Implementing Francis: lessons from Patient and Family-centred Care

As the NHS considers the findings of the public inquiry into events at Mid Staffordshire, few would disagree with Francis’ view that there is an urgent need to ensure that the NHS culture is one of patient-centred care. Francis unites the NHS behind the desire for better care for patients. What is less clear is how his report will help make these changes at the front line. 

Amid the vast number of recommendations are some receiving less attention than the system and regulatory changes we read about in the press. These, aimed at providers, would take important steps toward making the changes needed, including the need for an NHS culture which puts patients first.

On the Patient and Family-centred Care programme (PFCC), we work with teams of staff to improve patients’ and staff experience of care. We have observed some key success factors for achieving the culture change Robert Francis wants to see: the importance of having clear, patient-centred goals; strong leadership driven by patients’ needs; and working in a multi-disciplinary way in pursuit of those aims.

For teams working on PFCC, tackling patients’ and staff experience together means staff ‘get inside patients’ shoes’: reflecting on what it is like to be a patient in their organisation. They do this by shadowing patients as they receive care – something we encourage people at all levels of the organisation to do.

This profoundly changes people’s perspectives, giving a very different view from one prompted by a set of statistics: enabling staff to see what they themselves can do to make a difference for patients. It not only gives them permission to change things, but sets the expectation that they will change things. The need for the NHS to see the whole picture for patients, as identified by Francis, represents a huge challenge to the way the NHS commonly approaches its work.  

In our experience, senior executives actively sponsoring and doctors leading the work are critical to success: a degree of involvement not always evident in the NHS’s approach to improvement. Yet meaningful leadership of this sort makes a profound difference to the culture of organisations in terms of putting patients at their heart.

Enabling staff to connect with the experience of patients and reflect on what needs to improve is one way of building the positive organisational culture Francis demands. It empowers individuals, builds teams, and helps staff to realise that more is possible in improving patients’ experience than they might have expected.

This work reminds staff of their critical impact on patients – important when you consider that working in highly technical, almost industrial, hospital environments can be de-personalising to patients and staff alike. It can feel almost impossible, even for the most assertive, to feel that they can change the system.

Bev is a Fellow on the Point of Care Programme at The King's Fund.