Learning from Q Lab: reflections on flow theory

Since August 2023, five test teams from England and Wales have been working collaboratively to address issues with flow, build collective ownership and reduce waits.

On 21 September 2023, the test teams, co-researchers and contributors met in London for the first Q Lab workshop. The workshop provided a space for the test teams to share insights from their research and receive input from participants and contributors.

The workshop featured a presentation on the Theory of Flow, developed by the Flow Coaching Academy. After the presentation, participants were invited to explore how to use this approach to address the challenge of wait times.

Using the liberating structure of a Conversation Cafe, people were prompted to consider what they were thinking, feeling, or doing about the content that had been shared. From their reflections, three themes emerged.

While many participants were new to the flow theory, the ideas resonated with their experiences and thinking. As one mentioned, ​“it’s so much like the conversations we’ve been having in our [community paediatrics] work, just not calling it flow”. 

The two messages from the flow theory presentation that received the most attention were that demand is predictable and that flow x must equal flow y (in other words, the flow into a service must equal the flow out). Naming this equation explicitly provided participants with fresh energy for deeper exploration and discussion.

Teams explored concepts and theories such as failure demand and the theory of constraints. Participants observed that naming the common issues could help them to make a stronger case to their organisation for the need for a joined-up, system approach to tackling waits.

The importance of looking at issues systemically, central to flow theory, strongly resonated with the workshop participants. ​“You might be able to fix one bit of the system, but change is limited if other parts don’t change – flow theory shows this so clearly.” 

There were mentions of exciting and innovative practices from the UK and beyond. However, there were also frustrations with how much of the current practice is limited to quick fixes and influenced by risk aversion.

Participants discussed what is required to support sustainable change in reducing waits in elective care. 

First, leadership needs to be courageous and have trust in the professionals who are leading innovation and improvement to support them in challenging the established ways of doing. 

Second, there is also a need to rethink how and when we evaluate the success of initiatives, recognising that a system-level change likely takes longer for the positive impact to materialise. 

Finally, participants echoed the points made by the Flow Coaching Academy that tackling waits requires collaboration with stakeholders from across the system. Participants discussed different ways to approach this in the current climate and with winter pressures starting.

Sarah Rae offered her reflections on how involving patients from the onset can help teams to gain a more holistic understanding of the journey that patients go through as they move from one appointment to the next.

Sarah’s advice for anyone starting is to remember that co-production and working with patients is messy but that starting somewhere is always more valuable than not engaging patients at all.