Head & Neck Cancer Big Room – Continuously improving patient experience
In this article, we talk to Katie and get a Coaches perspective on how the Flow Coaching Academy’s (FCA’s) methodology has made a difference to the way patients experience care in the Head and Neck Cancer pathway across South Yorkshire and Bassetlaw ICS in partnership with Chesterfield Royal Hospital.
In 2018-2019, Flow Coach Katie Smith, Specialist Head and Neck Oncology Dietitian, began her journey to become a qualified Flow coach and to lead the Head & Neck Cancer pathway Big Room at Sheffield Teaching Hospitals. You can read about their initial vision and achievements in the case study here.
In this article, we talk to Katie and get a Coaches perspective on how the Flow Coaching Academy’s (FCA’s) methodology has made a difference to the way patients experience care in the Head and Neck Cancer pathway across South Yorkshire and Bassetlaw ICS in partnership with Chesterfield Royal Hospital.
We explore
- Focusing on ‘our’ patient helps to remove barriers to improvement
- Making it safe to make a difference
- Methodology focused on small improvements that have big results
- System-level spread and adoption
At the Flow Coaching Academy, we put people at the heart of what we do, this includes patients.
We asked Katie, how the FCA methodology’s focus on patients impacted the Head and Neck Diagnostic pathway service improvement programme.
The focus on patients helped us to look at doing things significantly differently to improve their experience across a complex pathway. It helped teams to view the patient as ‘our patient’ and consider priorities and improvements beyond their section of the pathway. This helped to remove silo thinking but importantly it provided each member of the Big Room a clear understanding of why we are doing this, which harnessed commitment from all
The FCA course teaches the power of bringing the patient story into every Big Room meeting. The Big Room is a unique space, it’s a weekly meeting that is at the heart of the FCA improvement methodology. Coaching pairs (or triplets) who train together on the course learn how to set up their own Big Room but importantly they are taught powerful relational skills that enable them to coach and motivate others to undertake improvements needed across a pathway or system.
We asked Katie about the role of the Big Room in the Head and Neck Pathway improvement…
The Big Room has brought the Head and Neck team together; we have worked as one team without hierarchy over the past 3 or 4 years. It has enabled patients, care providers and patient charities to collaborate to continuously improve head and neck services over this time. What is great about the big room is everyone can bring a topic for discussion; everyone can have a say and it is a safe space to trial ideas.
The Improving with people first course focuses on relational skills development but it also provides a road map for improvement and a toolbox of improvement methodologies. Coaches draw on this framework to manage the complexity of the change they seek in their pathway or system. The methodology encourages small tests of change using PDSA cycles to break down the complexity of pathway improvement. These small changes build together to enable the safe testing of new approaches and larger improvements.
We asked Katie about the effectiveness of the FCA methodology…
The FCA methodology for me was the perfect combination of service improvement, data capture and analysis but the most crucial aspect of patient experience. It has enabled us to implement many small tests of change, standardised protocols, implement patient collaboration projects and carry out deep dives into where the improvements really can make a difference to patients.
The FCA methodology is designed to support pathway-level improvement but has proven to be suitable for system-level transformation.
Katie, you worked across the South Yorkshire Region (SYB) to reduce variation in the systems. Can you tell us more about this?
The cancer pathway differs from other healthcare pathways as patients are cared for across multiple hospitals across SYB and within one patient journey can use th stressful and create increased anxiety. By understanding this, each team can come together in the big room to understand their role, clinical pressures and offer an outsiders view of the problem.This helped make the transition between teams efficient and timely reducing worry time for the patient and their care providers.
Finally, we asked Katie for some closing thoughts on the impact their work has and continues to have on patients.
What are the next steps for the Big Room?
Our work has not only involved the patient at each step, it has also reduced first seen appointment to 7 days, improved turnaround in radiology and histology, carried out a prototype ‘my head and neck pathway app’ and implemented ‘electronic holistic needs assessments clinics’ and treatment summaries within ENT, all of which are directly impacting on patient experience. Many other improvements less visible to patients including upgrading equipment for diagnostic tests, standardisations of policy and protocols to reduce variations in care, have been made across the region and are indirectly improving the experience of the patient in the pathway.
The Big Room has been a valuable resource for clinical and patient voice but also an opportunity to identify never seen before data to support business cases, improvement projects and dismiss preconceived ideas. It really came into its own during the COVID pandemic as the team had a platform to raise the question of ‘How do we continue to provide a service for our patients?’ and enabled us to continue to diagnose and treat patients throughout. We are now focused on meeting the national Head and Neck Cancer best practice timed pathway milestones. The views of the patients on why these are important for earlier, more efficient diagnostics are at the heart of our work so patients can be supported during their most vulnerable phase of the pathway
It’s evident from the work that Katie and the Big Room participants have been doing that the Flow Coaching Methodology is effective in the long-term. Their Big Room continues to drive improvement of cancer services 4 years on from its creation.
The case for its effectiveness is further highlighted by the spread of its use across other hospitals and services in the region and the establishment of 5 pathway service improvement working groups to carry out pathway analysis and implement tests of change.
If you are interested in being supported to create the conditions that Katie describes in this article and you have been inspired to want to become a Flow Coach or explore how the FCA’s methodology could support you to enable improvement in your organisation, then get in touch by completing our enquiry form.
Supporting information
The FCA has trained over 500 coaches and supported the creation of more than 150 Big Rooms, many of which continue to support continuous improvement in their organisation. As well as the example in this article, one of the most long-standing Big Rooms is the Frailty Big Room at the home of the FCA, Sheffield Teaching Hospitals NHS Foundation Trust. This Big Room recently refocused to support the delivery of the Trust’s new Frailty Virtual Wards, to read more about this visit the Flow Coaching Academy’s news section.
