A coaching perspective through the FCA
A coach’s journey through The Flow Coaching Academy’s ‘Improving with People First’ course is a truly unique experience, find out what they had to say in this article in which different coaches walk us through the stages of the course.
A coach’s journey through The Flow Coaching Academy’s ‘Improving with People First’ course is a truly unique experience, and many coaches shared their excitement about the unexpected opportunities that awaited them when they first joined the community. By the end of the course, coaches are beaming with enthusiasm for FCA methodology, and all speak highly of what it is to be a Flow Coach.
In this article, five different coaches from across cohorts from pre-hybrid participants to the most recent graduates give an account of their experience through the FCA. The FCA believes that their ‘Improving with People First’ course provides something special and feels the only way to capture it, is through the voice of trained coaches who have experienced this for themselves.
Throughout the course, coaches move through an 8-stage structure, as outlined in our Course page.
Read what the coaches had to say about each stage.
Introducing the FCA Way
From the moment coaches join their first session, they will begin to feel what makes the course special. It’s a meaningful time of connection during which our faculty will help coaches to prepare for the months ahead. We’ll share perspectives on what is quality improvement and measurement for improvement, in order to understand how we work.
Joining the course often starts with identifying a need for change, a service that requires improvement and importantly with the recognition that change is a human process. The faculty embodies the skills that the coaches need to build meaningful connections with each other, their stakeholders and their Big Room participants.
Read what the coaches had to say…
Co-coaches Sally Grose and Dave Nuttall, who joined Sheffield’s 3rd online training cohort in 2022 along with other coaches from the SQuIRe network, gave their recollection of their initial connection with the FCA.
Sally Grose, Inpatient Therapy Services Manager, Calderdale and Huddersfield NHS Foundation Trust:
I had a strong desire to improve my service improvement skills and joining the FCA felt like a really valuable learning opportunity for me as an individual. I was really keen to do the course and so approached Dave as my operational manager to see whether he wanted to be my co-coach, knowing that we would be able to support the development of our service.
When asked about how the pair were feeling in the early days before the course had fully started, both coaches answered enthusiastically that they were unsure about what to expect but were very excited about the potential outcomes of the course.
Dave Nuttall, Community Therapy Team Leader, Calderdale and Huddersfield NHS Foundation Trust:
“I was excited. Everybody always says we’re really busy at the moment. So signing up to the FCA was like signing up to that contract to say I’m going to give my time to this and ring-fence time to a specific service. When you’ve got multiple services it’s difficult, but it’s something that we probably should be doing. And it was, that was a really good opportunity. So yeah, I was excited.”
Sally added comments about identifying the need for change but with so many clinical pressures found she needed to learn new leadership skills and a need for designated time for improvement in order to make a difference.
Jyothi Nippani, National Clinical Lead – Hospital Transformation, Clinical Director – Emergency Care Improvement Support Team (ECIST), Elective & Emergency Care Improvement and NHS England & NHS Improvement, participated with the Flow Coaching Academy’s very first cohort back in 2019 when the course was still held face to face. She still practices FCA methodologies with her Big Room and provided a great insight into what she was feeling when she first joined the course too.
Filled with apprehension for trying something new, Jyothi was also excited for an opportunity for personal development. Jyothi commented,
“It was exactly what I wanted at that point in my career. I’m a glass half full person and always ready to take on a challenge. I’ve done lots of improvement projects before, but this focused on flow through pathways which was really interesting. I was most excited to improve my understanding of data and how I could present it in a way that was useful to clinicians.“
These feelings of excitement and anticipation help to cultivate meaningful connections between the coaches and their peers on the course. The FCA faculty skilfully recreates the emotive experience of creating a Big Room for the coaches on the course, so that they experience how to create the conditions that enable the work on improvement to begin.
Our Approach to Improvement
Our faculty will introduce the FCA Roadmap for Improvement and unique concepts. Coaches will learn about getting started with a Big Room using the Team Coaching Model to create the conditions for success.
Read what the coaches had to say…
The next part of the coaches’ journey involves getting an introduction to Quality Improvement as well as all the tools and platforms that make the FCA learning accessible. In 2020, the FCA moved to a hybrid model of the course as a reaction to the COVID-19 pandemic, this brought to life an e-Learning platform and the ability to train coaches from across the UK virtually.
Helen Pratt, Project Manager, Dementia United, NHS Greater Manchester Integrated Care, is a great advocate for FCA training methods. She said,
“The e-learning and how it was set up so you could go back to look at other modules was great, I found I was completing a module and then revisiting it just before a session, I might not have absorbed it all the first time around. I loved that I could always redo something and look at it again and just remind myself and that’s really valuable to have.“
She also commented on the value of being able to re-visit session slides and resources such as templates and example pieces of work.
Vicky Draper, HDFT Stroke Speciality Pathway Lead, Team Leader, Community Stroke and Neurology Team, also joined Cohort 3 in 2022. She commented on how the e-Learning also backed up the learning in taught sessions. She said,
“Having the e-learning was really good. I would put sessions in my diary to do the e-learning then I would be able to go into the discussion session feeling quite well prepared. The combination of e-Learning and discussion sessions works well.“
A key element of the FCA’s approach to improvement is organising the course with the FCA Roadmap to Improvement. The FCA Roadmap describes the methodology and structure coaches use to help Big Room teams achieve improvements. The roadmap guides coaches through a logical sequence of steps from assessment through to testing and standardisation in a continual process to achieve lasting improvement.
Dave is one of the FCA’s biggest advocates for the roadmap and frequently reminds the central team that he has it saved as his computer screensaver. He talked about how this element of structure through the course gave him a clear visualisation of what improvement should look like and repeatedly follows the steps through his continuous improvement work. He commented,
“I like the structure of the Flow Coaching Academy better than other courses. It’s really clear in showing that module one is where you start and that this is what you call your pre-phase work. You know which step to go to next and have something you can look back on to make sure you’re on the right track. I’ve been on other courses where the structure is similar in essence, but the FCA just puts it really nicely into a simple road. Maps are easy.”
Dave describes how the Roadmap to Improvement helps coaches to navigate their way through quality improvement. Not only does the FCAs ‘Improving With People First’ course provide the tools and skills to create sustainable change, but it also provides the ‘How’. The special thing about The FCA programme is the long-lasting support through a structured process that enables coaches to make continuous improvements.
Building a Big Room
Creating a compelling shared vision and discussing ways to include patient stories and experiences is about moving to action and setting up a Big Room. Learning in more detail the elements of the FCA Roadmap for Improvement is a time to invest in creating solid foundations as the Big Room will continue after the course has been completed.
Read what the coaches had to say…
Big Rooms are at the heart of the Flow Coaching Academy. Coaches at times find it difficult to understand the concept of a Big Room until they gain first-hand experience of running one for themselves.
Jyothi describes the Big Room from her perspective,
“At first I thought it was a physical space, and now I know it’s actually any place where you feel safe to talk about anything and to say whatever is on your mind. The conditions should ensure the hierarchy is flattened so anyone can express their ideas. Witnessing a small change idea being developed by the rest of the team and it actually being experimented the following week. Oh my, it gives you such a thrill!”
Jyothi works hard to ensure that everyone in the pathway is represented in her Big Room, this includes patients as well as staff which is why flattened hierarchies is such a vital part of the Big Room.
Vicky gives an honest account of starting her Big Room. It’s important to understand that there is no one ‘right way’ of starting a Big Room. Vicky spoke in depth about how herself and her co-coach went about things in a bit of a ‘topsy turvy’ manner in that we had already decided as part of FCA quite early on that we wanted to run some patient focus groups.
They had created a space with the patient voice at the heart and so it was a natural next step to harness this in the creation of their Big Room.
It can be a common theme that coaches are unsure when to start hosting their Big Rooms. Subgroups a core part of the structure of the course are peer coaching sessions hosted by the faculty to create thinking space for the coaches. They are an ideal place to share thoughts and concerns, she recalled a few concerns including her own;
“Has anyone done the Big Room?’ ‘Has anyone started a Big Room’ and we said no, we’re a bit nervous about it too.”
In conversation, Vicky spoke of the hard work that herself and her co-coach were putting in to building a Big Room. She described the pre-phase work they did and how they engaged stakeholders to get people in the room. She said with such excitement
“it suddenly felt like we had our Big Room.“
And took such pride in knowing that her efforts had paid off to run a successful Big Room
Sally and Dave had similar feelings about the full scope of the Big Room. Sally said,
“We struggled initially, we started with the small things then we realised that actually, it was the bigger picture we needed to improve. We thought well, let’s go big or go home. We stayed big and that worked really well and it has enabled us to develop and foster some really positive relationships.“
Dave continued,
“We spoke about the wording of ‘Big Room’, I think it caused anxiety within the subgroups, certainly that we were in. And I think the thing about the ‘Big Room’, was that it sounded like it had to be this huge thing, you know.“
Sally and I have reflected multiple times on when we started our Big Room and how we started it.
We almost wanted it to be complete and ready to the point that we knew what we were saying when we started it. But looking back, I would say just start this almost immediately and the rest will come.
The pair discussed in depth about their realisation that ‘Big Room’ can mean anything you want, ‘Big Ideas, Big Impact, Big Change’… not just the size of the room.
The Big Room is the engine of the Flow Coaching Methodology, a collaborative space that brings together all the service pathway participants in the improvement of the patient experience. It is in this space that the Flow coaches, coach the Big Room participants to use data and improvement tools to inform their pathway changes. Coaching improvement requires coaches to build their confidence in using data and evidence, they get lots of opportunities to do this in the next phase of the course.
Practice, Test and Learn
There will be an application of learning so far with a Quality is Personal project. Coaches can expect to gain confidence in using data and evidence, linking improvement theme to aims, being experimental. They will learn about and practise coaching techniques needed as the Big Room goes live.
Read what the coaches had to say…
At the mid-point in the course, coaches participate in an exercise called Quality is Personal (QisP). This allows coaches to practice their new QI skills on a situation that is personal to them as an individual, test changes in a safe environment and learn from the data that it shows.
Helen commented,
“The Q is P session was delivered in a very engaging and interactive way. I don’t know any other training so focused. I could see a huge amount of opportunity for us to practise, have a go and share what we’ve learned. We don’t get to do that very often when we’re learning. In training, we tend to get talked at, this has been the style historically. So yeah, I could see that was different in FCA delivery.“
Dave’s Q is P journey helped him to highlight the importance of gathering data throughout improvement work. He observed,
“The process was interesting, I completed the template provided and it made sure you were really getting that initial aim worded well. I think the first time I worded it thinking, ‘What am I actually testing here?’ Having the template made you really go back and think it through. I thought that was really quite useful. And then you drilled down into the concept a bit more and make it really specific. You add your data, and then you think. ‘Yes, I can prove that something has improved and not just changed.’ You can see it working within principle on something really quite simple and easy. I think I found that a really strong part of the course.“
Another opportunity at this stage is to practice your coaching skills in the Big Room. Jyothi shared her learning and methods of maintaining engagement. She explains how setting meeting roles – as outlined in effective meeting skills – can make sure meetings stay on topic and have positive outcomes.
“In the room, you have people who want to go on and do stuff and they’re motivated. And some that will just go with the flow. I learned very early on that, you have to get the positive people talking first.
I would have somebody who’s positive, somebody who wants to do, and who I know will say the right things. I’ll ask them to make sure that they are there in the beginning of the meeting to take on the roles.”
Jyothi expressed how important it was to have someone with a positive mindset helping her to facilitate the meetings. She would work to make sure everyone was heard and that good ideas were being shared and recorded.
“Having that little pre-work before a meeting and coaching the Big Room participants in a positive way really helps.”
Some of the coaches on the course will now be experiencing running their Big Room and others still working towards getting going. Coaches can experience their own reaction to change here as doing something new can feel unsettling and sometimes too difficult. At this point in the course the faculty guide coaches into action learning together to help build confidence and provide more tools to support them.
Action Learning Together
Our faculty helps to harness the collective brilliance of the group as the coaching pair reflect on their experiences of coaching a Big Room and learn form other experienced coaches. We’ll introduce more useful tools to aid the work being done in the Big Rooms.
Read what the coaches had to say…
Sally and Dave spoke to me in particular about their strong connection as a coaching pair. A key part of Flow coaching methodology is creating coaching pairs. One coach is a clinical coach on a particular pathway and the other is someone external to the pathway.
“Dave and I have worked with each other before and we value each other’s opinion and trust each other. For me, it’s been a real bonus working closely as Flow Coaches, it’s been really lovely to share the experience with somebody. I wouldn’t have wanted to have done this on my own because I wouldn’t have had somebody to reflect it all back to and been able to discuss ideas with. We would reflect together and check our understanding of the sessions which has felt really supportive. I think it’s been quite a nice honest relationship and we are able to give each other feedback on how we’ve done things.”
Jyothi was paired with a co-coach she had never met before and found the value of cultivating new relationships across departments. Her experience with her co-coach highlights the value of looking at how patients flow between different areas along their pathway and the importance of looking at their experience as a whole.
“My co-coach was one of the best things that happened. We were both aligned in our vision, which was very good. He was driven like me and it kept us motivated and brought positive energy. He brought suggestions and ideas which would never have occurred to me on my own. With his background, he knew how paramedics think, what they needed, what will make it easy for them and it became a key part of all our PDSA. Having someone that saw the same pathway but from a totally different perspective was great. He didn’t know much about how our hospital worked, but he knew that bit. So, putting both our experiences together, made it almost 1 + 1 = 4.”
Helen reflected on the value of the co-coaching model and how she continues to use this in her work. She expresses how useful it is to work with someone also using the methodology.
“There is a coach in Yorkshire, we’ve caught up separately to say, is there any work we could do jointly and we worked out that even though our systems are so different, we still have conversations and share things and interesting learnings. The lesson learned is that it’s not all about graduating but it’s about the skills, knowledge, competence and relationships.”
With boosted confidence and more tools to support them in their Big Rooms, the coaches are feeling more equipped to guide their Big Room participants. However, as their Big Rooms become more established it is time for the coaches to learn how to manage the roadblocks and implications of the wider system on their pathway improvement goals.
Coaching Focus & Development
The FCA way is underpinned by human connection. In this phase of the course coaches get to reflect on their coaching development needs and coaching roadblocks experienced. The faculty and peers will guide and support coaches as they learn more around system dynamic.
Read what the coaches had to say…
Coaches reflect on some of the challenges presented whilst coaching their Big Rooms and how they used the skills they have learned to address them. For many coaches it can be as simple as changing their mindset about what is a problem and how it can be reframed as an opportunity.
Dave suggested,
Getting Stakeholders in one room is the biggest challenge we met. But once we did it, we wondered why have we not done this before? There is a lot of similarity in the room of what people want and what people are working on, you start to think well, let’s just do that together. This was new for our services and trust in terms of how we approach things. And I think that would be the approach going forward, wouldn’t that?
Sally replied,
Yeah, you’re absolutely right. And when we spent all that time engaging with all our individual stakeholders and hearing exactly the same thing, it was a light-bulb moment.
Everyone’s wanting to do the same thing, but we’ve never told each other that. Looking at the pathway as a whole, you’ve got an opportunity for those pathways members to come together and talk about what they are doing, what they’re sharing and what they’re learning. We needed the FCA Big Room methodology to make us realise that. But now we’ve realised it, it’s going to be embedded in how we do things here as well as across other services.
Vicky also spoke of some of the skills she learned and how the FCA made a difference to how she continues to use and develop these skills.
As time went on throughout the course, we used the road map more. I was familiar with some methods like the 5Vs and PDSA cycles so that was a refresher, but at times it felt quite big to maintain those methods. One of the things I took from FCA was to try and keep it quite small and to gradually improve things over time
Armed with more coaching skills, greater self-awareness and insight from their peers, the coaches are given space to practice using their skills in their Big Room and will come back together in the next phase of the course to share their learning.
Show & Tell
The coaches will be sharing Big Room stories and coaching each other to overcome roadblocks. It’s an opportunity to celebrate, seek support and guidance as well as learning more concepts to support confidence growth in coaching the Big Room.
Read what the coaches had to say…
‘Show and Tell’ falls around the half-way point of the course and is where coaches can be at their most vulnerable and most supported. Vicky’s account in this following section is a lovely testimonial to how the FCA works hard to provide a psychologically safe environment for coaches to share experiences and learning for the rest of their improvement work ahead.
“I feel that you need to provide people with somewhere that they can say what’s on their mind and get things off their chest knowing that there’s no judgement and that there’s support if needed. It’s something that I’m very passionate about. So when the FCA offered that, it made me feel quite comfortable and quite secure and able to say ‘I have no idea what I’m doing, I’m finding it really stressful or overwhelming.’ You could talk safely with people you’ve potentially never met before and didn’t really know that well, it was probably one of the best parts of the course.“
Her statement continues and shows the value of taking the time to cultivate relationships through the 12-month process and why the FCA feels the length of the course is necessary.
“We all felt quite emotional on the last subgroup that we weren’t going to have that space again. We’ve continued it on to some degree, not quite with the same people, but maybe more regionally. It’s one of the best bits about it, making those new relationships.
It’s quite unusual to have that on a course. I think possibly because the course was as involved as it was, and it was over that long period of time. Rather than just being there for a day or a week.“
Jyothi mirrors Vicky’s sentiments and spoke highly of subgroups, her relationships with other coaches and the lasting relationships she built with faculty members.
“There’s a lot of opportunity to communicate between each other and we are inquisitive about the work that others are doing around us in their coaching pairs. The faculty are really good. They really made you feel safe. Which is very important.”
Jyothi continues to attend FCA events and is an enthusiastic advocate of the course and FCA methodology.
The Flow Coaching Academy believes that their course enables lasting improvement because it creates the time and space for the coach’s personal development, for them to build the collaborative relationships with stakeholders, frontline teams and patients vital for the change to be a success. Building human connection cannot be rushed, creating psychologically safe spaces and trust, requires leadership, empathy and time which is why coaches take 12 months to reach graduation.
Graduation, Reflection & Sustainability
The journey on the FCA comes to an end in this phase and we invite coaches to reflect on the last 12 months and celebrate their achievements. The FCA faculty support development plans to sustain the Big Room and personal coaching development for the long term.
Read what the coaches had to say…
The Flow Coaching Academy aims to cultivate a community of coaching expertise that graduates can connect with long after their 12 months has passed.
Helen talks about her continued contact with other members of the FCA community.
“Every now and again I dip into the FCA because I’m still part of it. It’s a combination of Workplace and reaching out to individuals that I know trained on the course.
I connected with one of the coaches from Yorkshire, we’ve caught up separately to say, is there any work we could do jointly and we kind of worked out that we couldn’t because our systems are so different. We’ve extended the opportunity to just have conversations and share things and interesting.
We catch up once every 6 to 8 weeks or something, but I’ll ask her about recent improvement we’ll talk about it. Then some of the colleagues from other areas will ask and link me in with work, which is lovely. You know, it’s absolutely lovely to hear from them. I feel like I am part of a community.“
The interview concluded with some final words from coaches about how they felt at the end of the course, what they would say to future coaches and what they thought were the best bits.
Helen spoke about the valuable things you will take with you as a trained flow coach.
“Do it! It is absolutely so valuable. You learn so many tools that you can take forward. It’s like having a quality improvement toolbox having had a go at things. Knowing who to ask, gaining a community of other coaches that have done something similar.
Learning about your own limitations and strengths you didn’t know you have and learning about reflecting on those, which is really important to do. Definitely give it a go.”
Dave included some comments for anyone considering joining the course.
“I’m so positive about the FCA experience and I would advise people to join the course. It helps you to get into that role where you can make a difference and change a pathway and you can engage with new people and get that sense of enabling improvement.”
Vicky gave some final words on her experience with the FCA and how it has affected her moving forward.
“Yeah, it was worth it. You will start to subconsciously using all those skills in other areas as well. There were skills that you’ll transfer into other aspects of your life not just work.
It’s something that I have recommended in the Community Stroke Service. It’s something I recommended that our acute colleagues consider going on as well as they are a very different services with different challenges. And I think there’s definite benefit in joining.“
The FCA believes the thing that makes the course so special is the human element to quality improvement and the time taken to cultivate strong and long-lasting relationships. Their aim is to provide tools as well as the support to use them as most problems have no ‘quick fix’. That can be difficult to express from just one viewpoint and hopefully, these coaches have provided an insight into what it is to be a flow coach.
Now that you’ve read what the coaches had to say, follow the related resources to find out more from their final presentations?
