As a member of the emergency care improvement team (ECIST) I visit lots of hospitals, and it is clear that patient flow in hospitals is a large, and growing, challenge to providing high-quality care. Waits and delays are not only disrespectful to patients, but they are also potentially harmful. When patients experience delays in treatment or are left to wait on trolleys in the emergency department or placed on wards not specialising in their care outcomes are worse and costs are higher.
The key challenge is for organisations to see staff involvement as an integral part of their approach to improvement.
Achieving hospital-wide patient flow, and ultimately improving outcomes and the experience of care for patients, requires all those involved in the patient pathway coming together to redesign it. Staff involvement is an essential ingredient of a sustainable approach to quality improvement. There are a range of ways in which staff can be involved in quality improvement activity. The key challenge is for organisations to see staff involvement as an integral part of their approach to improvement. In order to participate effectively in quality improvement, staff need protected time and training in quality improvement techniques. Greater staff involvement has been shown to deliver sustainable improvements.
In my role as an improvement manager, I work with many different staff groups, using improvement methodology to improve patient flow. When the opportunity arose to learn about flow coaching, I jumped at the chance as it appeared to be a pragmatic improvement technique that would engage frontline staff in order to improve patient care.
Flow coaching provided a real opportunity to gather all those involved in patient flow and to tap into their collective wisdom in order to start to solve something which is incredibly complex. Flow coaching also enabled staff to invest rather than buy into change.
The recent Q Visit to Imperial Healthcare NHS Trust – Flow Coaching Academy provided an excellent insight into a programme that empowers frontline staff to improve patient flow. During the day I learnt about the origins of flow coaching, from the early days at Sheffield Teaching Hospitals NHS Foundation Trust to its spread to numerous locations across England. I also gained an understanding of the Big Room process and met coaches who shared their experiences and learning. Finally, I heard how the improvement programmes, delivered through flow coaching, at Imperial are being evaluated in terms of their impact on improving care, the experience of staff, and return on investment.
Effective staff involvement is key to successful quality improvement programmes. With any new initiative or approach, there are always steps to consider and potential challenges to overcome. What I learnt from my Q Visit to Imperial was that flow coaching provided a real opportunity to gather all those involved in patient flow and to tap into their collective wisdom in order to start to solve something which is incredibly complex. Flow coaching also enabled staff to invest rather than buy into change.
I work with many organisations who are challenged in terms of achieving effective patient flow. However, I know that within those organisations staff have the potential to solve this ‘wicked issue’. So, I am now going to start to spread the word that flow coaching is one tool amongst many that they could use to start to address their challenges around flow. Within my own organisation I will be advocating that a critical mass of team members is trained as flow coaches in order to provide another improvement tool for our toolbox.
I thoroughly enjoyed my Q visit to Imperial and would like to thank the Q community for arranging and Imperial for being hospitable and generous hosts. I am now a huge fan of flow coaching and can’t wait to learn more about it and eventually put it into practice.
Key nuggets @sheffielddoc
Flow Coaching Academy principles
Pathways & Big Rooms
‘Successful Improvement 20% technical & 80% human’
— DrDominiqueAllwood (@DrDominiqueAllw) September 11, 2019