Article Figures & Data
Tables
Site No. Clinic Type Duration of PAC Patient Members in PAC, n Meeting Facilitator Meeting Language 1 Public health internal medicine health center, FQHC 1.5 years 7 to 9 Staff member English 2 Public health family medicine health center, FQHC 4 years 7 Staff member English 3 FQHC 10 months 15 Staff member Spanish 4 Non-profit network of family medicine FQHCs 3 years 22 patients representing network of 11 practices Staff member English 5 Academic family medicine health center 5 years 12 Staff and patient co-chair English 6 Public health community health center, FQHC 8 months 12 Staff member Spanish 7 Urban FQHC 2 years 15 Staff member Spanish 8 Rural FQHC 6 months 12 Staff member English FQHC, federally qualified health center.
Activity Best Practice Supporting Quotes Logistics/Setup Membership of 7–15 people with term limits, monthly meetings “At first we were only three or four and now we're 12 or 13 members, so I think that if we had more members from the very beginning the changes could have been achieved more quickly.” Reimbursement/ incentives “So for each, in compensation for like their time, each patient gets a gift card, a $10 gift card, each meeting they come.” Dedicated staff with protected time/resources for planning “There has to be sort of staff resource in place as far as is there someone who has the capacity to sort of lead this project… I'm a full time staff person and I spend a lot of my work life helping to manage this… so it does take some time and effort.” Engaged leadership “The top senior management team needs to be completely, 100% involved in the process and then get everyone excited and buy-in and help them through statistics and examples and patient stories.” Recruitment Formal interview process with consideration of communication skills So I think it was so important for us to sit down, to go through an interview process. Can you communicate with each other in a productive way?… And making sure that we had at least people with different experiences to bring, and then sharing with them really what our mission is about.” Focus on establishing a PAC that is reflective of the patient population served “We do, you know, in the kind of instructions we give them to recruit patients or support we give them to recruit patients, we really ask them to make sure that they recruit someone that's sort of reflective of some of the demographics of their practice. Support/training for new members “We empower them through the Advisory Council… we really teach our advisors to do that so if they don't come with those skills, those are teachable skills.” Term limits; ongoing/rolling recruitment “We do have term limitations on our council members… ‘cause we need fresh voices.” Meeting Process Strong, trained facilitators “You can create this trust where people like they don't feel like judged if like they bring an idea that's not good… I would really work on having this like safety space where everybody feels they can share ideas and they won't be criticized.” Patients bring their own experiences for practice improvement projects “Patients also initiate projects. It kind of comes up more like I have this concern. And then we break down what might have led to that experience.” Staff members come to present to advisory council for “focus groups” “Each meeting, there is always somebody from some—like the library or like today we had the lady with the other group. They come in and let us know what they're up to and what's going on with them.” PACs reach out to broader clinic to hear patient needs Implementation/Follow-up Clear definitions of roles for operationalizing projects, with both staff and patients contributing. “I think that in order that the council works things should be done together with the staff and I also suggested that all the staff members should be notified of the changes.” Selection of the “right” project on the right scale “Most of the time (clinic leadership) are very receptive to the ideas. And if for some reason they can't do anything about it right now, then they say, ‘That's a great idea but right now we're holding off on it.’ So then I reported that back to the Advisory Board.” Clear channels of communication and follow-up between advisory councils and rest of clinic “It's really important that the opinion goes somewhere so we try to be cognizant of trying to tell the council, “the last time you gave us this feedback. This is what happened to it and we think this is going to be the next steps we're going to take to making this change.” - Table 3.
Examples of Practice Improvement Projects Established by Patient Advisory Councils
Area of Impact Examples Clinic physical space Improved waiting room chairs Creation of wheelchair access Clinic artwork Posting of facesheets/bios of providers Healthy vending machine food Improved clinic signage Patient care/care communication Distribution of BP cuffs and scales for patients Creation of patient feedback comment box Patient emergency medical sheet Improved visit summary Improved Spanish-language materials Patient-designed clinic brochure and welcome letter Redesigned advance directive packet Feedback on provider practice regarding giving bad news Feedback on barriers to immunization Creation of patient visit preparation tool Patient calendar Clinic workflow/system Feedback on online patient portal/electronic medical record Feedback on staff customer service Designing PDSA (Plan-Do-Study-Act cycles) Program to reduce patient no-shows Improved telephone access and Spanish-language phone access Interventions to reduce patient wait time Impact on clinic culture Staff are more receptive to patient feedback Staff seeks patient feedback before initiating projects Staff draw connections between improved patient experience of care and improved patient adherence Staff exposure to patient narratives Changes in staff language more focused on patient experience Initial staff resistance has abated Movement to include patient members in other clinic programs and working groups Improved sense of gratification and mission in work BP, blood pressure.
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