The Health Foundation has been supporting efforts to improve the flow of patients along care pathways for more than 10 years. This has culminated in a UK-wide programme, the Flow Coaching Academy (FCA), led by the Sheffield Teaching Hospitals NHS Foundation Trust.

The programme is based on a co-coaching model combined with elements of improvement science. It aims to support establishing multiple FCAs across the UK, to scale up the approach and to build a community of practice to share learning. The training focuses on both the technical and relationship skills required to deliver continuous and sustainable improvement.

This learning report is based on the formative FCA evaluation completed in 2019 by RAND Europe and interviews with FCA programme leads during the COVID-19 pandemic. It focuses on how the programme has been planned, designed and implemented. The report also explores flow coaching academies in more detail, how coaches are selected and trained and how care pathways are chosen. In the 5 years from 2015 to 2020, the FCA programme has evolved from an emergent initiative into an evidence-based, replicable approach to improvement at scale and has been adopted at a strategic level by NHS organisations. The growing FCA community are committed to continuing to co-design the programme, sharing experience and co-innovating as the programme adapts to the changing context of health care.

The learning in this report will be of value to the national and regional organisations, system leaders and improvement practitioners involved in commissioning, planning and delivering improvement programmes in the NHS. 

Cite this publication

Crisp H, Watt A, Jones B, Amevenu D, Warburton W. Improving flow along care pathways. 2020. (

Further reading


Flow Coaching Academy


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