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Improving Improvement

A toolkit for Engineering Better Care


Flow Coaching Academy

The Flow Coaching Academy trains health and care staff in the team coaching, technical and relationship skills required to deliver continuous and sustainable improvement.




The Flow Coaching Academy provides a virtual/digital action-learning approach to delivering meaningful change within the NHS. It recognizes the need to deliver not only effective Quality Improvement training, methods and tools, but also a structure to provide the rhythm and pace for improvement. This is achieved by training a pair of coaches from within a specific patient care pathway, whilst creating a community of coaches from national networks and teams located in multiple places1.

The first coach will be an established clinician who works within the pathway and is motivated to improve it, bringing specialist knowledge and credibility. The second will be an experienced person external to the pathway, bringing a fresh pair of eyes, alternative perspective, objectivity and balance2.

The Flow Coaching Academy delivers improvement via a cyclical road map:

  • pre-phase
  • build a big room
  • broad themes
  • global aim
  • generate change ideas
  • driver diagram
  • standardise the changes.

The improvement process is underpinned by the 5Vs framework which is used to assess and understand a pathway. It is fundamental to developing a shared and ongoing understanding within the Big Room:

  • Value - what is important for patients and families?
  • inVolve - how is the Big Room going to involve staff and patients from across the pathway?
  • Visualisation - make evidence visual and accessible to help connect people and data
  • eVidence - the metrics that matter — data that helps to understand the system
  • Vision - a statement of how we see this work shaping the future.


  1. Improving patient flow. South Warwickshire NHS Foundation Trust & Sheffield Teaching Hospitals NHS Trust. The Health Foundation, 2013.
  2. Improving Flow along care pathways. Crisp, Watt, Jones, Amevenu and Warburton, The Health Foundation, 2020.

Getting Started


The pre-phase is the first and most vital step on the roadmap. Here coaches spend time identifying stakeholders, setting expectations and building relationships before starting the Big Room meetings. Coaches can expect to revisit pre-phase activities throughout the life of the Big Room. Initial pre-phase activities typically take 3-5 months from the beginning of coach training.

Build a Big Room

The 5Vs (Value, inVolve, Visualisation, eVidence and Vision) help to build the Big Room by providing a broad assessment of the pathway. Coaches will start this process and build upon the 5Vs with the Big Room. Whilst the process is started during pre-phase coaches and Big Room participants regularly refer back to them, particularly when considering a new change idea.

Broad Themes

Once the Big Room is confident the 5Vs have provided a comprehensive assessment of the pathway, coaches help the Big Room develop broad themes which describe opportunities for improvement based on the assessment.

Global Aim

From the themes the Big Room develops a global aim which describes the processes where improvements will take place, what they expect the improvement to look like and a statement about why it’s important to work on this.

Generate Change Ideas

When generating change ideas coaches have a range of improvement and thinking tools to help the Big Room develop ideas they can test.

Driver Diagrams

Driver diagrams help the Big Room organise their ideas and aims in a visual and original way. Coaches then use the Model for Improvement to help the Big Room develop specific aims which can be tested through plan, do, study, act cycles. Initially starting with small tests the scale of test increases based on data, evidence and the confidence of the Big Room.

Standardise the Changes

Once improvement is evidenced with a range of quantitative and qualitative data the Big Room may decide to standardise the improvements.


FCA (2023). Flow Coaching Academy. The Health Foundation.

NHS (2023). Flow Coaching Academy: Improving with people first. The Health Foundation.


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