Sheffield Teaching Hospitals use their FCA’s methodology to enable implementation of the Frailty Virtual Ward

The NHS is increasingly introducing virtual wards to support people and monitor their condition at the place they call home, including care homes. In a virtual ward, support can include remote monitoring using apps, technology platforms, wearables and medical devices such as pulse oximeters. Support may also involve face-to-face care from multi-disciplinary teams based in the community, which is sometimes called Hospital at Home. (Source: NHS England Virtual Ward)

The national focus for virtual wards is in two areas – frailty and acute respiratory infection. Sheffield Teaching Hospitals NHS Foundation Trust (STH) has a history in system redesign and improvement within geriatric medicine and community care^[1]. In 2012, the focus was to learn how the discharge process could be improved for older people who were currently undergoing a multidisciplinary assessment in hospital to determine the support required for their discharge home.

It embedded the use of methodology central to the Flow Coaching Academy’s (FCA) – Improving with people first programme, called The Big Room. The Big Room is a safe space to use for engaging front line staff and patients in the design of a healthcare processes, facilitated by coached discussions. The Big Room also facilitated the collaboration between hospital and community-based teams and continues to do so today.

The Frailty 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. Tom and Kevin worked with the new and existing Big Room members to reshape their aims, purpose and goals and relaunched with the aim of “creating 60 bed capacity for the virtual ward by April 2024, allowing for 257 patients per month to benefit from being taken care of in their own homes”

We asked Tom and Kevin why evolving the Big Room and using the Flow Coaching methodology was the right choice, to enable the establishment of their frailty virtual ward.

The Big Room participants have a lot of existing knowledge, and the framework of the big room makes it adaptable to a new context. Our experienced participants have helped new attendees to adapt well to the Big Room way of working. I have seen the collective improvement capability increase in only 5 weeks

Kevin Firth, Programme Manager

Tom commented that Healthcare improvement and service design is about collaboration and relationships, or as we like to say it is 80% human and 20% technical improvement skills. The Big Room rigorously integrates improvement tools and techniques, with tried and tested improvement approaches and team coaching to meaningfully transform services and outcomes.

The team have outlined the three main purposes of the Frailty Big Room as

• To create a reflective learning space to develop a patient focused service, that is tested and developed with community services and the patient at the heart.
• To create a collaborative space for stakeholder engagement and improvement work. A space for front line staff to communicate, share ideas and contribute to project and programme milestones
• To build ownership, improvement capability and maintain pace of improvement work, from planning phase through to testing and standardisation of delivery

The Big Room weekly meeting is part of a wider project and programme structure, that provides reporting, monitoring, governance, and strategic leadership for the Virtual Ward service development.

If you are in the process of establishing a virtual ward in your organisation or considering designing or redesigning a current service, then talk to the Flow Coaching Academy about how their Improving with People First Course could be the enabler you are looking for. Get in contact.