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Patient and Family-Centred Care tools overview

The tools section describes a selection of techniques that our programme teams used in their Patient and Family-Centred Care (PFCC) projects to translate their ideas into manageable, achievable actions. You may use some or all alongside other approaches to quality improvement already used in your organisation.

The tools are listed in the order in which you will use them, beginning with those that will help you to understand the care experience viewed through patients’ eyes; understand the influences on the experience; devise measurable goals for your PFCC project; and then generate and test your ideas for improvement.

  • Process mapping – A process map is a visual representation of what happens to the patient at each stage of their care experience. It enables teams to identify which steps in the care process add value for patients and who is responsible for each step.
  • Shadowing – This method forms the core part of the PFCC approach. It involves accompanying a patient throughout their care experience – for example, from arriving at reception to leaving at the end of the day – and taking notes and discussing experiences with patients. It is this aspect of the PFCC approach that has had the greatest impact on staff.
  • Patient stories – This approach involves interviewing patients to gather their insights into the service they have received. It is a useful adjunct to shadowing.
  • Driver diagrams – These are used to identify the ‘drivers’, or main influences, on patients’ experiences. This then helps to identify the aspects of care that need to be influenced if improvements in patients’ experiences are to be achieved. A driver diagram is a conceptual framework that helps teams to set an aim and then identify the key drivers (main areas of focus) and subsequent interventions they need to put in place that will align to support the achievement of the overall goal.
  • Measurement – Measurement is an essential part of any quality improvement initiative. It must be carried out beforehand, to set the baseline, and then again at stages throughout and following the intervention. This enables you to demonstrate the impact and to identify any aspects that may need tweaking during the project.
  • The model for improvement – This well-established approach to improvement incorporates Plan, Do, Study, Act (PDSA) cycles – also known as small tests of change, or rapid cycle improvement – which make it possible to test interventions on a small scale, and to tweak these, before rolling out more widely.
  • Snorkelling – A group activity that enables a wide variety of health care staff to think creatively and develop their own ideas for changes that will improve patients’ care experiences.

Patient shadowing, patient stories and other ways of describing patient experience allow staff to examine patient care using a lens with a different focus from other measures of quality of care. The different lenses we use to examine our service allow us to build a comprehensive picture of the care we provide.

John Alexander, Consultant Paediatrician, University Hospital of North Staffordshire

Key points

  • Devising the driver diagram and setting aims and measures are key and should be done at the outset so that the team have a clear sense of direction.
  • Within the PFCC methodology, shadowing is the most important and most influential tool. By identifying the elements of the care process that have the most impact on patients’ experience, it helps ensure that the project is truly patient-centred.
  • For some care experiences, such as end-of-life care, shadowing may not be the most appropriate method to capture the experience – listening to patient or family stories or interviews might be more fruitful. Some organisations also used experience-based co-design – an approach that uses filmed patient interviews to trigger wider discussion and co-design.
  • The model for improvement offers an opportunity to test change on a small scale. This helps to avoid being overwhelmed by the scale of the task, providing a quick, simple way to trial a change before making adjustments or rolling it out more widely.
  • You may want to combine the tools described in this section with other methods of capturing patients’ feedback on their experience, such as interviews, focus groups, or others that your organisation is already familiar with.