Advice: Practiced Flow Coaches share experience of building a Big Room

The Big Room is the foundation of the Flow Coaching Academy’s (FCA) methodology and a key component of the training programme.
The workshop allowed our coaches to reflect on their learning progress and how they have found creating their own Big Room, whilst being able to ask dedicated questions to a panel of experienced coaches from our nationwide network.

• Catherine Roberts, Coach of Sepsis Big Room and Tissue Donation Big Room, Lancashire Teaching Hospitals NHS Foundation Trust
• Paul Wike, Coach of Dementia Big Room, Sheffield Clinical Commissioning Group
• Michelle Wilde, Coach of Dementia Big Room, Sheffield Clinical Commissioning Group
• Gemma Wright, Coach of Lung Cancer Big Room, Lancashire Teaching Hospitals NHS Foundation Trust

It was a great session with questions spanning method of delivery, maximising stakeholder engagement, knowing the right time to start and more. There were some great insights shared in the session which we wanted to highlight to help others coaching a Big Room in our network.

Building a Big Room advice

Defining focus

• It can often feel overwhelming at first to know what to focus on, engaging people early in the process and conducting stakeholder interviews helped us identify what was important
• In some early Big Rooms, we held workshops with a focus on ‘What matters to me’ from the viewpoint of the patient, this helped us focus on what would have a positive impact to the patient and then on what we could change
• We spent time mapping out the pathway with those in the room this helped us identify what data was available so we could appropriately measure if the changes we were making were improvements

Building Trust and understanding

• The format of the Big Room has allowed us to build trust across the pathway and have better visibility of those people working in it, we now structure the Big Room in the same format each time and we start with a different service explaining what they do to those in the Room
• You do not need to have all the answers as a coach, the Big Room has helped us better understand our pathway and what was already out there that we weren’t aware of
• Sitting on your hands and letting others work through problems can sometimes feel difficult or counter intuitive, but this has prompted some of our best work and increased ownership in the group

Ensuring the right people are involved

• Bringing everyone together is one of our biggest successes – when we first set up the Big Room, I was worried people would think I was wasting their time but by having everyone in the room we have managed to form the best solutions.
• Getting non-clinical support in the room from those working in IT and other areas has been valuable to us as a team, speeding up processes and moving the work forward quicker
• Having carers and patients involved in the Big Room has meant we can really understand their experiences and what is important to them and is an important reminder of why we are all here

Learning together

• It’s okay to make mistakes – the Big Room is a development process where you can all learn together
• It’s all about ownership so it’s really important to get everyone involved – you don’t necessarily need the same people in the room every week, people can come and go as it is helpful
• As coaches we have seen how the people in the room have changed in the way they work with one another – they want to be involved in the work and make a difference
• Sending documents ahead of meetings allows everyone to get involved – there will be different levels of IT competency so you can’t assume people will be able to access things through a Microsoft Teams channel or other format
• Multi-voting is a tool we have used quite often and has helped make sure everyone’s voice is heard, it also helps us to prioritise our work

Taking a mixed approach

• Having the Big Room in a virtual format has meant more people can join particularly those working clinically
• We see the benefits of having an “in-person” Big Room every now and then as some of the tools such as process mapping are easier to do when you are all together
• We only have our Big Room once a month which many may think is not often enough, however that is what works in our context and creates the best engagement – the work doesn’t stop in between

Avoid jargon

• As trained coaches we are familiar with tools such as a fishbone diagram or driver diagram, you don’t necessarily need to use these names when working on these
• If you think a certain tool would be helpful, it’s sometimes good to just give it a go based on what you’re hearing in the room – you can then use this to sense check and bring others onboard
• Some of the jargon can turn people off so meet them where they are at, if the work is progressing it doesn’t matter what you call it

Securing funding

• Use the connections in the Big Room as they might already be working with universities or charities which may offer funding for projects if needed and can support with writing a funding bid
• There are several QI funding streams which come available through the Health Foundation
• Looking into your local AHSN is a good place to look as they usually have innovation funding