A Third of the Front Line: Why We Train So Many Coordinators
In one hospital, about a third of frontline staff became coordinators. Why so many, what they actually do on a shift, and what the research on champions says.
The Roadyom team · · 6 min read ·
When we started a frontline programme in a hospital's four public-facing departments, we did not pick one champion per department. We picked about twenty people. Roughly a third of the frontline staff became coordinators.
That number surprises people. It was a deliberate choice, and it came from one belief: people are the heart of every experience, and people learn a practice by seeing a colleague do it.
What a coordinator is, and is not
A coordinator is a colleague on the same shift, in the same uniform, doing the same work. The role has one main job: to remind. Not with memos. With how they speak to a worried family, how they hand over a patient, how they explain a delay, with colleagues and in front of them.
We call this being a living model. A coordinator does not inspect, rank or report people to management. They observe, coach on the spot, and record good practice by the colleague's name.
Why so many
A single champion works office hours. Patients arrive at night, at weekends and during the lunch break. With about one coordinator for every three frontline staff, spread across shifts, someone who knows the department guide is present on almost every shift.
The number also absorbs change. Coordinators rotate. Some leave, others take their place. A network of twenty survives a departure that would end a programme built on one person.
The split followed the size of each team. Two departments had most of the coordinators. The smallest desk had one.
What the research says about champions
Edward Miech and colleagues reviewed 199 articles on champions in healthcare implementation. They found the term used loosely. Most often it was a simple yes or no: was there a champion or not? Across individual studies, the presence of champions was consistently linked with more effective implementation.
A yes or no says little about the work itself. "Having champions" is not a method. What they do on a Tuesday night is.
Positive deviance offers a second lens. David Marsh and colleagues describe an approach built on a simple observation: in most communities, a few people already solve a common problem better than their peers, with the same resources. The work is to find those practices and spread them. A coordinator network does this inside a hospital. The best explanation of a delay, the calmest way to manage an entrance at visiting time, is usually already on the floor. Someone has to notice it, name it and pass it on.
What coordinators do on a shift
- Rounds that follow the patient's path. The rounds we designed with them are short and frequent. In the emergency waiting room, every hour: what is the mood, does each person know their next step, who looks left alone? At admissions, the entrances and the main hall, every two hours: is anyone waiting too long, are the papers clear, can people find their way?
- Coaching in the moment. One observation, one next step, close to the event.
- Good practice by name. When a colleague handles a hard moment well, the coordinator records what they did and credits them.
- Training in small doses. Coordinators had two or three short training sessions, depending on the department, and then each department held workshops on its own guide for the whole team.
The guide learns from the floor
Each department started with its own guide: the situations it meets, the steps, the words that work. Once coordinators' notes started coming in, all four guides were revised from them. Nothing changed in a guide until a person approved it.
That loop is the point. A guide written once in an office goes stale. A guide fed by twenty colleagues on the floor keeps up.
What we would tell another institution
- Choose more coordinators than feels comfortable, and spread them across shifts.
- Write the role as a model and a reminder, never as a monitor.
- Plan for rotation from day one. Keep each coordinator's record when they move on.
- Give each department its own guide. One standard for everyone fits no one.
How Reflection supports coordinators
Reflection gives each department its own guide and rounds, reminds coordinators when a round is due, and lets them record good practice by name in seconds. Departments stay separate, staff see only their own path, and what coordinators record can feed the next version of the guide once a person approves it. People decide; the app keeps the evidence.
Sources
- Inside help: An integrative review of champions in healthcare-related implementation. SAGE Open Medicine, 2018.
- The power of positive deviance. BMJ, 2004.
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