Big Room Workshop Tom Downes Clinical Lead for Quality Improvement, Sheffield Teaching Hospitals The Health Foundation / IHI Quality Improvement Fellow 15th November 2016 Version 3 13 August 2014

Introduce the Improving Flow programme Group activity exploring making data visible and the value of coached conversations including staff from across the pathway Questions

Michael Porter: Value in Healthcare

Sheffield Microsystem Coaching Academy www.sheffieldmca.org.uk

Cohorts 1, 2, 3, 4, 5 & 6 MCA Coaches are: Doctors Nurses ODPs Therapists Managers Facilitators Exec Directors MCA Coaches are from: STH Hosp & Community The Children’s Hospital The Care Trust Sheffield Hallam University Primary Care Northern Ireland Scotland London

In December 2015 they started weekly Big Room meetings. Big Room meetings aim to gather together everyone involved in the skin cancer pathway – including plastics, dermatology, primary care, admin, oncology and so on and focus on the experience of patients. With the Big Room, Nick and Claire are working on building improvement capability by helping the team collaborate, collect and analyse data, develop aims and change ideas and making small tests of change that will add value to the patient experience. Over time the Big Room has developed these small tests of change on the basis of data and results into larger tests that they predict will be sustainable and demonstrate improvements for patients and staff.

Outcome – Length of Stay

Outcome – Expected death rate Data from Dr Foster

The Big Room in Action Physiotherapist gives an account of the test of change to get a patient home on the day they were discharged by the GSM consultant Senior registrar General Manager For Medicine GSM Matron Service Improvement Social Services Community manager Physiotherapist Secretary Discharge Liaison

Benchmarking and visits Improving Flow: Roadmap Change Ideas Brainstorming Change Concepts Benchmarking and visits Process/Value Stream Map Fishbone Spaghetti Diagrams Selection criteria & Multivoting Global Aim Driver Diagram Specific aim Standardise Themes ‘Post-it Frenzy’ Change idea A P S D Build a Big Room Define measures A P S D A P S D Pre-Phase Coached weekly meetings Patient stories System data Reflective learning

Measuring system dynamics Flow in – the DEMAND of water Amount of water in the bath – the WORK IN PROGRESS Time from the start of each process to the end – a CYCLE time How long from water entering the bath until leaving through the drain - the LEAD time Flow out – the SUPPLY of water to the next system

Improving Flow: Cohort 1

Replication by social franchise Improving Flow: Replication by social franchise Cohort 2 starts January 2017: Bath Imperial Northumbria Sheffield Warwick

Oct 2015 In October 2015, Nick and Claire joined the Improving Flow programme

Sheffield Teaching Hospitals NHS FT x 10 Sheffield Teaching Hospitals NHS FT x 6 South Warwickshire NHS FT Along with 10 coaches from Sheffield, 6 coaches from Warwick and 6 from Bath. x 6 Royal United Hospitals Bath NHS FT

Sheffield Teaching Hospitals Claire Skin Cancer Specialist Nurse Nick works in Service Improvement at Sheffield Teaching Hospitals. Claire is a Clinical Nurse Specialist in Skin Cancer at Sheffield Teaching Hospitals. Nick Service Improvement Sheffield Teaching Hospitals Claire Skin Cancer Specialist Nurse Sheffield Teaching Hospitals

BIG ROOM MEETING AGENDA Patient Story (5 mins) Discussion of Patient Story – what does this highlight about the patient experience along the pathway that your individual service data doesn’t highlight?   Share both sets of data with the whole group What is the way forward? Evaluate

SARAH’S STORY

BIG ROOM MEETING AGENDA Patient Story (5 mins) Discussion of Patient Story – what does this highlight about the patient experience along the pathway that your individual service data doesn’t highlight?   Share both sets of data with the whole group What is the way forward? Evaluate

KATIE’S STORY

To infinity… and beyond Oct 2015 Although the monthly learning sessions have ended, the Big Room meetings continue at the same time in the same place every week; an ongoing commitment to continuous improvement from both the coaches and the team has developed. To infinity… and beyond Sep 2016

Questions?