sharp end of the pandemic. Karl is Clinical Director for the Anaesthesia and Operating Services department at Sheffield Teaching Hospitals NHS Foundation Trust. In this leadership role during the pandemic, he describes his FCA coaching skills as being invaluable. At the height of the first wave he facilitated Big Room-style team huddles to flatten the hierarchy, use data objectively to inform decisions and collaborate as a team on key challenges – all fundamental aspects of FCA methodology. The collective ownership, performance and morale this engendered in his team helped the department navigate the biggest professional challenge they had faced to date. 

What would you like NHS and national leaders to do, to support take up and spread?  

Laura: The Flow Coaching Academy is a very effective tool in our toolbox, which can help us get out of the quite acute situation that we find ourselves in at the moment, where health care services are doing their best to balance care for COVID-19 patients and non-COVID patients in a way that is safe for all. The FCA approach has strong evidence of effectiveness across a wide range of clinical areas and types of organisation.  

We are seeing a lot of hospitals applying FCA methods to COVID-19 challenges. For example, we have at least one Big Room bringing people together to develop services for people with long-COVID. There’s also a real opportunity for trusts to use these methods to tackle long waiting lists in other services. In this spirit, I invite NHS leaders to explore the value proposition of the FCA, which is unusual in having the maturity and evidence base of a national network and an evidence base developed over 10 years. Together with the central FCA team, we are currently in conversation with a range of senior stakeholders about how we will get maximum benefit from FCA capability over the coming years.    

Tom: What we’re looking for from NHS and national leaders now is to be inquisitive about the programme. Come and see how it’s improved care in so many organisations already and helped develop people and their leadership skills. The need for efficient and effective flow through the health care system is more obvious than ever.  

Find out more 

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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