Step 2: Establish a guiding council

The guiding council plays a crucial role in the PFCC process. It is responsible for initiating the programme, keeping it on track, maintaining senior oversight of the work and demonstrating organisational commitment to it. It will also review and choose areas of focus, and devise an approval process to test and assess changes. It will establish and support the working groups and will support the project teams. (See PFCC guiding council and working group practical suggestions)

Ideally, it will also set a small PFCC fund so that participants can use small amounts of resource to put in place the improvements they identify as necessary.

Many of the changes do not require specific resources, but might involve changing the way things are organised (for example, changing the way clinics are organised, visiting arrangements, or changing documentation). Others will require (often modest) resources – for example, changes to eating arrangements and crockery on wards, inducting volunteers to support patients with particular activities, or producing patient information. Others require more significant resources – for example, if the project identifies the need for staff training or freeing up their time for reflective practice.

Initially, the guiding council is made up of three champions:

• the administrative champion
• a clinical champion – an individual with clinical credibility and influence, able to inspire clinical colleagues
• a PFCC co-ordinator responsible for managing the shadowing process, booking meetings, maintaining details of all the change projects, and overseeing communication between all group members.

It will also include a scribe, who takes notes. Later in the process, the council will evolve into a larger group called the care experience working group.

Members of the guiding council are the first people to carry out the shadowing activity. This helps them get a sense of the care experience from the patients’ and families’ perspective, and to identify the key touchpoints (events that resonate strongly, whether positively or negatively). The results of their shadowing are used as a basis for methods such as process mapping, which are used later to determine improvement projects.

When we started seeing things from patients’ eyes, it completely changed the approach we took. My experience has stayed with me very powerfully ever since. It was a mother of a child with asthma. The mother said, ‘The nurses look really busy and I don’t want to disturb them.’ She was reluctant to pull the alarm cord. It changed the approach to safety on my ward, all triggered by me sharing the experience of care with a patient.

Hesham Abdalla, Consultant Paediatrician, formerly Walsall Manor Hospital

Key points

• Each of the champions needs to have support from the top of the organisation to lead change.
• The first meeting should include aims and objectives of the programme, a driver diagram, measurement and local challenges, potential care experiences and the infrastructure you will put in place. This involves deciding who will be in which group, how often you will meet and arrangements for recording actions and reporting within your organisation. You then assign responsibilities and identify next steps. Ideally, the council should meet for half an hour fortnightly. If people are unable to meet in person, they need to commit to an alternative, such as regular conference calls, to avoid losing momentum.
• If any individual is unable to attend meetings from time to time, ask them to identify one named individual who will deputise for them on a standing basis, rather than a succession of different people. They need to be fully briefed about the programme, in a position to take decisions on their behalf, and committed to feed back to the individual concerned.
• It is a good idea for the scribe to be someone from the administrative champion’s office, so that any invitations to meetings can come from the top, to demonstrate organisational commitment.
• PFCC will vary in the resources it requires depending on how broad or complex the care experience is, how long the changes are expected to take, and how many people are involved. It is helpful at the least to have some support from the organisation’s improvement team, and some project management support. (See PFCC examples of leadership and sponsorship)