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  The Big Room method

As a self-confessed improvement nerd, jargon such as ‘co-design’, ‘bottom-up engagement’ and ‘new power’ roll off my tongue. I have written previously about using the clinical microsystems Flow Coaching Academy methodology in my hospital maternity unit to bring staff groups together and create a culture of continuous improvement.

With great sadness in April 2022, after four years, we collectively decided to close our weekly Big Room. The Big Room approach aims to bring together multidisciplinary staff along the care pathway, enabling them to focus on the patient experience and assess, diagnose and iteratively test changes to improve patient flow.

Whilst it was excellent at mobilising staff and bringing people in the hospital together, staff shortages and funding priorities were not making space and time for improvement to happen.

Can a Big Room be built outside of a hospital?

Over subsequent months, I came across the idea of anchor organisations and learnt about my trust’s intention to improve health, wealth, well being and equity of our community.

The idea of moving away from hospitals being ‘fix-it shops’ was a paradigm shift.  Could I find improvement resource and power outside the hospital?

I connected with Maternity Champions, local third sector partners based in Kensington and Westminster. I learnt that these two boroughs had the largest variations in health outcomes in the country. People living less than two miles apart could have a difference of 15-17 years in life expectancy.

For seven years I had worked in West London, cycling to work through leafy streets, passing numerous private schools along the way, unaware of the scale of educational, health and employment inequity in these two boroughs.

The Maternity Champions programme trains and recruits local volunteers to support and engage with parents through their pregnancy journeys and beyond.  They have baby groups, breastfeeding groups, cooking classes, exercise classes, playgroups and all sorts of free activities to bring local community members together.

I asked myself why the hospital was not already integrating with these groups to improve the health of our local population?  Health is about so much more than clinic appointments, wards and scans in hospital. It means being supported by people around you when times are tough. It is about knowing basic things like how to choose and prepare healthy foods, moving your body and teaching your kids to do the same.

Sona, the Maternity Champions Programme Manager for Kensington, told me, ‘We need a way to reach first-time mothers and fathers in pregnancy. By the time they learn about our activities, their babies are often older. They tell us, “I wish I had known about your breastfeeding group when I was pregnant”, as early support for breastfeeding is so key.’  Maybe we could help each other – I speak to pregnant mums and birthing people everyday!

Co-creating an inclusive Big Room where all can speak

We began to work together and established our Big Room at the Venture Community Centre in the Golborne Estate. At our first meeting last September, we started with 18 people, including five Maternity Champions (local volunteers), six local mums, one GP, and three hospital staff members.

In contrast to previous engagement events I had run by video link, where we really struggled to get ethnic minority women to turn their cameras on and speak, most of the champions and mums were people of colour.

That first meeting, we decided to name our Big Room ‘Family Voices’. We hold Family Voices Big Room sessions monthly in person and weekly by video link. We use Flow Coaching QI methods and always make a point of remembering that we are a working improvement meeting.

Storytelling with a focus on postnatal mental wellbeing

In the first few weeks we explored champions’ and community members’ experiences of pregnancy and parenthood and their relationships with formal healthcare structures.

We heard powerful stories from individuals who often felt that they were let down, not listened to, and had lost trust in the health care service. We confronted prickly topics, such as how being black or brown influences our health and health care experience.

After holding multiple votes on an improvement pathway, we decided to prioritise mental health around the postnatal period, with a focus on infant feeding support as this is a major cause of anxiety in new parents.

The Family Voices Big Room has extended its invite list to psychiatrists, GPs, user experience professionals, partners from the Integrated Care System and the Academic Health Science Network.

A partnership model for hospital and community-based care

It is early days into this way of working but I am hopeful. This partnership approach with local parents is helping me to re-experience joy in improvement. I feel re-energised by our monthly meetings at the community centre where we have lunch together, get out sticky notes and flip charts, and huddle round tables to share ideas and plan next steps.

Recently, as I was cycling my usual 16km route from Tottenham to the hospital in Acton where I am based, I stopped to say hello to Shirin, one of our Maternity Champions who has made an invaluable contribution to our Big Room. She was on her way to suss out a new venue to teach aromatherapy to local residents. As we parted, I peddled away with a feeling of warmth, knowing that we both were going to spend our day trying to improve the health of this diverse and wonderful community.