EXCELLENCE THROUGH
PATIENT AND FAMILY
CENTRED CARE
BAY OF PLENTY DISTRI CT HEALTH BOARD
3.1 GETTING KEY INTERNAL
STAKEHOLDERS INVOLVED
Excellence through Patient and Family Centred Care
3.1 GETTING KEY INTERNAL STAKEHOLDERS INVOLVED
Averil Boon RN, Grad Cert HInf, PG DipN
Bay of Plenty District Health Board
Cameron Road
Private Bag 12024
Tauranga 3143
Phone (07) 5798000
June 2012
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TABLE OF CONTENTS
INTERNAL STAKEHOLDERS ........................................................................................ 3
THE ROLE OF THE PROJECT SPONSOR AND STEERING COMMITTEE ............... 3
Role of the Steering Committee ...................................................................................... 4
Individual Steering Committee members ......................................................................... 5
Steering Committees meetings ....................................................................................... 5
Responsibilities of the Project Manager .......................................................................... 7
HOW TO ENCOURAGE STAFF INVOLVEMENT ........................................................ 7
Doctors ........................................................................................................................... 7
Nurses ............................................................................................................................ 7
Managers ........................................................................................................................ 7
Professional Bodies ........................................................................................................ 8
Politicians........................................................................................................................ 8
Patients ........................................................................................................................... 8
Communication Plan ....................................................................................................... 8
Internal Education ........................................................................................................... 8
REFERENCES ............................................................................................................ 9
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GETTING KEY INTERNAL
STAKEHOLDERS INVOLVED
You have defined your project, your organisational leaders have completed their
personal self-assessment, and the organisational self-assessment has been completed
along with an analysis of the stakeholders who can either help or hinder your progress.
Congratulations! You are ready to proceed, but you should not proceed alone. To be
effective, you should join friends and colleagues, and even opponents, to work together
to achieve your objective.
Y
our stakeholders are people who have a common interest in improving the services
your organisation provides. This includes those responsible for delivering a patientcentred service and the local community who use it.
Key stakeholders are likely to include:

Those who govern and run the organisation – executive and non-executive
board members, foundation trust governors and members

Staff – managers, clinical staff, support staff and volunteers

Local commissioners who purchase your services

Patients, carers and the public – including local voluntary groups, community
groups and patient representatives.
INTERNAL STAKEHOLDERS
While the stakeholder analysis helps to determine how the stakeholders can be included
in the project, potential partners, critical to the success of the project can provide a
“coalition” of support.
All your work so has been to encourage Leaders to make an explicit commitment to
patient and family centred care and it is vital to continue their involvement and build on
their opportunity to serve by acting as role models for engaging with patients and families
across the organisation. Leaders provide resources and support for all aspects of your
project.
Leaders welcome pathways to improve health care and quality, they put systems in to
place to measure progress and outcomes and will oversee and encourage partnerships
in strategic initiatives.
THE ROLE OF THE PROJECT SPONSOR AND STEERING
COMMITTEE
A project Steering Committee is the key body within the governance structure which will
be responsible for the business issues associated with the patient and family centred
care project that are essential to ensuring the delivery of project outcomes and the
attainment of project outcomes. This includes approving budgetary strategy, defining and
realising outcomes, monitoring risks, quality and timelines, making policy and resourcing
decisions and assessing requests for changes to the scope of the project.
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It is imperative to identify an executive sponsor for patient and family centred care who
will be the “Project Sponsor” and the membership of the steering committee is
determined by the project Sponsor, who normally chairs the meetings. Other members
may include:

Representatives of Business Leaders and Clinical Leaders

A representative with project management governance expertise

Representatives from key stakeholders including at least two consumer
representatives

Representative from Quality and Patient Safety
The Project Manager is not a member of the Steering Committee but is contracted to
ensure the work of the project is undertaken as agreed, whereas the Steering Committee
provide the support, guidance and oversight of progress. The Project Manager will
normally attend meetings of the Steering Committee to speak to their reports and answer
any questions raised by members.
An additional resource required is a member of the administrative staff who may assist
by preparing the agenda, recording the minutes and decisions of the Steering committee
meetings.
ROLE OF THE STEERING COMMITTEE
The components of the project that are to be monitored by the Steering Committee are
documented in the Terms of Reference (TOR). Once developed, the TOR defines the project
scope and the Steering Committee as a whole must own the document. The Steering
Committee’s Terms of Reference should include:
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
Responsibility for the project’s feasibility, business plan and achievement of
outcomes.

Ensure the project’s scope aligns with the organisational strategic objectives.

Provide those directly involved in the project with guidance.

Ensure effort and expenditure is appropriate to expectations.

Ensure that strategies to address potential risks to the project’s success
have been identified, cost recognised and approved, and that the risks are
regularly re-assessed.

Address any issue which has major implications for the project.

Keep the project scope under control as emergent issues force changes
to be considered.

Reconcile differences in opinion and approach and resolve disputes
arising from them.

Report on project progress to those responsible at a high level, such as
Board and Executive Management groups.

Depending on the nature of the project, take on responsibility for the
progression of any whole of organisation issues associated with the
project.
Excellence through Patient and Family Centred Care
INDIVIDUAL STEERING COMMITTEE MEMBERS
Individual Steering Committee members are not directly responsible for managing project
activities, but provide support and guidance for those who do.
The Project Sponsor should provide each member of the Committee with a briefing of the
project to enable all members to contribute fully to the process.
Thus, individually, Steering Committee members should:

Understand the strategic implications and outcomes of all initiatives being
pursued through project outputs.

Appreciate the significance of the project for some or all major
stakeholders and represent their interests.

Be genuinely interested in the initiative and the outcomes being pursued
in the project.

Be an advocate for the project's outcomes by being committed to and
actively involved in pursuing the project's outcomes.

Have a broad understanding of project management issues and the
approach being adopted.
In practice, this means they will:

Consider all ideas and issues raised.

Ensure the project's outputs are aligned with organisational priorities and
include key stakeholders.

Help balance conflicting priorities and resources.

Provide guidance to the project team and users of the project's outputs
(patients, families and other consumers).

Foster positive communication outside of the Committee regarding the
project’s progress and outcomes.

Review the progress of the project.

Check adherence of project activities to expected standards both within
the organisation and in a wider context.
As members of the Steering Committee are selected based on their individual knowledge
and skills that they bring to the Committee, there can be some confusion and conflict in
the accountability of members. The first responsibility of members is the achievement of
the project’s success and secondly to their business area. Similarly, members who have
expertise in a particular area should avoid taking a narrow view of their responsibility.
STEERING COMMITTEES MEETINGS
The frequency and duration of the meetings will depend on the size and complexity of
the project. The meetings should be often enough that progress can be reported against
a number of milestones since the last meeting. A project milestone is different to a
project task/activity. A milestone does not involve any work, it can be seen as a progress
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‘marker’. For example, ‘Training Plan developed’ is a milestone, whereas ‘Develop
Training Plan’ is a task/activity. Ideally, the timing for the meetings should be linked to
key milestone dates (including the end of a phase), and not to a pattern; for example, the
last Friday in the month. Prior notification of meeting dates/times should be provided to
members via an agreed meeting schedule.
At least five (5) working days before each scheduled meeting, preparation of the
business papers for the next meeting should be distributed to those involved. They
should include:

an agenda

minutes of the last meeting, including an action list

a progress report on the status of the project since the last meeting
prepared by the Project Manager

other documents to be considered at the meeting (if any)
The Project Sponsor usually chairs the meetings. The Chair will conduct the meeting
according to the agenda, ensuring that all members are encouraged to provide input
throughout the meeting and that any decisions or recommendations are adequately
resolved and confirmed by the members.
A basic agenda would include:

Received apologies

Confirmation of minutes from previous meeting

Reviewing the status of action items from previous meetings

Report on the status of the project by the project manager

Discussion on other documents to be considered (if any)

Report from quality consultants (if any)

Any other business

Confirmation of date, time and venue for next meeting
Steering Committee members, have the opportunity to raise any issues not previously
discussed at the meeting under the item Other Business.
The Chair will arrange for the meeting minutes to be recorded.
Large projects are generally broken into phases, which are discrete, logical chunks of
work normally carried out in sequence. There should be a review done at the end of
each phase. This enables the Steering Committee to confirm that the phase has been
successfully completed and determine if the project should proceed to the next phase.
This involves confirming the scope, time, cost and resources for the next phase.
Within a week of the meeting, a copy of the minutes of the meeting should be circulated
to all members. This is far more effective in ensuring that the minutes accurately reflect
the decisions and discussions of the meeting. Members are more readily able to recall
what was discussed at the time and ensure that any important issues or comments
raised during the meeting have not been inadvertently overlooked.
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RESPONSIBILITIES OF THE PROJECT MANAGER
The Project Manager should be busy managing the project according to the agreed
Implementation Plan. This will involve the management of the project scope, time, cost,
quality, change, issues, human resources, stakeholders, communications, risk and
procurement
The Project Sponsor should meet with the Project Manager on a more frequent basis.
The Steering Committee can expect the Project Manager to objectively report to them on
the status of the project, including any problems or issues that require their direction.
HOW TO ENCOURAGE STAFF INVOLVEMENT
In her scoping paper for the Health foundation; “Implementing shared decision making in
the UK”, Angela Coulter states that “promoting the concepts of shared decision making is
not difficult but generating sufficient interest to get people to agree to incorporate into
their daily routines may be more difficult and of course it crucially depends on who you
are trying to persuade”. Her findings can be equally valid in persuading people to get
involved with patient and family centred care.
DOCTORS
Doctors respond positively if they think it will benefit their patients without causing them
extra time and trouble and the potential benefits to patients include increased
understanding of their condition and the treatment options, more realistic expectations of
benefits and harms, clearer preferences, better match between their favoured option and
what is actually received, more individualized care, improved communication and
improved adherence to medical advice and therapy.
It is important to find out which problems doctors find difficult and time consuming and
design a strategy that will make their lives easier. Reduction in the number of complaints
may also be of benefit for doctors. Depending on who is responsible for counselling
patients, it may reduce the time the doctor has to spend providing basic information
enabling them to have better informed, more effective discussions.
NURSES
Nurses appreciate recognition of their important role in educating and advocating for
their patients, but it is essential to involve them from the very beginning. Not surprisingly
nurses can react badly if decisions that will affect their workload and method of working
are taken without their participation. Nurses sometimes find it difficult to accept the
notion of patient autonomy and clinical uncertainty over whether proposed changes will
be actually be beneficial, so comprehensive training is likely to be essential.
MANAGERS
Managers are interested in the potential for effective demand management and cost
savings. There is evidence that shared decision making can reduce unwarranted
variations in preference-sensitive care and that well designed decision aids reduce the
demand for more cost-intensive options. They may also improve adherence to the
chosen therapy.
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PROFESSIONAL BODIES
Professional Bodies should value patient and family centred care because it concurs with
ethical practice guidelines and encourages the implementation of evidence based
medicine.
POLITICIANS
Politicians should be interested in patient and family centred care as an important
component of an organisational strategy to promote patient involvement and choice,
tackle health literacy and encourage a more realistic assessment of strengths and
limitations of the provision of medical care.
PATIENTS
Patients who participate in projects are usually overwhelmingly positive about it. They
appreciate receiving detailed and reliable information, their views being sought and
listened to, and having a say in what happens to them and in their local healthcare
organisation.
COMMUNICATION PLAN
See 2.2 Stakeholders and Communication Plan
INTERNAL EDUCATION
At the heart of patient family-centered care is the belief that health care staff and the
family are partners, working together to best meet the needs of the patients and their
families. Education and training of staff members about PFCC is the key for their buy in.
Education to staff must be provided regularly, to allow them to understand diverse needs
and expectations of all patients and families. All in-services and training sessions should
incorporate the core concepts of patient and family centred care.
Inviting patients and/or their families to assist with the orientation of new staff is also
recommended.
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REFERENCES
1. Coulter, A. (2009). Implementing shared decision making in the UK. In A Report for
the Health Foundation, Inspiring Improvement: The Health Foundation.
2. Tasmanian Government Project Management Framework Project Management Fact
Sheet: Steering Committee ‘nuts and bolts’, Version: 1.2, November 2008
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