Cover: Independent Evaluation of the Flow Coaching Academy Programme

Independent Evaluation of the Flow Coaching Academy Programme

Final report

Published Nov 24, 2020

by Miriam Broeks, Eleftheria Iakovidou, Jack Pollard, Rachael Finn, Sarah Ball, Joanna Hofman, Tom Ling

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Research Questions

  1. Is the FCA team effective in training Flow coaches and in supporting the development of the programme by a process of continuous feedback?
  2. What is the impact of the programme within target areas (pathways and patient outcomes), and in terms of the ability of coaches to develop local capability and capacity to contribute to improvements in patient flow in different contexts?
  3. To what extent has the programme spread beyond initial sites and was this achieved successfully?

The Flow Coaching Academy (FCA) programme, is a Quality Improvement (QI) training programme aimed at empowering frontline staff to improve patient flow through the healthcare system. It is designed and delivered by a team based in Sheffield Teaching Hospitals NHS Foundation Trust and the programme is funded by the Health Foundation. RAND Europe conducted an independent evaluation of the programme looking at: 1) it's effectiveness to train FCA coaches (i.e. participating healthcare staff) to improve local capability; 2) the impact of the programme in improving patient outcomes; and 3) the potential of the programme to spread across the United Kingdom. The evaluation found that there were consistently high levels of satisfaction with the training by participants and reports of feeling prepared to be Flow coaches. There was also evidence that the programme had positive human and technical impacts linked to embedding Flow coaching techniques in daily practice. In terms of impact on patient outcomes, the evaluation found evidence in some cases that there is clear positive improvement in healthcare pathways resulting from Flow coaching. However, there were cases where evidence was positive but additional data was needed to be able to assert that impact was due to the programme. Finally, the evaluation found that the Central FCA team was successful in establishing new local FCAs. To sustain this growth and to ensure the quality of delivery of the programme in new sites it will be important to provide central direction while enabling a degree of local adaptation.

Key Findings

  • Flow coaches reported consistently high levels of satisfaction with their training and almost unanimously believed themselves to be well prepared for their roles as Flow coaches
  • Identified improvements brought by the programme to include: bringing new skills into the pathway; better communication along the pathway; improved sense of ownership and 'flattened hierarchies' allowing better flows of information and ideas among team members working on a pathway; and an improved collaborative culture.
  • Based on the secondary data analysis of pathway data, the evaluation found some cases where there is clear positive improvement in pathways resulting from Flow coaching. In other cases there was evidence of positive change, but further data points were needed to corroborate.
  • The Central FCA team was successful in scaling-up and spreading the programme to new sites across the UK in the first three-years of the programme delivery.


  • Central FCA should produce comprehensive and systematic written guidance for delivering the FCA programme and build-in a system for local FCAs to provide feedback.
  • The Central FCA should provide greater support to pathways to produce and communicate quantitative measures of impact.
  • To facilitate future spread of the programme the benefits of the Flow coaching approach should be amplified to the wider policy community.

Research conducted by

This research was commissioned by the Health Foundation and conducted by RAND Europe.

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