Advice: Experienced coaches provide personal reflections on building a Big Room

Coaches training as part of our first virtual training cohort in Sheffield recently attended a ‘Building a Big Room’ Workshop. The Big Room is the foundation of the Flow Coaching Academy’s (FCA) methodology and is the main action component of the course.

The workshop gave them an opportunity to revisit their hopes and fears which they recorded at the beginning of the course and reflect on their learning progress with many of the coaches having now started a Big Room of their own.

As part of the workshop, coaches attended a question and answer (Q&A) session with some experienced coaches from the Flow Coaching Academy (FCA) network.

The Q&A panellists included:

• Katie Smith, Dietician and Coach for the Head & Neck Big Room in South Yorkshire, Sheffield Teaching Hospitals
• Ben Morris, FCA Programme Lead at Lancashire & South Cumbria (L&SC), Coach for Nutrition Big Room (has previously been in endoscopy and enhanced care), Lancashire Teaching Hospitals
• Nick Deayton, Programme Lead for Passionate Communities Sheffield, previously coached End of Life Big Room at Sheffield Teaching Hospitals

As many coaches move towards coaching in a virtual world, the discussions held was incredibly topical and feedback from those training has been positive. Some key themes came out of the session which we thought would be useful to share.

Building a Big Room advice

Patient involvement

• Patient experiences could be brought to your Big Room through its participants – those working in a pathway have a personal as well as professional relationship with patient care.
• Understand which carers or patients are in the right head space to be part of the Big Room – you may want to focus on those who have already gone through the pathway instead of currently going through it.
• If patients don’t feel comfortable attending Big Room sessions particularly on a screen think of ways you can still bring their story in – video consultations which can be recorded and played back are a useful tool or recording a telephone interview has also worked. (When sharing or recording information, it would be good to link in with your Information Governance and Communications teams.)
• If you are struggling to get patient involvement, Health Talk has lots of videos of patient stories which may start to get your Big Room talking, these can be found here.

Making progress

• Pre-phase work and the 5V’s framework help articulate the complications in the pathway. Do not rush the process as you may end up focusing on making changes to an area which might not actually be that impactful which may lead you back to a pre-phase stage.
• Site visits during pre-phase have been invaluable. This really helps put you in the mindset of a patient.
• You need to allow people time to get onto the FCA’s Roadmap for Improvement, meet them where they are at and try to read the room.
• Pre-phase has been important in helping Big Room participants work through the roadmap. Having the right data and information at the right time in the journey will help bring people along.
• You may have a great idea which receives a lot of push back, this might be because people are not ready for this but might be in 12 months’ time. Don’t let this put you off go where the energy in the room is.
• In our Big Rooms we are often looking to overcome complex problems which may have been present for the last decade. So, it’s unlikely that these problems will be solved in 6 months. Take your time with it. It could be useful to reflect this back to participants, how long has this been a problem?
• The Big Room can be so much more than just focused on outputs it can be a great wellbeing tool and really form those relationships across a care pathway. Ultimately a change in culture over outputs will mean long-lasting improvements are made.
• We can often frame pre-phrase as not making progress. The opposite is true. Pre-phase is helping you identify what problems you face, how to overcome these and helps build those relationships important to improvement work.
• If your Big Room runs in absence of its coaches, then your participants have the ownership in the work and that is true progress.

Overcoming personal reservations

• Don’t let your self-doubt drive you. I remember fearing nobody would attend my Big Room, but people always attended and would come back again.
• If you are worried about starting your Big Room, what would make you less worried? – One of our coaches found speaking to all the participants 1:1 before the first meeting settled their nerves. They had an opportunity to introduce more about what the FCA and the Big Room were all about.
• You as a coach add great value to the room. I’ve often felt like an imposter wondering how I will approach more senior consultants or medical staff. Remember the Big Room participants only know what they know, you have the data and patient stories that can help bring them to your ways of thinking.
• It is okay to say you are not an expert in the field being discussed. Humility to ask questions and learn together is a positive step towards ownership in the Big Room.
• Don’t feel like a fraud if you aren’t doing things in a certain order outlined in the FCA roadmap to improvement. Techniques can be helpful, but you need to be mindful of if this is the right time to introduce them.

Engaging stakeholders

• Separate the Big Room from other meetings, make it a fun inclusive place where people are inspired and want to be part of it.
• Don’t worry about how many people attend. If only six people come, but they are the right six people than you will achieve what you set out to.
• I had a challenging experience when trying to engage a certain group of staff. I worked with my co-coach and boss and tried everything we could to engage the group, but they still would not engage. At that point we needed to realise we’ve done what we can. So, we focused on people who did want to engage instead in the hope this group of people might be the laggards who join the process later on.
• One of the best Big Room sessions I attended was led by a Healthcare Assistant. The conversation was very focused on hands on patient care. Encourage all your participants to get involved and make it clear that this doesn’t need to be driven by the most senior staff in the room. Flatten the hierarchies from the start.

Making the best use of time

• From a time-perspective being a coach does take a long time. Remember not all items need to be discussed in the Big Room. A lot of conversations can happen outside the Big Room and be brough back to it as a forum.
• Make this work part of everyone’s day to day aspects of their job rather than just the Big Room – this will mean it doesn’t feel like an add on or extra work.
• Don’t feel like you must meet people face to face.
• Staff are often busy so think of ways to work around this. I have a regular 10-minute meeting with a clinician, and we are just very specific with how we spend this time.
• The relationship with your co-coach is important, staying in touch with each other and having open communication will help – this could be via text, WhatsApp, MS Teams etc.
• There is no set time to be a coach. I was supporting people outside the meeting and doing a lot of preparation for the room each week when I first set it up. Now I have not a lot of input. Be proud of what you are doing and not what you are not doing.
• The Big Room is everywhere. It’s not just a specific space. In Sepsis Big Room we use The FCA’s Online Improve Community platform – Workplace. We might have 6 people at the meeting, but we have many people between sessions who input here and move the conversation forward.
• Effective meeting skills have been a real booster to our meetings. It helps people realise that they are the people driving the change. At the end of the session, we assign an agenda and meeting roles for the next meeting, so no time is wasted at the next session.