Lessons for QI facilitation – from assembling flat packed furniture

UCLPartners is currently running seven Quality Improvement (QI) collaboratives across four CCGs in North Central and North East London, covering over 80 GP practices. A key element of these collaboratives is the six-weekly learning sessions, where UCLPartners brings practices in each locality/network together to learn about QI and share their experiences. To make this collaborative model sustainable, UCLPartners has also recruited and trained two local QI leads per network (GPs and practice managers), who can facilitate future locally-run QI collaboratives.

In this blog, Phil Hadridge, reflects on facilitation skills and shares his 3-point checklist for effective QI facilitation. Phil is an organisational development expert, international mediator and leadership coach, and has supported our local QI leads with their facilitation skills development.

What does facilitating groups working for quality improvement have in common with DIY?

Not a lot you might think.

However recently one of us visited a family member in her new flat. She had bought a flat-pack chest of draws – and our task before lunch was to assemble it. I was a bit apprehensive recalling a recent experience with a different brand of self-assembly and struggling with flat-pack products in the past!

However, it went well: in 90 minutes of time we added value to the box of bits, and the life of my family member. The deal with IKEA is clear: we will sell you a cheap product and your time will make it into something that would otherwise have cost far more.

We were impressed by the simplicity of the instructions and how it did what it said – the design and supply of bits was spot on and we were pleased we added an electric screwdriver to the suggested list of tools.

And the analogy to QI facilitation…?

Overall, when working with a group focusing on improving the quality of health and care:

a) Value: we need to add value to what they are doing. Facilitation is about making things easy (or easier). Helping a group get further and faster with their task and relationships than they could on their own. And to complete our FFFF of facilitation, doing that in ways that are both fun (or at least engaging) as well as focused.

b) Structure: we need to think about the way we structure and explain sessions – so they are in some ways fresh (another ‘f’) and helpful: sharing what we are planning to do in ways that earn confidence without confusion.

c) Skills: we need to be aware of the key personal skills and knowledge we might need: from a new creativity technique or a bit of digital kit or an in depth understanding of group dynamics, for example.

Small group facilitation supports engagement and promotes learning. These skills help colleagues move from overall inspiration to specific implementation – in a way that answers their questions and addresses their concerns.

So, to expand a little bit, if IKEA furniture comes with some simple steps, what are a few things to get right in our delivery of QI facilitation?

There are three skills or routines we think are important from our years of work in this area, and recent experience of training QI leads in London. Make our three points your checklist, and see how you get on:

First, prepare/practice/early arrival:

Do not underestimate the importance of preparing for the facilitated session. Talk to someone who knows the group to understand the group dynamics, understand the needs of the group (through a pre-survey) or establish the outcomes the group expects early.

Arrive early to give yourself time to check last-minute arrangements and get yourself mentally ready for the session. This includes checking seating arrangement to ensure the set-up is ideal for your session, and making sure the audio-visual hardware is working smoothly.

Second, remember the 4 roles:

The role of a facilitator is to guide and manage a group so that the objectives of the group are met effectively, with good participation and buy-in from everyone. This may mean calling on different skills, such the four listed below, to enable you to guide the group towards its conclusion:

1. Keeping to task: this means remembering the purpose and outcome of the session and keeping the group focused on the task at hand
2. Keeping to time: this role can be outsourced to a colleague or participant in the room to help you focus on the other roles
3. Capturing: after each segment or activity, as well as at the end of the session, it’s important to summarise what has been covered and feedback to the group. By doing this, you are checking and confirming understanding and agreement before moving on to the next part of the session. If possible, outsource the writing down of ideas on a flipchart or screen to a colleague or participant so you have your full attention on keeping the focus and getting participation from everyone.
4. Managing participation: this may possibly be the most important of the four roles, and can be challenging but very rewarding when done effectively. To make this process as smooth as possible, start with the ground rules for the group; set the scene and expectations, and be clear with the aims and outcomes you’re working towards as a group. Another key aspect of this is to get things flowing, keep momentum and energy, while listening, engaging and including everyone.

Third, take time to review

At the end of the session do a check-in with the group. Encourage feedback. Summarise often. Conduct a debrief session with other facilitators or the sponsor to capture learnings and understand how to make it better for next time.

All the best with your bricolage.

Chiya Jones, Improvement Projects Manager, UCLPartners and Preeti Sud, Primary Care Development Programme Manager, UCLPartners also contributed to this blog.