Patient Family

Advisory Councils
2019 TOOLKIT

For more information contact Matthew Bulfer, CHA project manager,

at [email protected] or 720.330.6076
© 2019 CHA
Table of Contents
Introduction.................................................................... 1

Determining a Level of Engagement.............................. 3

Timeline.......................................................................... 4

Step 1: Establish a Sense of Urgency:

Is this Hospital Ready to Engage in a PFAC?................... 5

Step 2: Create the PFAC Launch Team,

the Guiding Coalition...................................................... 6

Step 3: Develop a PFAC Strategy.................................... 8

Step 4: Prepare Hospital Leadership, Clinicians

and Staff to Work with Advisors..................................... 9

Step 5: Recruit Council Members................................. 10

Step 6: Implement and Coordinate

Advisor Activities.......................................................... 13

Step 7: Share the Story:

Keeping Engagement Alive........................................... 14

Step 8: How to Utilize a PFAC:

Incorporating Cultural Changes.................................... 15

Conclusion.................................................................... 17

Additional Resources.................................................... 18

Acknowledgements...................................................... 18

About CHA and the Quality and

Patient Safety Department........................................... 18

References.................................................................... 19
Introduction
Why build a patient and family Improved HCAHPS® Hospital Survey scores
advisory council? The Hospital Consumer Assessment of Healthcare
With the shift in the health care landscape from volume Providers and Systems (HCAHPS®), developed in 2012
to value, more hospitals are engaging patients in their by CMS, is a survey to measure patient satisfaction. This
everyday hospital activities. Like any profession, learning value-based purchasing program was created to incentivize
from the consumer can provide great insight on how to hospitals to focus on key quality indicators. Under the
provide better service. Integrating patient and family program, achievement and improvement on patient
advisory councils (PFACs) within the hospital setting is an experience of care scores (based on the HCAHPS® Hospital
excellent approach to learn from patients and increase the Survey) are used to calculate value-based incentive
quality of care delivered in a hospital. Hospitals across the payments.7, 8 Hospitals that have implemented strategies
country are beginning to recognize the many benefits of to improve PFE have seen subsequent improvements in
working with patients and families such as: 1 patient ratings of care.9
• Improved quality and patient safety
• Improved financial performance Improved patient outcomes
• Improved HCAHPS® Hospital Survey scores Better communication with patients and families has a
• Improved patient outcomes positive effect on patient outcomes – specifically, emotional
• Enhanced market share and competitiveness and physical health, symptom resolution, pain control and
• Increased employee satisfaction and retention physiologic measures such as blood pressure and blood
• Response to The Joint Commission standards sugar levels.10, 11

Improved quality and patient safety Enhanced hospital market share and
The Planetree designation program provides a structured, competitiveness
operational framework for evaluating the organizational For hospitals in a competitive marketplace, enhancing patient
systems and processes necessary to sustain organizational experiences can serve as the foundation for brand identity.
culture change. Through a set of experience-based and In a survey of more than 2,000 patients, 41 percent indicated
evidence-based criteria, the program transforms the they would be willing to switch hospitals for a better
ambition of becoming more “patient-centered” into patient experience.12
something that is defined, measurable and attainable.
Planetree-accredited hospitals require an active PFAC. Increased employee satisfaction
Planetree-designated hospitals that implemented patient- and retention
centered strategies exceeded Centers for Medicare and At Bronson Methodist Hospital in Michigan, implementing
Medicaid Services (CMS) national averages on several patient-centered and family-centered care practices led to
core quality measures, including care for heart attack, a decrease in the average nurse turnover rate (from 21 to 7
pneumonia, heart failure and surgical sites infections.2 percent).13 The hospital estimated that higher nursing staff
retention has led to savings of $3 million over the span
Improved financial performance of five years. In addition, a nurse bedside change-of-shift
Research from the Gallup Management Journal shows that report increased both nurse and physician satisfaction, as
patient and family engagement (PFE) consistently predicts assessed by a staff survey.14
hospital performance on an array of crucial business
outcomes, including EBITA (earnings before the deductions
of interest, tax and amortization) per adjusted admission
and net revenue per adjusted admission.3 Patient-centered
and family-centered care also decreases litigation and
malpractice claims4 and leads to lower costs and shorter
lengths of stay per case due to fewer complications.5, 6

Page 1
Introduction continued
Response to The Joint Commission • PC.02.03.01 The hospital provides patient education
standards and training based on each patient’s needs and abilities.
The Joint Commission has established standards that relate • PC.04.01.05 Before the hospital discharges or transfers
to patient-centered and family-centered care. Hospitals a patient, it informs and educates the patient about his
with PFACs can be better prepared for inspections by or her follow-up care, treatment and services.
meeting the following guidelines:15 • R1.01.01.03 The hospital respects the patient’s right to
• PC.02.01.21 The hospital effectively communicates with receive information in a manner he or she understands.
patients when providing care, treatment and services. • R1.01.02.01 The hospital respects the patient’s right to
• PC.02.02.01 The hospital coordinates the patient’s care, participate in decisions about his or her care, treatment
treatment and services based on the patient’s needs. and services.

Page 2
Determining a Level of Engagement
When considering integrating a PFAC into an organization, it is important to determine the level of engagement the
hospital is prepared to implement. Just like learning to ski or snowboard, there are different levels of skill and difficulty.
The first tier, Green Circle, is the introductory level of engagement and includes steps one and two. The second tier, Blue
Square, involves moderate engagement and includes steps one through five. The final tier, Black Diamond, indicates a
high level of engagement and encompasses all eight steps for creating, implementing and sustaining a PFAC. The chart
below illustrates the three tiers of engagement and corresponding steps.

Green Circle Blue Square Black Diamond

“Just Getting Started” “Forming the Council” “Developing the Program”
Estimated time commitment: Estimated time commitment: Estimated time commitment:
1 – 4+ months 1 – 7+ months 7 – 9+ months

Step 1: Establish a Sense of Step 3: Develop a PFAC Strategy Step 6: Implement and Coordinate
Urgency 3a. Identify Areas of Opportunity Advisor Activities
1a. Readiness Assessment and Potential Projects 6a. First Council Meeting
1b. Ensure Leadership Support 3b. Create a Shared Vision 6b. Discuss Confidentiality

Step 2: Create Launch Team Step 4: Prepare Hospital Leadership, Step 7: Keep Engagement Alive
2a. Assemble PFAC Launch Team Clinicians and Staff to Work with 7a. Generate Short-Term Wins
2b. Clarify Structure - Charter Advisors, Communicate the Vision 7b. Bedside Rounding
2c. Identify a Council Coordinator 4a. Build Informal Internal Support 7c. Use Stories to Motivate
and Draft a Budget 4b. Communicate the Changes
2d. Develop Measures for Success with Staff Step 8: How to Utilize a PFAC,
2e. Engage Marketing Incorporate Changes into the Culture
Step 5: Recruit Council Members 8a. Learn from Other Councils
5a. Find the Right Patients 8b. Monitor Measurements
5b. Find the Right Staff 8c. Report to Senior Leadership
5c. Recruit, Screen and Interview 8d. Sustainability
Applicants
5d. Advisor Orientation
5e. Schedule a Meet and Greet

Page 3
Timeline
Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10

1a. Readiness
Assessment
1b. Ensure Leadership
Support
2a. Assemble PFAC Launch Team
2b. Clarify Structure – Charter
2c. Identify a Council Coordinator and Draft a Budget
2d. Develop Measures for Success
2e. Engage Marketing
3a. Identify Areas of
Opportunity and
Potential Projects
3b. Create a Shared
Vision
4a. Build Informal
Internal Support
4b. Communicate Begin Meetings
the Changes
with Staff
5a. Find the Right Patients
5b. Find the Right Staff
5c. Recruit, Screen and Interview Applicants
5d. Advisor Orientation
5e. Schedule a Meet and Greet
6a. First Council
Meeting
6b. Discuss
Confidentiality
7a. Generate
Short-Term Wins
7b. Bedside
Preparation and Planning Rounding
7c. Use Stories to
Motivate
8a. Learn from
Other Councils
8b. Monitor
Measurements
8c. Report to Senior
Leadership
8d. Sustainability

Page 4
Step One
Establish a Sense of Urgency: Is This Hospital Ready to Engage in a PFAC?
The strategic goal of working with patients and families as advisors is to bring the perspective of patients and families
directly into the planning, delivery and evaluation of care.16 PFE encompasses behaviors by patients, family members,
clinicians and hospital staff, as well as the organizational policies and procedures that support these behaviors.17 However, it
can be a challenge to determine if the hospital, staff and the patients being served are ready to embrace a PFAC.

1a. Readiness Assessment 1b. Ensure Leadership Support

Before moving forward, it is essential to gauge the Leadership support is the most critical step in the initial
readiness of the stakeholders involved and establish a stages to creating a PFAC.19 Support from senior leaders
sense of urgency.18 A HCAHPS® Hospital Survey score, allows for the assembly of a team with enough power to
recent feedback from patients or a desire to be more develop a PFAC.19, 20 Clear communication with hospital
connected with the community are just a few factors that leadership will aid in gaining their support. At this stage,
can contribute to a hospital’s sense of urgency. consider consulting the legal department on any barriers
that may impede the hospital’s ability to create and
Recommended: implement a PFAC.
• Are Families Considered Visitors in our Hospital or Unit?
This tool, created by the Institute for Patient and Recommended:
Family-Centered Care (IPFCC), is a checklist to assess • Kaiser Permanente Proposal Template
how well family presence and participation is supported Developed by Kaiser Permanente, this template provides
through examining the infrastructure of the hospital a good example and overview of the components
and the priority for change within staff practices. needed for a PFAC. This three-page document is
aimed at senior leaders and includes purpose, goals and
Optional Tools: objectives for starting a PFAC.
• A Checklist for Attitudes About Patients and Families
as Advisors
Developed by the IPFCC, this tool offers a list of discussion
questions to explore attitudes about patient and family
involvement in the delivery of their health care and
as advisors. It can be used for self-reflection and to
spark discussion among staff and physicians prior to
working with patients and families.
• Family-Centered Care Self-Assessment Tool
Developed by Family Voices and the Maternal and Child
Health Bureau, this survey tool provides an organized
methodology for health care facilities to assess current
areas of strength; identify areas for growth; plan future
efforts; and track progress. The survey provides feedback
on a hospital’s readiness to improve the family/provider
partnership.
• Leadership Readiness Assessment
Developed by the National Institute for Children’s
Health Quality (NICHQ), this self-assessment survey
is designed for senior leaders and serves as the basis
for conversations among the hospital’s leadership when
determining the level of readiness for launching a PFAC.

Page 5
Step Two
Create the PFAC Launch Team (Guiding Coalition)
Launching a PFAC is an exciting and challenging endeavor. Plan to spend at least six months from the initial concept to
holding the first council meeting.21 Before beginning, create the guiding coalition that will execute the creation of the
PFAC and include all necessary stakeholders within the hospital.

2a. Assemble a PFAC Launch Team 2b. Clarify Structure

A champion liaison/coordinator and key launch partners Will this PFAC be informal or formal? There are many ways
are critical to creating an effective PFAC launch team. in which a PFAC purpose and structure can be determined.
Champions are typically senior leaders, physicians Keep in mind the staff members who participate in launching
or nursing leaders that are well-respected within the the group may not be the same staff members who sit and
organization. A core planning group will help define facilitate the council. It is important to create a PFAC that
the focus and scope of the council and will assist with is unique to the hospital’s culture and level of readiness.
recruiting members, staff and patients. The core planning Creating a mission statement and identifying objectives
group should bring together key leadership, providers, for the PFAC will help the hospital have a good idea of why
administrators, the quality department, a front-line staff this is an important project. It is recommended to create a
member and at least one patient. Consider including charter for the PFAC.
communications staff on the PFAC launch team so they
can be involved in the recruiting of patients and staff, Recommended:
notifying staff of changes and spreading achievements • Sample Hospital Charter
across the organization.22 Some examples of PFAC launch This template provides a good example and overview of
team members could include: physicians, advance practice the structure of a PFAC charter.
nurses, nurse managers, administrators, care experience/ Optional Tools:
service excellence leaders, spiritual care leaders, health • Chartering Your PFAC: Purpose and Structure
care ombudsperson mediators, social workers, risk Developed by NICHQ, this list of questions will help
management staff, human resources, an environmental the team develop the purpose and structure of the
services representative and legal counsel. PFAC, including what skills and resources will be needed
to ensure success.
• Kaiser Permanente North California Regional Life Care
Member Advisory Council Charter
This tool, established by Kaiser Permanente North
California Regional Life Care Member Advisory Council,
is a team charter example that clarifies the role of sponsors,
stakeholders, co-leaders and members. It also provides
valuable background information on developing a PFAC
mission, establishing desired outcomes and deliverables
and offers a timeline for PFAC implementation.
• Your Practice PFAC and Bylaws
Developed by NICHQ and IPFCC, this checklist provides
information on what is needed to complete the PFAC
bylaws and includes two hospital examples.

Page 6
Step Two continued

2c. Identify a Council Coordinator and Draft a Budget 2d. Develop Measures for Success
The budget should include the council’s coordination, a What are the hopes for what the PFAC will accomplish in
meal or refreshments served at each council meeting, this hospital? It is important when setting up the launch
mileage reimbursement for travel to the council meetings, team that there are clear goals and success measurements.
0.25- 0.33 FTE council coordinator to ensure a successful Kaiser Permanente offers three types of measures
implementation and printing materials.23 Plan for (structural, process and outcome) recommended for PFAC
compensation of time, expertise and expenses for patients launch teams.24
and families. However, keep in mind that the budget will • Structural Measures:
differ for each hospital. Along with the budget, determine Number of councils, committees, workgroups, events,
the council coordinator. This individual will be responsible etc. in which advisors participate and alignment of
for leading the launch team throughout the planning and council activities with organizational and national
implementation period. quality and patient safety priorities.
• Process Measures:
Optional Tools: Council member evaluations of, and feedback on, the
• Essential Allies Patient, Resident, and Family Advisors council, tracking council accomplishments and impact of
A Guide for Staff Liaisons council input and using ethnography (the study of
Developed by IPFCC, this guide for staff liaisons includes culture) as an approach to storytelling.
a job description for the council’s coordinator. • Outcome Measures:
• Budget Template Impact of specific outcome measures such as
Developed by Colorado Hospital Association (CHA), hospital-acquired infections, nursing sensitive measures
this tool is an excel workbook that outlines a basic and avoidable hospital readmissions.
three-year budget for quality improvement projects • SMART Goals:
such as the implementation of a PFAC. Budget items SMART goals can be useful for every project. SMART
should include meals for the council and marketing (Specific, Measurable, Attainable, Relevant and
materials. Time-Bound) goals are specific goals for each project or
task the council works on.

2e. Engage Marketing

The marketing or communications department will be
critical to success in creating a shared vision, building
informal internal support and recruiting the right patients
and staff to the council. The marketing department can
help create recruitment materials for the council. Example
templates to help recruit patients can be found in step five
of this toolkit. Engaging the marketing department in early
will likely increase participation in the PFAC.

Page 7
Step Three
Develop a PFAC Strategy
Now that the PFAC launch team has been established, it is time to begin refining some strategic goals. By now, the launch
team has determined some key structural, process and outcome measures that will help guide the direction of the PFAC.
The next step is to create a vision that will help steer the PFAC and develop strategies for achieving that vision.24

3a. Identify Areas of Opportunity and Potential Projects 3b. Create a Shared Vision
A good place to start would be with the quality department, In order to establish a shared vision, it is important to set
as they typically have patient safety and patient experience up an action plan. All team members and stakeholders
data. Areas of opportunity can be evaluated through quality, must approve the action plan before moving forward.
safety and service metrics for the hospital, department Starting with small, tangible goals can aid in the process of
or unit. Many organizations begin with HCAHPS® Hospital launching and implementing a PFAC.
Survey or current literature related to PFE. Also, review
the hospital readiness assessment from step one to help Recommended:
identify areas of opportunity and interest. • Action Plan Template
Developed by CHA, this tool is used to set up an
improvement project. This template helps document
small tests of changes, evaluate new ideas, capture
metrics and implement positive changes.

Page 8
Step Four
Prepare Hospital Leadership, Clinicians and Staff to Work with Advisors
One of the most important factors for ensuring the success of a PFAC is the belief by hospital leaders, clinicians and staff
that partnering with patient and family advisors is absolutely essential to improving hospital quality and safety.25 By
creating a shared vision and strategy, the PFAC launch team will be able to build strong partnerships and garner support
for patient and family advisors among hospital leadership, clinicians and staff.26 Make sure as many staff as possible
understand and support the PFAC vision and strategy.27

4a. Build Informal Internal Support 4b. Communicate the Changes with Staff
Just as it is important to gain the support of hospital With internal support, the launch team may now communicate
leadership, it is equally important to gain the support and the action plan on implementing the PFAC by following
momentum of clinicians and other hospital staff before these steps:
the council is built so that all stakeholders feel that they • Meet with clinicians and staff individually and in groups
have a voice in the process. Before getting started, gather to discuss the action plan and what it means to work
information about the hospital’s culture by using these key with patient and family advisors.
strategies: • Identify staff members who can help champion the idea
• Identify and get to know the formal and informal of patient and family advisors and the PFAC launch
leaders in the hospital team’s action plan.
• Learn how organizational decisions are made • Invite staff and leadership to participate in a walkabout
• Learn about the clinicians and hospital staff to explore how the hospital welcomes, engages and
• Assess the hospital’s experience from the patient’s supports patients and families.29 Engage with individuals
perspective28 willing to support the PFAC and begin implementing the
• Identify the patient safety champions action plan with small, achievable goals. Remember,
there may be some staff that will be resistant to the
new change that is being implemented.

Recommended:
• Working with PFAC for Staff
Developed by the Agency for Healthcare Research
and Quality (AHRQ) for clinicians and hospital staff, this
document outlines the benefits of working with patient
and family advisors as part of patient-centered and
family-centered care programs.

Page 9
Step Five
Recruit Council Members
It’s now time to start recruiting patient and family advisors, but where should the team begin? When recruiting patients
for the PFAC, it is important to eliminate obstacles and change systems or structures that seriously undermine the vision.
This includes patients characterized as negative or extreme.30 Also, confirm that any documents that will be distributed to
patients or family members have been approved by senior leadership and legal counsel. When recruiting patients, plan
to recruit at least three times the number that will be seated on the council to select the best candidates and to allow for
candidate attrition.31

Recommended: 5a. Find the Right Patients

• Sample Patient and Family Advisor Recruitment Flyer Review the tools provided below to help find the
This customizable brochure, developed by AHRQ, characteristics of an effective family advisor. The criteria
offers a description of the patient and family advisor should involve finding previous patients or family members
role, addresses responsibilities of the advisors and who want to play an active role in improving quality
provides tips for recruitment. and patient safety. It is crucial to find advisors who are
active members of the community, well-respected and
Optional Tools:
who will help bring positive change to the hospital. It is
• Tips for Recruiting Patients and Families to Serve in
recommended to recruit advisors who have received care
Advisory Roles
at the hospital within the past three to five years, have
Developed by IPFCC, this tool helps hospitals identify
had diverse health care experiences and who mirror the
areas best for recruiting patients and family members to
diversity of the patients and families the hospital serves.32
serve in advisory roles.
• Become a Patient Advisor: Information Session Recommended:
Developed by AHRQ as a part of its Guide to Patient • Patient and Family Advisor Application Form
and Family Engagement, this customizable slide deck This three-page application form, created by AHRQ, can
is to be used by the hospital at presentations intending be customized for each individual facility to retrieve
to recruit patients or family members to serve as PFAC basic information on potential candidates.
advisors.
• Recruitment Plan Worksheet Optional Tools:
Developed by NICHQ, this worksheet helps clarify which • Patient and Family Advisor Application Form
patients and families would serve as effective Developed by the Healthcare and Patient Partnership
participants in an advisory council. Institute (H2Pi), this application form offers hospitals
the basis for obtaining basic information on potential
patient and family candidates.
• Characteristics of Effective Family Advisors
This tool, established by NICHQ, is a checklist of advisor
attributes to provide to staff and PFAC launch team
members for review when recruiting a patient or family
member. The list outlines the most effective behaviors
recognized in successful patient and family advisors.

Page 10
Step Five continued

5b. Find the Right Staff Colorado Hospital Association (CHA) recommends that all
As important as it is to find the right patient, it is equally potential candidates fill out an application form. Once all
important to find the right staff members that will serve on nominations have been submitted, call potential candidates
this PFAC. It is important that all members of the council, to screen for sustainability and level of commitment. Contact
whether they are staff or patients, go through the same the hospital’s legal counsel to see if the candidate has a
recruitment, screening and interview process. history of legal action within the organization. This will
not disqualify the candidate from serving on the council
Recommended: but is important information of which to be aware.34
• Readiness to Partner With Patient and Family Advisors Most hospitals will have the PFAC launch team determine
Developed by AHRQ as a part of its Guide to Patient which applicants should be interviewed. An interview
and Family Engagement, this tool is a checklist for should last approximately 30 minutes, either in-person
clinicians and other hospital staff to determine their or via telephone, with at least two members of the PFAC
willingness to work with patient and family advisors. launch team. After all interviews are conducted and the
Optional Tools: launch team has selected the council members that will
• Staff Readiness Assessment be appointed to the PFAC, it is important to make sure all
Developed by NICHQ and adapted from IPFCC, this applicants are notified if they will be on or off the council.
self-assessment survey tool is designed to determine Use the sample letter of invitation or regret.
staff’s level of readiness for launching a PFAC. • Patient Advisory Candidate Review Form
This checklist, established by H2Pi, can be used by the
5c. Recruit, Screen and Interview Applicants PFAC launch team to review candidates in a
When choosing patients, ask the staff for suggestions and standardized approach and score favorable applicants.
post recruitment flyers in all hospital units.33 Speak with • Guide to Interviewing Potential PFAC Members
departments or people who take complaints, grievances This guide, created by Health Research and Education
and compliments. This department or person may be Trust subject matter expert Tanya Lord, can be used to
able to identify patients and/or family members that are help prepare and guide the interview process.*
able to discuss improving the hospital in an effective way. • Sample Letter of Invitation and Regret
Translation services or patient navigation groups may Developed by AHRQ, this sample invitation, welcome
also be able to suggest a potential member of the council letter and letter of regret can be customized to the
who represents the population being served. Colleagues specifics of the council and hospital.
that could serve as key stakeholders on the advisory *used with permission from Tanya Lord PhD, MPH
council should be represented and can include physicians,
advanced practice nurses, nurse managers, administrators,
care experience/service excellence leaders, spiritual
care leaders, health care ombudsperson mediators,
social workers, risk management, human resources, an
environmental services representative and legal counsel.
Hospital employees should comprise no more than half
of the council; the remaining members should include
patients and family members.

Page 11
Step Five continued

5d. Advisor Orientation 5e. Schedule a Meet and Greet

After the PFAC launch team has decided on council members, To ensure best success, it is recommended to provide
the next step is for all patient and family advisors to food or refreshments for all council members before the
participate in training at the hospital. Training for patient first council meeting. This will allow time for building trust
and family advisors is similar to the training conducted and confidence in the process before the first council
for hospital volunteers. It is customized to the individual meeting begins. The meet and greet is a great time for
hospital depending on the action plan of the PFAC. the CEO or senior leadership to meet the council and
Volunteer training may include background checks, health welcome their feedback to the hospital. In addition, the
screenings, confidentiality requirements and vaccination meet and greet is a time where the launch team can hand
compliance. Some hospitals may need to train the patient out the orientation materials, confidentiality waivers and
and family advisors in specialty areas such as Health important documents so that council members have time
Insurance Portability and Accountability Act (HIPAA) to read and review all the documentation prior to the start
guidelines. It is also important to show patient and family of the first council meeting.
advisors where to access to information on hospital
quality and patient safety, patient and family engagement
and principles of patient- and family-centered care.35 In
addition, ensure the patient and family advisors receive a
hospital tour, understand expectations from the hospital
about the role and responsibilities of the advisors, are
offered a review of the council charter and an opportunity
to ask questions and are provided an explanation of the
PFAC action plan.

Recommended:
• Sample PFAC Orientation Manual
This orientation manual, created by AHRQ, can be
customized to a hospital and council. It includes five
sections: responsibilities and expectations; resources
on how to be an engaged advisor; working with
advisors to improve the quality and safety of health
care; hospital review of hospital culture and
infrastructure; and additional resources.

Optional Tools:
• Tips for How to Be an Effective Patient and Family
Advisor: A Beginning List
Developed by IPFCC, this two-page checklist helps direct
patient or family advisors on how to work on the
advisory council and offers a concise overview of the
characteristics of an effective advisor.

Resources:
• PFE Fundamentals PFAC Orientation

Page 12
Step Six
Implement and Coordinate Advisor Activities
The launch team is now ready to begin the first round of advisory council meetings. During the first few meetings,
include time on the agenda for introductions, sharing stories and ice-breaker activities to help council members get to
know one another, build trust and develop supportive working relationships.36 A good tip for success is to establish a
designated mentor for new advisors – this will help ensure that advisors remain confident in their participation on the
council. Offer advisors sufficient information to help them understand the project background, action plan and timeline
of implementation.

6a. First Council Meeting 6b. Discuss Confidentiality

The goal of the first council meeting is to build trust Confidentiality can be a tricky issue for many PFACs.
within the council and between the patient and family Hospital legal counsel should be involved in the creation of
advisors and the hospital. Frame all discussion of safety the advisory council and have the opportunity to provide
issues in a way that embraces culture and the view that recommendations. Ensure the patient and family advisors
errors represent system breakdowns, as opposed to an have proper training, such as how to carefully review
individual’s mistake.37 Make sure to make name tags for all HIPAA guidelines, and have signed and submitted any
members of the council and to continue to track measures confidentiality agreements.
of success starting with the first council meeting.
Recommended:
Recommended: • Sample Confidentiality Statement for Advisors
• Medical Center of the Rockies Example Draft One and Developed by AHRQ, this one-page confidentiality
Medical Center of the Rockies Example Draft Two statement for advisors can be customized to meet the
Provided by the Medical Center of the Rockies, these needs of a hospital and council.
two agendas provide an overview of the content
discussed at a PFAC meeting, items to be addressed and
which team member will lead discussions.

Optional Tools:
• Tips for Group Leaders on Involving Patients and
Families on Committees
This checklist, created by IPFCC, offers activities for the
coordinator to help keep the PFAC launch team,
planning and implementation on track.
• Tips for Using a Focus Group in a PFAC Meeting
This fact sheet, established by NICHQ, offers helpful tips
for facilitating successful PFAC meetings.
• Understanding Difficult Conversations with Patients
Developed by NICHQ, this tool details how to effectively
overcome the most challenging council conversations
by providing three useful guidelines that help identify
common patterns when opinions differ.

Resource:
• PFE Fundamentals Session 4 - PFA’s: You got them,
Now What?

Page 13
Step Seven
Share The Story: Keeping Engagement Alive
It is critical that the momentum of the PFAC continuously thrives. This can be achieved by generating short-term wins,
learning from other PFACs and using patient stories to motivate the council at large. When sharing stories, it can be
challenging to stay on track with the improvement efforts underway. Below are some valuable resources on how to
inspire continuous engagement from the council while staying focused.

7a. Generate Short-Term Wins 7c. Use Stories to Motivate

When creating the advisory council, the PFAC launch team Storytelling is a powerful tool that will serve to motivate
is likely to lose steam over time. Keep the team motivated and re-energize the PFAC launch team. It will help to
by celebrating short-term wins. Plan for achievements strengthen the connection and trust within the council, as
that can be made easily visible, follow through with those well as support staff to continue improving their work, with
achievements and recognize hospital employees who were the help of patients and families. Use increased credibility
involved.38 Engaging the communications department to change systems, structures and policies that don’t fit
may be useful for sharing the news of short-term wins the vision. Hire, promote and develop employees who can
throughout the hospital. implement the vision. Finally, reinvigorate the process by
incorporating new projects, themes and change agents.39
7b. Bedside Rounding
Incorporate the PFAC into the culture of the hospital Recommended:
through bedside rounding. The PFAC can help develop • Sharing My Story Planning Worksheet
standard protocols and provide valuable feedback to staff Developed by AHRQ, this is a one-page document with
on bedside rounding. three key questions that help outline patient and family
experiences in the hospital.
Recommended:
• Nurse Bedside Shift Report Optional Tools:
This handbook, created by AHRQ, covers how to include • Sharing Personal and Professional Stories
patients and families in bedside rounding. This tool, created by IPFCC, offers ideas for the
• AHRQ Nurse Bedside Shift Report – What is it? How Can facilitation of storytelling, with helpful information for
You Get Involved? sharing personal and professional stories. It helps focus
This pamphlet, created by AHRQ, explains bedside the purpose, introduction, exercise and conclusion of
rounding to the patients and why it can be a useful storytelling.
patient family engagement exercise. • Sharing Your Story – Tips for Patients and Families
• How to Conduct a Walk from the Patient and Family Developed by IPFCC, this two-page guideline offers best
Perspective practices for patient and family advisors when sharing
This tool, created by IPFCC, is useful for hospitals when their experience in the health care environment.
they are interested in viewing their hospital from the
patient and family perspective. This activity is intended Resource:
to obtain perspective and experiences of care. • PFE Fundamentals Using Patient Stories to
Impact Change
Optional Tools: • Are Patient Stories Valuable in Healthcare?
• Applying Patient and Family Centered Concepts to
Bedside Rounding
Developed by IPFCC, this tool outlines the steps
involved to apply patient- and family-centered concepts
to bedside rounding. It provides guidance for patients,
families and staff.

Page 14
Step Eight
How to Utilize a PFAC: Incorporating Cultural Changes
Like any new change, it is important that the PFAC becomes a sustainable and integral part of the hospital’s culture. By
sharing news of short-term wins throughout the hospital, the team is now ready to further pursue the long-term goals. In
order to build the PFAC into the culture of the hospital, ensure the council has developed its own agenda of action items.
Articulate the connections between the new behaviors and organizational success and develop the means to integrate
leadership development and succession.40

8a. Learn from Other Councils

PFACs exist in many forms. Learn from others in Colorado on how to help motivate a PFAC launch team and continue the
momentum in an organization.

Children’s Hospital Colorado

Children’s Hospital Colorado has created a PFAC model to fit the unique needs of the hospital. The Family
Advisory Council (FAC) focuses on three areas: family advocacy, policy/procedure input and marking on
partnership opportunities. There are three levels to the council:

1) The Family Centered Care Council (FCCC) is the Steering Committee of the FAC. The Council consists of parent
co-chairs from the FAC and executive leadership of the hospital. The Council sets vision, oversight and
guidance for family-centered care. FCCC links the work of FAC to other organizational priorities and initiatives
as well as sets, approves and monitors the progress on long-term goals.

2) FAC is a larger group comprised of families and hospital staff. This is the family partner group for the hospital.
FAC creates family-centered goals each year and responds and gives feedback from the family perspective to
hospital initiatives. FAC put issues of concern to families on the hospital’s operational agenda. FAC is responsible
for training, orienting and mentoring of families who participate in hospital work. Members play an advisory
role on hospital initiatives and in family-initiated projects.

3) Youth Advisory Council (YAC) is a larger group comprised of patients 13 – 18 years of age and hospital staff.
YAC operates similar to FAC, initiating work and providing feedback to the hospital.

Children’s Hospital Colorado engages and encourages parents to be an active voice in their child’s care. Parents
and family members are considered a vital resource in the journey of quality and patient safety. The success
of the FAC is demonstrated with parent participation in approximately 30 different hospital committees; FAC
participation in communication training throughout the hospital; FAC review of Children’s Colorado’s guidelines
to identify a more family-friendly approach; and a creation of a family advocacy program that focuses on
enabling families to voice concerns about the patient’s care. For more information, please contact Children’s
Hospital Colorado here.

Page 15
Step Eight continued

Longmont United Hospital

Designated as a Planetree hospital in 2008, Longmont United Hospital is a mentor in the state of Colorado for
implementing patient-centered initiatives. Such initiatives include annual patient focus groups, story catchers
program for end-of-life patients, a quiet campaign and the Health Center of Integrated Therapies, which
offers holistic healing services to patients with over 10,000 visits annually. In 1993, Longmont United Hospital
developed the Longmont United Hospital Community Advisory Board, which recruited patients who were
working to evolve their own health care needs and develop their own goals to align with the Longmont United
Hospital patient-centered philosophy. The advisory board focused on transitions of care and developed the
“How’s Your Health” online health assessment, supported the development of the transitions of care toolkit and
started a volunteer care partners program. The care partners were able to help patients at risk for readmission
to navigate care at Longmont United Hospital. They also provided phone calls and a home visit based off the care
transitions intervention as part of the semi-weekly multidisciplinary rounding.

For more information, please contact Longmont United Hospital here.

University of Colorado Hospital

University of Colorado Hospital has built a patient-centered and family-centered care program (PFCC).
Patient-driven councils are comprised of patients, caregivers and select employees. They act as a resource,
assisting University of Colorado Hospital departments and units in making more informed decisions that
positively affect patients, their families and the University of Colorado Hospital staff. PFCC is present throughout
the hospital, striving to be represented at all levels of care and the vast majority of patient advisors are recruited
by the staff. University of Colorado Hospital patient advisory council helped to develop a tobacco-free campus
which started as a question from one of the advisors who had a lung transplant; the tobacco-free campus was
instituted on July 1, 2008. In addition, the PFAC has helped to answer billing questions for patients. They aimed
to improve communication to patients and families regarding their health care bills and have created a billing
workshop to help answer questions and concerns. For more information, please contact University of Colorado
Hospital here. Click here to view the University of Colorado Hospital’s presentation.

Page 16
Step Eight continued

8b. Monitor Measures of Success

Monitoring the measures throughout the improvement 8d. Sustainability
process is key to knowing that the changes have led to To ensure the sustainability of the PFAC, it is important to
hospital improvements. Continue to monitor structural, implement plans to address issues of burnout, turnover
process and outcome measures to provide evidence of the and developing new projects for the council. Spread the
PFAC’s success and the continual upgrades that are being scope of the PFAC and add patient and family advisors on
produced in the hospital. SMART goals can help guide the internal committees.
process along the way. • PFAC Sustainability Worksheet
Developed by NICHQ, this one-page checklist helps
8c. Report Back to Senior Leadership the facilitator brainstorm ideas on how to sustain the
It is important to keep senior leadership informed of the life of a PFAC and includes information on communication
progress and accomplishments of the PFAC. The changes in strategies and outreach to new departments in an
the hospital to improve quality and patient safety that the organization.
PFAC will recommend need to be approved and supported • Engaging Patients and Families in Quality Improvement
by senior leadership. The Guide to Patient and Family Engagement in Hospital
Recommended: Quality and Safety, developed by AHRQ, is a helpful
• Patient and Family Advisory Council Report resource for assisting hospitals to work as partners with
Developed by CHA, this one-page document provides a patients and families to improve quality and safety.
nice summary and recommendations from the PFAC.
This report can be used to update or recommend
changes to senior leadership for approval.

Conclusion
Building and sustaining a PFAC can be an exciting journey. In the beginning, it’s best to pursue the first tier, Green Circle.
As the team develops its skills, transition to the more challenging runs like the Blue Square or Black Diamond. Just like
in any quality improvement project, a deliberate approach to building a solid foundation always produces the best
results. CHA commends every hospital that takes on the task of creating a PFAC and making a commitment to engage
patients and families in a meaningful way. Through use of national tools, educational resources and local success stories,
the Association hopes to have provided the essential building blocks a hospital needs to implement a PFAC. For more
information or tailored support, please contact the CHA Quality and Patient Safety Department.

Furthermore, CHA wants to hear from you! If you have a success story or want to share your progress on building PFACs,
please email the Association at [email protected].

Page 17
Additional Resources
• A Leadership Resource for Patient and Family Engagement Strategies
• A Roadmap for Patient and Family Engagement In Health Care Practice and Research
(Gordon and Betty Moore Foundation, American Institute for Research)
• Patients Advisory Council Playbook 2013 Kaiser Permanente (2014 Kaiser Foundation Health Plan)
• Pursing Perfection in Health Care: Involving Patients in Redesigning Care (IHI Open School)
• Strategies for Leadership Patient- and Family-Centered Care a Hospital Self-Assessment Inventory
• Supporting Patient and Family Engagement Best Practices for Hospital Leaders
• Working with Patient and Family As Advisors Implementation Handbook
(AHRQ Guide to Patient and Family Engagement)
• PFE Fundamentals PFAC Application Process
• Agency for Healthcare Research and Quality
• Health Research and Educational Trust Resource Compendium
• Health Research and Educational Trust Hospital Improvement
and Innovation Network Patient Family Engagement Roadmap
• Healthcare and Patient Partnership Institute
• Institute for Patient and Family Centered Care http://www.ipfcc.org/

Acknowledgement
CHA would like to thank its hospital partners who have helped create this toolkit, especially Children’s Hospital Colorado,
Longmont United Hospital, University of Colorado Hospital and UCHealth Medical Center of the Rockies. CHA would also
like to thank this project’s subject matter expert, Patty Skolnik, founder of Citizens at Patient Safety, for her support in the
development of this toolkit.

About CHA
Colorado Hospital Association (CHA) is the leading voice of Colorado’s hospital and health system community.
Representing over 100 member hospitals and health systems throughout the state, CHA serves as a trusted, credible and
reliable resource on health issues, hospital data and trends for its members, media, policymakers and the general public.
Through CHA, Colorado’s hospitals and health systems work together in their shared commitment to improve health and
health care in Colorado. Learn more about CHA at www.cha.com.

About CHA Quality and Patient Safety

The Association’s Quality and Patient Safety Department is committed to improving health care quality and patient safety
in hospitals across the state. CHA works to create a culture of safety among member hospitals by offering educational
opportunities, technical support and guidance on a variety of evidence-based initiatives that both expand the quality of
care and advance leadership’s commitment to patient safety concerns.

Page 18
References
1
Agency for Healthcare Research (2014). How Patient and Family Engagement Benefits Your Hospital. [web log
post.] Retrieved March 26, 2019 from http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/
howtogetstarted/index.html
2
Frampton S, Guastello S. Patient-centered care: more than the sum of its parts. AJN. 2010;110 (9):5.
3
Robison J. What is the “patient experience”? Hospitals are becoming increasingly frustrated wasting money – trying to
hit the wrong target. Gallup Management Journal Online. 2010:1-3.
4
Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. JAMA.
2002:287(22):2951-7.
5
Stone S. A retrospective evaluation of the impact of the Planetree patient-centered model of care on inpatient quality
outcomes. HERD. 2008;1(4):55-69.
6
Charmel PA, Frampton SB, Building the business case for patient-centered care. Healthcare Finance Manager.
2008;62(3):80-5.
7
HCAHPS fact sheet (CAHPS hospital survey): Centers for Medicare and Medicaid Services; 2010 [updated November
2017]
8
Centers for Medicare and Medicaid Services. Plan to implement a Medicare hospital value-based purchasing plan.
Washington, DC: U.S. Department of Health and Human Services;2007.
9
Iacono S. A study on the relationship of patient satisfaction and utilization of a Planetree model in care delivery.
PlaneTalk Newsletter. 2001.
10
Epstein RM, Street RL, Jr. Patient-centered care for the 21st century: physician’s roles, health systems and patients’
preferences. Philadelphia: American Board of Internal Medicine Foundation; 2008.
11
Roter D. Which facets of communication have strong effects on outcome: a meta-analysis. In: Stewart M, Roter D,
editors. Communicating with medical patients. Newbury Park, CA: Sage;1989.
12
Grote KD, Newman JRS, Sutaria SS. A better hospital experience. McKinsey Quarterly.
13
McCarthy D. Case study: achieving a culture of patient- and family-centered care at Bronson Methodist Hospital.
Quality Matters. 2007.
14
Anderson, CD, Mangino RP. Nurse shift report: who says you can’t talk in front of the patient? Nursing Administration
Quarterly. 2006; 30(2):112-22.
15
Advancing effective communication, cultural competence, and patient-and family-centered care: A roadmap for
hospitals. Oakbrook Terrace, IL: Joint Commission; 2010.
16
Agency for Healthcare Research (2014). Guide to Patient and Family Engagement. Working with Patient and Families
as Advisors Implementation Handbook. Agency for Healthcare Research and Quality. P.1 [web log post] Retrieved
March 26, 2019 from http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy1/index.html
17
Agency for Healthcare Research (2014). Guide to Patient and Family Engagement. Working with Patient and Families
as Advisors Implementation Handbook. Agency for Healthcare Research and Quality. P.5 [web log post] Retrieved
March 26, 2019 from http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy1/index.html
18
Kotter International (2014). 8 Step Process for Leading Change. Step One. [web log post] Retrieved accessed April 1, 2019
from https://www.kotterinc.com/8-steps-process-for-leading-change/
19
Kaiser Foundation Health Plan (2014) Patient Advisory Council Playbook 2013 Kaiser Permanente. Page 3. [web log
post] Retrieved October 14, 2014 from http://kff.org/
20
Kotter International (2014). 8 Step Process for Leading Change. Step Two. [web log post] Retrieved accessed April 1, 2019
from https://www.kotterinc.com/8-steps-process-for-leading-change/
21
Kaiser Foundation Health Plan (2014) Patient Advisory Council Playbook 2013 Kaiser Permanente. Page 3. [web log
post] Retrieved October 14, 2014 from http://kff.org/
22
Kaiser Foundation Health Plan (2014) Patient Advisory Council Playbook 2013 Kaiser Permanente. Page 4. [web log
post] Retrieved October 14, 2014 from http://kff.org/

Page 19
References continued
23
Kaiser Foundation Health Plan (2014) Patient Advisory Council Playbook 2013 Kaiser Permanente. Page 4. [web log
post] Retrieved October 14, 2014 from http://kff.org/
24
Kotter International (2014). 8 Step Process for Leading Change. Step Three. [web log post] accessed April 1, 2019
from https://www.kotterinc.com/8-steps-process-for-leading-change/
25
Agency for Healthcare Research (2014). Guide to Patient and Family Engagement. Working with Patient and Families
as Advisors Implementation Handbook. Agency for Healthcare Research and Quality. P.13 [web log post] Retrieved
March 26, 2019 from http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy1/index.html
26
Agency for Healthcare Research (2014). Guide to Patient and Family Engagement. Working with Patient and Families
as Advisors Implementation Handbook. Agency for Healthcare Research and Quality. P.13
27
[web log post] Accessed April 1 2019 from http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/
strategy1/index.html
28
Kotter International (2014). 8 Step Process for Leading Change. Step Three. [web log post] accessed April 1, 2019
from https://www.kotterinc.com/8-steps-process-for-leading-change/
29
Agency for Healthcare Research (2014). Guide to Patient and Family Engagement. Working with Patient and Families
as Advisors Implementation Handbook. Agency for Healthcare Research and Quality. P.13 [web log post] Retrieved
March 26,2019 from http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy1/index.html
30
Kaiser Foundation Health Plan (2014) Patient Advisory Council Playbook 2013 Kaiser Permanente. Page 5. [web log
post] Retrieved October 14, 2014 from http://kff.org/
31
Kotter International (2014). 8 Step Process for Leading Change. Step Three. [web log post] accessed April 1, 2019
from https://www.kotterinc.com/8-steps-process-for-leading-change/
32
Kaiser Foundation Health Plan (2014) Patient Advisory Council Playbook 2013 Kaiser Permanente. Page 5. [web log
post] Retrieved October 14, 2014 from http://kff.org/
33
Agency for Healthcare Research (2014). Guide to Patient and Family Engagement. Working with Patient and Families
as Advisors Implementation Handbook. Agency for Healthcare Research and Quality. P.16 [web log post] Retrieved
March 26, 2019 from http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy1/index.html
34
Kaiser Foundation Health Plan (2014) Patient Advisory Council Playbook 2013 Kaiser Permanente. Page 5. [web log
post] Retrieved October 14, 2014 from http://kff.org/
35
Kaiser Foundation Health Plan (2014) Patient Advisory Council Playbook 2013 Kaiser Permanente. Page 5. [web log
post] Retrieved October 14, 2014 from http://kff.org/
36
Agency for Healthcare Research (2014). Guide to Patient and Family Engagement. Working with Patient and Families
as Advisors Implementation Handbook. Agency for Healthcare Research and Quality. P.20 [web log post] Retrieved
March 26, 2019 from http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy1/index.html
37
Agency for Healthcare Research (2014). Guide to Patient and Family Engagement. Working with Patient and Families
as Advisors Implementation Handbook. Agency for Healthcare Research and Quality. P.24 [web log post] Retrieved
March 26, 2019 from http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy1/index.html
38
Agency for Healthcare Research (2014). Guide to Patient and Family Engagement. Working with Patient and Families
as Advisors Implementation Handbook. Agency for Healthcare Research and Quality. P.25 [web log post] Retrieved
March 26, 2019 from http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy1/index.html
39
Kotter International (2014). 8 Step Process for Leading Change. Step Three. [web log post] accessed April 1, 2019
from https://www.kotterinc.com/8-steps-process-for-leading-change/
40
Kotter International (2014). 8 Step Process for Leading Change. Step Three. [web log post] accessed April 1, 2019
from https://www.kotterinc.com/8-steps-process-for-leading-change/

Page 20