Before you can start the project, you need to win support from the right people in order to build momentum. This section draws on the learning from our PFCC projects. It summarises what participants felt were the key influences on the success of the projects.
The impetus for embarking on a programme of Patient and Family-Centred Care often comes from the enthusiasm of clinicians with the support of leaders in organisations. But enthusiasm alone will not be enough. If you are thinking about using the PFCC approach, this section will help you get started.
You will need someone with influence and credibility who can champion the initiative across the organisation. Identify a board-level executive who has real enthusiasm for quality improvement and a commitment to improving the patient experience.
This person, known as the administrative champion, will need to be actively involved. They will need to act as a figurehead for the work, chair the guiding council, and promote the work to the board. An active administrative champion will make all the difference to the project, so it is worth spending time selecting the right person and helping them develop their role.
Consider your stakeholders
Before you begin, it is essential to consider who are the main stakeholders in this work, who will be affected by it, and how they will be affected. Are they likely to actively support what you are trying to achieve; are they likely to accept it passively; or are they likely to obstruct the work in some way? Also you should reflect on how you will involve different stakeholders – whether actively, as part of the guiding council, or simply by keeping them informed. If you spend time at the outset talking through the work with stakeholders, this can save a lot of time later. Examples of stakeholders include different groups of clinicians, ‘back office’ staff who might be affected by the changes you make, members of patient or service user groups, or non-executive directors in your organisation.
Before you get down to the detail of which care experience you want to work on, you need to gauge the attitudes of senior clinicians towards this work. Find some like-minded people who will support the idea. It is worth putting in some time and effort to engage with medical colleagues to generate their support, and identify the broad clinical area in which you will focus your work.
Understand your organisation’s motivation
What is the motivation for getting involved in this work, and where is the drive coming from? It is not unusual for national policy priorities, local priorities, or general quality concerns to lie behind this work. Above all, there needs to be energy and enthusiasm from the team for the work to be a success.
Identify where PFCC fits
PFCC works best when it is integrated into the way the organisation functions. At the outset, think about where this work could fit with other quality improvement initiatives taking place in the organisation. Consider where the quality improvement expertise lies within the organisation, and who might be able to help with quality improvement methods and measurement. Involve those people at the outset – and make sure PFCC is integrated into whatever improvement structures you have in place. For example, it should be integrated with the work reporting in to the Quality Committee alongside other service improvement activities.
Think about how to involve patients and families
PFCC involves patients, service users and carers in two ways: in sharing their experiences of care and in being actively involved in the project – for example, through making suggestions for improvements that can be tested by staff.
To make this happen, you should actively seek to involve service users as active members of the guiding council or working group, or as part of the ‘snorkelling’ approach, to generate ideas for improvement. There may already be user groups with experience of the particular service under review.
However, there is no fixed way of doing this within the methodology, and your organisation may already have its own ways of identifying and involving service users. Alternatively you may like to try an established method such as experience-based co-design. Either way, you need to be aware of the importance of involving patients and their families from the outset and incorporate this element into each stage of the project plan. Your organisation’s public and patient involvement lead may be a useful source of advice on this aspect.
Persuading staff of the need for change
Gather any existing internal data on staff morale. Once you have started the PFCC process, this in itself can be a great way of energising and enthusing staff. But some staff may be sceptical about the work – especially if your organisation has been involved in one-off improvement projects that have had no visible or lasting impact. Use any current data as a baseline to persuade staff of the need for change and, later, to measure and demonstrate what has improved. Examples of patient experience data include patient surveys, complaints and compliments, waiting times and cancellations. Examples of data on staff experience include staff surveys and data from the human resources department on staff sickness, vacancies and turnover.
Invest time in engaging with staff and showing them how the PFCC approach differs from other service improvement approaches. The key points to emphasise are listed below.
- Use compelling patient stories to make your case.
- PFCC focuses on the experience of care of patients and staff alike.
- The methodology emphasises how patients experience health care, and works on the real day-to-day issues that affect patients and staff.
- Ideas for improvement can come from all members of staff, including health care assistants, porters, catering staff, managers, doctors, nurses, therapists and human resources staff.
Raising awareness of the work
Produce an article for your website, newsletter or for external media to let staff and the public know about your plans and invite support. The more people who know about it, the wider your potential support base.
Be aware of what is going on elsewhere in the organisation and in the external environment, and how this might affect staff’s response to a proposal to run a PFCC programme. The NHS is a tough environment in the current economic climate, so you will need to have an honest discussion with your administrative champion about the need to free up time for staff to carry out this work.
- The administrative champion does not have to be someone usually associated with quality – it could be any member of the board, as long as he or she is willing to commit to the role and has sufficient credibility and influence.
- Discuss with the administrative champion how you can maintain focus over the long haul if the organisation is faced with a challenge that could divert attention away from the work, such as an application for foundation trust status or a Care Quality Commission inspection.
- Clinical involvement is critical for the success of the project. A key to this is clinical leadership, with clinical leaders meeting regularly with the rest of the team to discuss progress and solve problems. Leaders can also help to identify doctors who might get involved.
- Use the case studies in this toolkit to show people how much staff elsewhere have benefitted from using this approach.
- Remind staff that anyone can get involved, and the more people who do, the more manageable the workload.
- You will not usually need formal ethics committee approval for service improvement work. However, do contact your local research or ethics committee well in advance in case there are local protocols (with respect to training observers, for example, or how the material you gather from patients and families can be used) that you need to adhere to. The chair of the local research ethics committee will be a useful source of advice.