What is PFCC and why is it needed?

There is a high degree of commitment among organisations to improve patients’ experience, but it can be difficult to know where to start. Patient and Family-Centred Care (PFCC) is a method of improving health care quality that changes the perspective of staff delivering care, and helps them reconnect with their values and motivation for working in health care.

What is it?

PFCC is a simple, low-technology health care quality improvement approach designed to tackle two parallel aspects of health care: processes of care and staff–patient interactions. Together, these have a profound effect on how patients and staff experience health care.

PFCC helps tackle issues in:

the organisation of care (care ‘transactions’ – how care is delivered)
‘relational’ aspects of care (the human interactions that take place between patients and families, and their professional carers).

Examples of the sorts of improvements that teams have achieved include improvements in assessment processes for patients, the management of pain, and communication with patients.

The approach achieves this by focusing the attention of staff on the lived experience of care for patients and their families. Using this approach puts staff closely in touch with what it is like to be a patient, and helps build empathy into the service.

PFCC has been used to:

improve all dimensions of quality, including clinical effectiveness
improve patients’ and families’ experience of care in hospital
support staff to provide the sort of care they would like for themselves and their families
improve staff experience of delivering care in hospital
build capacity to deliver patient-centred care.

The method was pioneered by Tony DiGioia at the Innovation Center at the University of Pittsburgh Medical Center (UPMC). This toolkit draws on the experience of the Patient and Family-Centred Care programme, which was run in partnership by The King’s Fund and the Health Foundation. Many of the resources come from the Innovation Center at UPMC and we gratefully acknowledge their generosity in making them available.

Why is PFCC needed?

There has never been a greater focus on patients’ experience as a key component of quality, nor greater acknowledgement of the value to staff of delivering excellent care. The response to the Francis Inquiry highlighted the importance of the patient experience, and the Department of Health Operating Framework 2012/13 restated the spirit of the NHS Constitution, with a key theme of ‘putting patients at the centre of decision-making’. There is much to be proud of within our health care system. But we are still a long way from reliably providing an excellent patient experience.

Health care staff work in highly pressurised environments, carrying out work that is often complex, intense and emotionally challenging. Evidence shows that this has an impact on staff wellbeing, which in turn affects their ability to care for patients with compassion (see PFCC further reading).

What is different about this approach?

PFCC tackles the challenge of providing high-quality patient-centred care in a new way. Rather than blaming staff when things go wrong, it seeks to understand where care systems and processes prevent them from providing the kind of care they would wish for themselves or their families. This understanding helps staff to see where improvements are possible, and enables them to reconnect with their motivation for working in health care, promoting a new workforce culture.

When it comes to health services, improvement initiatives tend to focus either on clinical processes or on patient experience. But both are essential for high-quality health care. PFCC focuses both on processes of care (transactions) and on relational aspects of care, producing benefits for patients and staff alike. It is compatible with other service improvement initiatives, such as those in place to improve access, safety or the efficiency of care.

The approach is enacted by a multidisciplinary team, rather than individuals acting alone. It cuts across boundaries to look at care experiences from the patient’s – rather than the organisation’s – point of view. It also forges links between the board and frontline staff, developing commitment at executive and clinical levels.

Importantly, PFCC acknowledges the link between positive patient experience and positive staff experience – you cannot have one without the other (see PFCC further reading).

PFCC has been successful because it combines leadership support, a framework for improvement, a clear focus on a care experience, clear aims and measures, a multidisciplinary team and a focus on care seen through patients’ eyes.

The clarity and simplicity of the PFCC method, with its structure and milestones, have given boards that have used it confidence that investment in the programme will yield demonstrable benefits and organisational learning that can be built on and diffused across the organisation.

What does it involve?

The resources required for PFCC consist principally of staff time to participate in the guiding council and working groups, and hands-on work on improvement projects to bring about the changes. How much time, and from which staff, will very much depend on the breadth of the care experience you work on, how much you involve frontline staff in improvement projects and how intensively you plan to deliver your goals. Widely inclusive teams build greater commitment and spread the load.

The structured approach to reporting the benefits to be achieved and the focus on measurement meant that the board had a clear view of the programme delivery at key milestones in the programme.

Lynne Wigens, PFCC Executive Sponsor, Ipswich Hospital Trust

Benefits of PFCC

Patients benefit by:

feeling confident that the care that they receive will be of consistently high quality
feeling that their care has been designed in a way that acknowledges its place within their broader lives.

Staff benefit by:

becoming more engaged in their work
developing an understanding of the current experiences from patients’ point of view
developing the skills and confidence to improve the care experience
gaining experience in trialling practical improvements, measuring impact and spreading change
having more time to provide individualised care, thanks to smoother and more standardised processes where appropriate.

Organisations benefit by:

making a reality of policy commitments to improve patient-centred care
understanding what drives patients’ experiences of their services
improving patients’ experiences of care (depending on the goals chosen, PFCC may be used to improve safety, clinical effectiveness, patient-centredness, timeliness and efficiency)
improving staff engagement, resilience and focus on patients’ experience
building capacity, so that lessons can be sustained and shared across the organisation
building their reputation for high-quality, compassionate care.