Frailty Virtual Ward Big Room Progress at STH
Flow Coaches Tom and Kevin talk about how the FCA methodology is supporting their progress and get a sense of the story so far.
If you read the story in September you’ll know that the Frailty Virtual Ward Big Room is coached by two Flow Coaching Academy Faculty members and experienced improvement specialists; Dr Tom Downes, Consultant Geriatrician and Clinical Lead for Quality Improvement and Kevin Firth, Programme Manager at the trust.
At this time the team were 5 weeks in and already seeing the benefit of using the FCA Big Room methodology to design the patient-centred, community-based Virtual Frailty Ward.
12 weeks on we thought we’d check in with Tom and Kevin and see how the FCA methodology is supporting their progress and get a sense of the story so far from the coaches.
Tom, I have attended a number of the Big Room meetings over the last few months, and I was amazed by the scale of the meeting, with up to 80 people on the invite list. How do you decide who needs to be involved?
“If we’re honest we don’t. The success of a Big Room requires getting the right people in the room together, though not necessarily all at the same time! Initially, we identified some key staff from the hospital and community teams, and a patient representative. We started the Big Room meetings and others have joined by word of mouth or when the ‘unknown’ became ‘known’ that we needed input from others.
Our Big Room now consists of Community Matrons, Consultants, Dr’s, Pharmacists, GP’s, ACPs, project managers from the hospital, existing community services and local transport. We have leadership and executive support from our Medical Director’s office and help with data analysis.”
Kevin can the Big Room be a productive space with so many voices and so much to discuss?
Complexity is a consistent feature of any improvement initiative, and especially in pathway design like this. We use the FCA Roadmap as our guide and in the early weeks of our course we focused on defining our shared purpose, vision, aims and objectives. This helped us to define our core themes and agree leads for each of the themes. The leads help co-ordinate work on each of the themes between big room meetings. Meeting outside of the big room helps make progress and helps develop thinking so that when the big comes together we make the best of the time we have.
The Big Room is the space where the groups bring back their findings and new ideas, use the collective brilliance and experience of those present to make decisions based on data and test results. Tom and I ensure that everyone has a voice, and we hold the space for the frontline teams to have productive conversations and make clear decisions and plans.
We use the effective meeting skills taught on the FCA course to encourage ownership of the work by everyone in the meeting, breaking down hierarchies that would otherwise exist.
The FCA ‘improving with people first programme’ teaches coaches how to coach a Big Room, it provides them with tools and techniques to manage the room and overcome resistance, challenges and obstacles.
Kevin, tell us about some of the roadblocks that the Big Room has encountered and how you have worked as a coaching pair, with the FCA methodology to overcome them.
The scale of the task can feel huge, where do we start….
When the teams feel overwhelmed, we turn to our global aim, which describes the processes where improvements will take place or where new processes will be required. The statements remind the team about why its important to focus and what is important to work on. We turn to a range of improvement and thinking tools taught on the FCA programme. We’ve been working hard to define our process map for patients going from an acute setting home, from home back to an acute setting or straight onto the virtual ward whilst still at home.
Driver diagrams help the Big Room to organise their ideas and aims in a visual way, as Coaches Tom and I use the Model for Improvement to help the Big Room develop specific aims which can be tested through, ‘Plan, Do, Study, Act’ cycles. We remind teams that initially starting with small tests is important, the scales of test increases based on data, evidence and the confidence of the Big Room. It’s lovely watching the teams start PDSA cycles which accelerate the learning and generate patient stories.
Complexity is a consistent feature…
I mentioned earlier that complexity is a consistent feature in improvement and at times has been a roadblock in the Virtual Ward Big Room. Defining the patient journey through the process has led to a lot of discussions about communications, operating procedures, existing services to name just a few. To manage the complexity of the discussions which can often be detailed Tom and I will use key coaching skills; summarising what we hear to check understanding in the room, reflecting back core elements of the discussion to help bring focus and reframing the conversation to help the teams move through resistance or make progress when they feel stuck.”
With a clear purpose to “Enable frontline teams to deliver acute care in the patient’s home”, the Virtual Big Room have been spending the last few months immersed in learning what it will take to look after someone safely and effectively at home.
Tom, tell our readers the key learnings about establishing a Frailty Virtual Ward so far?
Putting the patient voice at the heart of the process is vital, it is a principle we apply at the Flow Coaching Academy. For the virtual ward, we start every Big Room with a patient story, this helps remind us why we are meeting, engages, enthuses, and often generates new ideas.
A wider project team is critical, whilst the Big Room focuses on the Patient service, teams looking at IT, Workforce and transport are working to bring all the supporting elements together.
Virtual meeting platforms have enabled us to coach the staff to iteratively design a safe, effective patient experience – and yet the group only met in person this week for the first time.
Kevin and Tom share with our readers what the next steps in the process are and what they can expect to hear about when we check in with you and the team next time.
There is more to do to test our new processes so this will be our focus in the short-term, and the team plan to test the new virtual ward with patients before your next update.
I hope you agree it’s been a fascinating look inside the Frailty Virtual Big Room, we will be sharing more updates on the progress over the coming months, to make sure you don’t miss out on the next installment sign up to our newsletter
