IN-DEPTH: BIG ROOMS


BIG ROOMS THE


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n a meeting room at St Mary’s Hospital, a group of doctors, nurses, therapists, managers and receptionists gather together every week without exception. They don’t all know each other, but they have one significant thing in common – their patients. In this, the ‘big room’, staff involved in every step of a patient pathway come together to explore the pressure points and find simple, practical ways to address them. The focus is squarely on improving patient care and identifying change ideas that can be tested. “There are so many people involved in patient care, but we often exist in our own silos,” said Dr Anne Kinderlerer, consultant physician and big room coach. “The big room meetings enable us to discuss our part of the whole together, and look at


“The big room provides us with a disciplined format for weekly meetings and a safe space for the team to design and test out their own changes”


Winter 2017/2018


ways we can work more cohesively – which is pretty unusual in medicine.” The big room concept was developed by the car industry in Japan. Known as obeya, it was imported by Sheffield Teaching Hospitals NHS Foundation Trust in 2010 and embedded as an improvement technique. Obeya is based on the principle that small changes, rigorously tested, add up to significant improvements for the whole system. Ralph Critchley, improvement


manager at the Trust, said: “The big room provides us with a disciplined format for weekly meetings and a safe space for the team to design and test out their own changes. It means staff own the changes they make and don’t feel they’ve had them imposed on them.”


Big room meetings are structured so there is no hierarchy – everyone’s voice is of equal importance, leaving staff free to challenge each other’s ideas in a respectful way.


Alongside their own experience, participants in the big room are encouraged to use data and patient stories to shape change ideas. Changes


Junior doctors Ed Matthews and Dan Huntley at the diabetic foot big room


How a method developed in the Japanese car industry is improving patient care


can be small and simple – from editing the content of a form to make it more user-friendly, to setting up a staff training session where a skills gap has been identified.


THE BIG ROOM PILOTS The Trust is piloting the big room approach to improve three common patient pathways: sepsis, diabetic foot, and children’s asthma and wheeze. Since the start of the pilots in spring 2017, the feedback from staff has been overwhelmingly positive. Inside the big room, the enthusiasm is palpable: “Teams are focused on making changes that add the very highest value for patients,” continued Ralph. In time, the big rooms will expand to include current and former patients, and colleagues from partner organisations in the community. During 2018, staff will experience the ‘big room’ approach for a further six care pathways.


FOR MORE INFORMATION Email: Imperial.quality.improvement@nhs.net Pulse/ 5


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