1. 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

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

3. Michael Porter: Value in Healthcare

5. Sheffield Microsystem Coaching Academy

6. 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

7. 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.

8. Outcome – Length of Stay

9. Outcome – Expected death rate
Data from Dr Foster

10. 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

13. 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

14. 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

15. Improving Flow:
Cohort 1

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

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

18. 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

19. 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

20. 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

21. SARAH’S STORY

22. 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

23. KATIE’S STORY

24. 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

25. Questions?