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Purpose – To report on how service changes can be accelerated by working with large groups that represent all parts of a complete healthcare service or care pathway, during specific events, and using well‐defined facilitation techniques. Design/methodology/approach – Case examples are cited from the Clinical Governance Support Team's “protected time” programme and subsequent work, and specific quotes and examples from large group events are used to describe the potential impact of the approach. Findings – Established group facilitation techniques can be adapted for use in the context of a large group representative of a whole clinical system or pathway, to accelerate service improvement. Originality/value – The paper reports on the practical findings from Clinical Governance Support Team group facilitators working on large group events from a number of UK NHS Trusts.

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