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On 13 March 2019, the third annual conference of the national Radiotherapy Quality Special Interest Group (RTQ SIG) met in the format of their first ‘Unmeeting’. Below, a few of RTQ SIG members have shared their experience and what they felt they gained from the day.

Michelle (Design Team member):

As a Quality Manager working in Radiotherapy, I must admit I wondered what an ‘Unmeeting’ was! It all sounded slightly negative for the word to begin with ‘un’. All I could bring to mind was ‘unappealing’, ‘unimaginative’, ‘unreliable’ and ‘unhappy’ before I joined the design team and experienced the Unmeeting first hand.

Isabel (Lead organiser, and Design Team member):

Many Quality professionals working in Radiotherapy (RT) share the same frustrations around engaging colleagues with quality issues and often feel isolated working in this niche area. The Unmeeting came about as an unconventional way of organising an event where the agenda is both determined and run by delegates. If someone had asked me whether our community was ready to embrace an Unmeeting, my answer would have been ‘I don’t have an answer yet’.

Full engagement in any meeting means everybody contributing ideas, discussing options and shaping the next steps actively and unrestrained; this applies to engagement in Quality issues too. However, the conventional ‘BIG 5’ approaches used in most workplace meetings are not the most effective tools for engaging people. The first three – presentation, status report and managed discussion – give maximum control of content to one or a small number of people with no structure to engage others. The other two – brainstorming and open discussion – provide a structure to include others, but give them little or no control over content.

Instead, the Unmeeting format utilises techniques known as Liberating Structures which give everyone the space to share and understand the common challenges we face, generate multiple ideas, new perspectives and solutions by undertaking rapid design, build and feedback exercises using a range of creative methods and tools to break the mould of the ‘BIG 5’.

Our day started with ‘Transformation’ and ‘Catalyse’ card decks, which members used to link the past, present and future of their personal and career developments. This self-diagnostic process offers an open-hearted way to explore individual and common approaches to life and leadership. It also provided a very effective way to reflect on why we were there, stimulating conversations around the tables.

One of the first tasks of the day was using a Liberating Structure called ‘25/10’ where we invited everyone to write down a bold idea for change on an index card. People then milled around the room passing the idea cards from one to another for a quick review with participants rating the different ideas landing in their hands; this repeated for five rounds. At the end of the five rounds, the ideas that had generated the highest scores from the whole cohort were revealed. This activity harnessed the group’s ability to tap into the collective intelligence of our own community, encouraging people to think boldly in an environment in which good ideas can bubble up in less than 30 minutes. You can see all the ideas we came up with during our Unmeeting through our photos from the day.


I thought the Unmeeting was great, really really good! The tool where we all write our ‘great idea’ (25/10) and ‘what-we-want-to-talk-about’ (‘Unconference approach’) is a really good way to see what’s on everyone’s mind and I really liked that. Essentially, we all have the same thing on our mind! We just have different priorities. I was surprised how many wanted to discuss incident reporting/sharing. The only downside to the Unmeeting approach was it was so good we didn’t have much time for informal networking.

Our quality management system (QMS) was basically built 20 years ago and now times are totally different, and with modern technologies emerging at such an explosive rate, our QMS seems like a rambling array of add-on documents. I had a lively discussion with one of the attendees about managing the QMS by means of process mapping which I have given a lot of thought. It makes a lot of sense regarding using a process mapping approach to organising the complex system and I would love to explore further.


Although I’m a Radiotherapy Physicist, I spend a reasonable portion of time looking after the department QMS in Inverness.  While that system is a traditional ISO9001 system, I’ve begun to think we need to be pursuing other Quality Improvement techniques to really take us in the direction we should be going and hopefully to encourage others to become active in Improvement. In fact, this is exactly why I joined Q. This has led me to find approaches such as Liberating Structures, 15s30m, and in there ‘Unmeetings’

I really have to agree with the 25/10 ‘agenda setting’, I thought it was really effective as it both ensured the topics of greatest interest were addressed but also allowed us all to see what was of interest/concern to everyone there and how similar (or different) our own interests were.

Even though the Unmeeting did consume practically the whole day I did manage to discover at least another couple of Radiotherapy Physics based at QMS, so perhaps I’m not too odd? I wasn’t directly involved in the process mapping discussion but I think this sounds interesting and I now wish I’d had time to get involved in this stream. It has been one of my aims to transform (and encourage others to do it!) as many of our traditional documents into something more diagrammatic.


I agree with Caryl. Introduction of QMS through the Quality Assurance in Radiotherapy (QART) initiatives into RT services started in the 80s following the Bleehan Report, and RT is dramatically different now than when I first started my RT education in the 90s. Technological advancements have increased the quality and accuracy of RT delivery and also revolutionised communication methods so that sharing knowledge and exchanging ideas have become almost instantaneous.

Our historical focus on QMS in RT has embedded a strong culture of safety in our services but our community needs to be aware of the changes in quality thinking in the wider healthcare system. While a demonstration of continual improvement is a requirement for a certified QMS, quality improvement methods are not about reinforcing mechanistic and hierarchical models. QMS is effective, and disengagement often lies in the context of implementation and mindset about change. Our Quality community must rethink our approach to engaging our RT colleagues, particularly as generation Y and Z are entering the healthcare workforce, bringing their different values and expectations into the complex realm of healthcare system transformation.


I hadn’t come across the Unmeeting format before and I found it quite inspiring. We are discussing how we could use it to increase engagement with staff and have come up with a couple of ideas but we need to work it through. It was great to get the opportunity to discuss the things that are important to me with a wide range of people. I feel I was in a similar position to a lot of other people – so while there are plenty of issues still, I don’t feel alone in tackling them.


I am already an advocate for Safety II and it was fantastic to hear that another department is about to launch a Learning from Excellence project in RT. We can organise some education sessions around this because it would be beneficial for people to understand the theory behind it! Involving everyone from the beginning with some easy to use and fun tools is a good starting point. The Unmeeting instilled a feeling that we really are the “drivers of change”. I left the day reflecting on what my original thoughts on the Unmeeting had been. The words that now flooded into my mind were ‘unlimited’, ‘universal’ and most importantly in summing up the day – ‘united’!

If you’d like to find out more, join the Radiotherapy Quality Special Interest Group.


  1. Isabel,

    It sounds as if it was another successful unmeeting. Well done. I'm very keen to explore, with any of your members, a more 'process based' QMS along the lines indicated in Caryl's comment above. I'll send to you an illustration of a QMS that I designed and was responsible for back in 1990. I think it will illustrate how far the NHS is behind in quality management system design. Please feel free to forward this illustration to any of your members. I'd be very happy to elaborate if anyone is interested.

    Regards Tom

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