Patient and Family Advisory Councils: Two hospitals’ success stories

As of October 2010, all hospitals in Massachusetts were required to have established a Patient and Family Advisory Council (PFAC). DPH’s regulations for PFACs require hospitals to write annual reports describing their PFACs’ activities over the previous year and to make those reports available to any member of the public upon request. Members of HCFA’s Consumer Health Quality Council (CHQC) ( reviewed and summarized all of the annual reports that were made available to them. The CHQC members identified two hospitals’ PFACs as role models for other hospitals-one community hospital (Milford Regional Medical Center) and one academic medical center (Beth Israel Deaconess Medical Center). Leaders of those hospitals’ PFACs described their activities at last week’s monthly meeting of the Massachusetts Coalition for the Prevention of Medical Errors.

Kim Munto, the Director of Risk Management at Milford Regional Medical Center, described their PFAC’s activities in her presentation, elaborating on them in a later interview. Since their PFAC members are particularly attuned to health literacy, the application for prospective PFAC members is available in Spanish, Portuguese, and English.

Milford’s PFAC completely reworked the hospital’s discharge instructions, translating clinical language into terms more often used by laymen. The PFAC’s suggestions greatly clarified the instructions about medications, e.g., which ones to stop taking, which to continue taking, and in what doses. The PFAC also stimulated changes to the forms used to convey information on patients as they transitioned from the hospital to each of three extended care facilities (ECFs). The PFAC performed several rounds of intensive review, working with the three outside ECF organizations, in an example of collaboration across healthcare organizations that is all too rare.

To help Milford begin providing mealtime menus to patients for the first time, the PFAC reviewed the menus and the presentation of the food, and then at a PFAC meeting, ordered dinners from the menu, which were delivered to the conference room.

For Beth Israel Deaconess Medical Center, Barbara Sarnoff Lee, the Director of Social Work, and Elana Premack Sandler, Project Leader for Patient and Family Engagement, described their four PFACs as components of a broader strategy of engaging patients. BIDMC’s Neonatal Intensive Care Unit (NICU) had been the first to set up a PFAC, followed by PFACs for the ICU, the entire hospital, and Universal Access (focusing on the needs of patients and staff with disabilities and other access challenges). BIDMC also engages 100 patient advisors in pairs on committee seats, department-specific groups with embedded advisors, focus groups for patients especially concerned with a single issue, and ad hoc projects.

A PFAC member had mentioned how much easier it was to heal when it was quiet at night. The hospital applied best practices to quiet the patient areas, creating a notable improvement in the eyes of patients surveyed in HCAHPS (patient experience surveys): 33% more patients said it was always quiet at night after these changes (60%) than before (45%). This positive change was discussed in a recent Boston Globe article.

BIDMC had noticed an opportunity for improvement in pastoral and spiritual support for patients, based on FS-ICU (Family Satisfaction – Intensive Care Unit) data. Following redesign efforts with feedback, the FS-ICU scores improved. Another effort, to improve the ICU’s waiting rooms, also raised FS-ICU scores. In a ripple effect of the improvement, seeing the change, hospital administrators then awarded more funds for renovating the waiting rooms.

These are merely a few examples of many more at these hospitals, and indeed, at many other hospitals in the state. The Consumer Health Quality Council hopes to encourage hospitals to test and adapt these practices so their patients can also benefit. Keep an eye out for the release of the Consumer Council’s summary report of all of the PFAC reports, where you will be able to read about more PFAC accomplishments. In the meantime, go to the hospital PFAC page on the HCFA website to learn more about any individual hospital’s PFAC.

[This blog post was written by Ken Farbstein, a long-time member of the Consumer Health Quality Council, and professional patient advocate at Patient AdvoCare. Ken writes Patient Safety Blog to empower patients to partner with their doctors and nurses.]

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