 Good morning everybody. This is Donna Prosser, Chief Clinical Officer with the Patient Safety Movement Foundation. And we're really excited today to bring you this webinar on how to leverage patient and family advisory councils to improve patient safety. So we have a lot to get to today. So really looking forward to our discussion. We're going to talk just a little bit about what key facts are and what are some of the expectations that organizations can expect from the different ways that people can get involved and how patients and family members can get involved in patient improvement work. And so you can see as always we are able to provide continuing education credit from MedStar Health, our CE provider for nurses, pharmacists, and physicians. Unfortunately only those who attend the live webinar are able to get the CE credit for this. So please, if you registered as a nurse, a pharmacist, or a physician, then you should be getting an email from MedStar within the next five to seven days telling you what you need to do to be able to collect that CE. Respiratory therapists likely can use nursing credit for their state licensure. So please check with your state to see if that's possible. We are also offering ACHE credit. That's the American College of Healthcare Executives, Certified Professionals and Patient Safety, and Board Certified Patient Advocate. The CE for CPPS and BCPA will be coming directly from the Patient Safety Movement Foundation and so you should again receive some information from us within the next five to seven days. As you can see here, none of the speakers today or any of the planning committee has any conflicts to report. And so I'd like to get started by introducing our moderator today. Marty Hadley is joining us as the moderator for this event. So welcome Marty. Thanks so much and I'll hand it off to you for introductions. Thank you Dana and welcome everybody. It's a life-long experience to be here with a fantastic panel and with with you all to talk to you about some work that all of us have been working on for quite a while. Several years. You've got a panel of deep expertise here. Very quickly I'm going to just introduce my friends and colleagues here starting with Evan Lofton who's the Senior Vice President for Integrated and Acute Care Services and also the Chief Nursing Officer at Parish Medical Center in Florida. Armanu Nahum who is got multiple titles. He's the Director of the Center for Engaging Patients as Partners at the MedStar Institute for Quality and Safety. He's also the co-principal with me of an organization called H2PI which stands for Healthcare Patient Partnership Institute. And Kelly we left we're gender neutral here so we didn't do ladies first but Kelly Goodson is a longtime colleague and expert subject matter expert on performance improvement, patient safety, and health equity with Visiant. Really the the kind of coordinator of the interface between all those issues those important issues at Visiant. So welcome all. It's just wonderful to be with you as we go forward. What a really wonderful program. Let's go to the next slide. So we're going to start with this slide and Ed when I think you're going to walk us into this moment and we'll go from there. Thank you Marty so very much and to everybody on the program welcome. The picture you see here does have a pretty important backstory to it. We began our PFAC probably five to seven years ago and three years ago Kelly and team from Visiant contacted us as they were doing some research on effective PFAC set organizations and Kelly came to a visit. I think it was in the summer of 17 and she brought two of her colleagues with them, Marty and Armando. And I did not know Marty and Armando very well at that time and we worked for an entire day in my work room which you see a picture of a wall here and in my work room we've got all of our patient safety data. We look at where we can find points of improvement and I've got four pictures there that are there every day to remind us that never again can we allow a medical error to hurt somebody. I'm going to cut to the bottom picture that you see there of the gentleman with the parachute on. And as I was telling Marty Armando and Kelly the stories of these people and I said this is Josh. He did not bow when he jumped out of a perfectly good airplane in his parachute didn't open. He did doubt when he attained sepsis from dirty instruments in the operating room. And Marty at that time leaned forward to me and said Edwin you do realize that Josh's father is sitting right next to you. And neither Armando or I had put two and two together until that moment in time. And for me and I think for all four of us it reinforced the vitality of the patient family advisory committee and what has to happen in the clinical, operational and optical points of the organization. So Armando I'll turn to you. Armando you're on mute. Yeah thank you for that Edwin. Ed was a very special moment I thank for all of us and especially for me. Thank you brought tears to our eyes. So thank you again for what you do. I'm going to go through these three questions briefly explain what is a PFAC? A PFAC is a patient and family advisory council or advisory committee and there are a few other acronyms used out there but this is the more common one. As a patient safety advocate I personally pay less attention at its name and more on what its mission is and what it accomplishes. But regardless of what it is called it is a formal group that meets usually monthly and it consists of patients and family members, administrators, clinicians, staff and all partnering together on the voluntary basis. It provides a mechanism to enhance the delivery of high quality and safe care. The members of these councils should be regarded as consultants, advisors and not volunteers. And I would like to underscore that when we help organizations build these PFACs we build them under the quality and safety umbrella. Therefore we place a Q&S at the end of the acronym. This does not mean that we disregard the importance of patient satisfaction. We certainly address that but our focus is definitely on quality and safety. And at the end of the day that's what it's important to patients and families. So why do you have a PFAC? Well a PFAC should have a clear mission aligned with the organization. And that should be to improve the delivery of safe and quality care by providing a way for the community to collaborate with hospital staff, improving outcomes and therefore enhancing the experience for patients and families. And a PFAC is not a place for sharing complaints because there's usually a dedicated department for that. It's a place where collaboration occurs to make that organization the best it can be. And finally, how does a PFAC help? Well there are certain criteria that need to be in place in order for a PFAC to help the organization. The support of leadership and the board is really very, very important but it should not stop there. Because the message on the importance of developing a PFAC should always be bilateral. Top down and bottom up. It's important for the organization to make sure that everyone knows about its council or it really will cease to exist. And the community members side of the council, you know, they bring a certain perspective that clinicians rarely have unless they have been patients themselves. I always like to use the following analogy because I come from the film industry. Clinicians go from patients to patients, saving lives, and they only get to see the trailer of each individual patient. We, on the other hand, see the whole movie. So I'm going to pass it on to Edwin if he's got something to add. Otherwise, Kelly. Yeah. Well, Edwin, you're on mute. Go ahead. Sorry, I was going to say, Armando, excellent description of why and where for. And again, you've got to, every organization has got to make a commitment to listen to the person that we have the honor to partner and care with. We'll talk a little bit later about how do we engage them in certain activities. But it truly is a commitment and a part of the culture of an organization to be successful. Kelly. Kelly, before you go, if I could just do a little bit of context. Armando distinguished, you know, the PFACs that we're talking about today from those that are more interested in patient satisfaction. And we know from our own experience that there's been a lot of PFACs that were originally built to really improve patient satisfaction. And they, they were less likely to be involved in safety and quality improvement. So the work that we did, the work that we were doing when this picture was taken when we did this visit to Edwin's organization was really part of a busy and project on looking at the PFACs that were very involved in safety and quality. Right? Yes. And, you know, it was, it was a great project that, that we did under the CMS HIN program, the Hospital Improvement Innovation Network program, which many of you might have been involved in. So it goes to that question, how does a PFAC help? And we were researching that question was, was really what we were trying to figure out. And we were able to identify leading performers who had very effective PFACs. And that was one of the reasons we were down visiting Parish. We did 11 site visits total. And we were able to rank, it was, it ended up being a multi year project in which we had over 200 hospitals involved, where we were able to rank their PFE efforts in relationship to quality and safety. And those hospitals that had higher levels of PFE, including working with PFACs and quality and safety like Edwin's organization, had lower rates of falls with injury and lower readmissions, 30 day readmissions. So if you go to the next slide, we had part of that research, we had developed this logic model, whereas this was sort of our hypothesis, but it's also what we were able to prove that and I'll start in the circle. And we know that hospitals have a commitment and a strategy around quality and safety. And you see that in the purple square there that we stood up in the last several decades, quality and safety programs at our hospitals that have budgets and metrics and accountability and structure and leadership. And for that, we have gotten a certain level of quality and safety, which you see by the purple bar in the bar chart. So our hypothesis and what we were able to prove was if you if you focused in on PFE and integrating that into quality and safety, including engaging with PFACs, that you got what's in the yellow box, which is what we call the PFE enhanced quality and safety culture. And you were able to reach a higher level of quality and safety at your organization. You see the little yellow piece added on to the purple bar. So you were able to reach higher levels of quality and safety because you had a PFE enhanced quality and safety culture, which included a PFAC 100% of the time. And Kelly, I'm sure we have a number of hospitals here who were active in the HIN network, which was a big CMS improvement project. And we were measuring the number of hospitals, the boxes you referred to five HIN metrics, but we were measuring the number of hospitals in the country that had PFACs. As I remember the last data I saw, you probably saw more recent data. It was about 60% of hospitals who reported they had PFACs. Am I remembering that right? You are remembering that right. It was 62% of the hospitals that were participating in any of the HINs. So it was over 4,000 hospitals. We had a measure of 62% had PFACs. And then with our our vision study, our vision members, it didn't even hire a number. So the study I mentioned that we did, it was 82% of those that were involved in our study had a PFAC. So, you know, but it's not just enough to have a PFAC. It's really important that they be involved in quality and safety as we've been pointing out here. And studies have shown that, including ours that I mentioned, but there's another study that the New York State Health Foundation had done with the Institute for Patient and Family Center Care, where they looked at PFACs in the state of New York. And they found that 29% of the hospitals had a high performing PFAC. So, you know, you can have a PFAC. It doesn't mean it's going to be high performing. And I see some questions already in comments about that in the chat. We can talk more about that. But, you know, when you have that that high performing PFAC is where you see these improvements in quality and safety. And I'll mention in our study, we had only 20% of ours were considered high performing by our standards. And when I say high performing, I mean that they, you know, they not only spend the time and resources it takes to onboard and orient PFAC members, but they offer a variety of ways for PFACs to help them, including full membership on key committees, quality improvement, safety teams, and governing boards. And they document these activities that include the PFAC and they measure the impact of that. So, that kind of gives you a description of what a high performing PFAC is and really how many of them are out there. When we looked at this logic model too, and I'm sure this will just be, this is sort of the image behind it, but this kind of high performing PFAC, this kind of a program, this kind of improvement PFAC adding to your quality improvement results really only happens in organizations where there's strong leadership. I mean, otherwise this just doesn't happen. And so that was another fact we found. I know we're going to come back and talk about that later. But with that said, thanks for that introduction, that framing of what we're talking about today. And let's go to our first polling question. And Dany, you're going to help me set this up today to help our, great. I know. So, for those of you in the audience, we'd like to trial a new product today called Slido. I would love for you to take your device, whatever kind of device you might be, you might have a mobile device. You can take a picture of the QR code up here in the corner and it should automatically bring you to the website. If you have any trouble with that, you can just go straight to Slido.com and type in this number four five seven four. So, so we would love, oh, look at that. We're getting lots of responses already. Okay, so while everybody is answering that, I'll pass it back on over to you, Marty. Okay, well, let's just go on to our next question while we're waiting for the results here. Although it is kind of cool to watch the results accumulate. So, and we're going to actually get some more data here about how common they are. Forty eight percent say you have PFACs that work on safety and quality, and another 35 percent. So, yeah, this kind of mirrors Kelly what we found, and that is that there's some PFACs that really just have avoided working in quality and safety. And it looks like it's going to be close to half and half. And about that, Marty, I'll just add it was a key point in how we ranked our PFAC numbers or how high performing the PFACs were was how many committees they were involved in that that worked on quality and safety. Okay, okay, so a little bit higher than the data we had before, but that's a that's a good sign, and more hospitals working in quality and safety. Fantastic. Okay, let's move on to how we establish PFACs. What's involved in getting one off the ground? Kelly, I think you're going to take this question first as well. I am, and I'll just quickly run through this because there are really many free tools and resources out there, including ones from H2PI, which I'll go over here in a second, and which is the one that we used at Vizient. But the Agency for Healthcare Research and Quality, even CMS and the, you know, Institute for Patient Family Center Care and others, they have, there's a lot of resources and tools out there. So don't recreate the wheel. There are well established processes. And what we did was we used H2PI's road to success here. And if you go to the website, you'll you can download this this information, but we bucketed it into really three buckets of work. So the the first stage is assessment and planning, and that's about the first three months of work where you're getting your leadership support, if you don't have it yet, which we strongly recommend that is number one. You're forming your project team, you're looking at the different areas where PFE is occurring or could be occurring in your organization. And you're really talking about the fact that you're going to build a PFAC. You're orienting the staff, especially the medical staff, you're talking about what you're going to be doing, because it's very important for everyone to understand what why you're creating a PFAC. Then in the next three month phase, you are building that PFAC. So you're developing your charter, your covenants, your getting your applications broadly out to the community, you're interviewing and selecting your advisors. And there's lots of tips and tricks in there that we could get into detail, but I'm not going to do that right now. If you have a specific question, let us know. But that's about another three month process. And one thing I will say is be sure to look at your grievance process as a way to recruit your PFAC members. And if you want diverse PFAC members, you've got to work at it. It takes some work. So then the last three months is really getting those selected PFAC members oriented, giving them some training. There's all sorts of things like HIPAA and privacy, and do they need to be vaccinated, and all those kinds of things, certainly that was all pre-COVID. It's still applicable now, I think. But then you'll get them in action. You'll have the monthly meetings. And then yet, when you really it's important to create a feedback loop and track the loop. Bando, Edwin, I know you've got experience in working with this too. Is there anything you want to kind of highlight here before we move on to actually what PFACs help you find people to work on? Anything else you want to say about establishment or recruiting? Sure. In establishing and recruiting for us, we look at it several ways. One is they're a member of the community, a patient that has an interest in supporting us. That's always an easy way to get there. But the other thing we do, and Kelly referred to this, is we take our mistakes and try to turn them into action. My first three PFAC members were family members of former patients who we did not do the best we could do. But I was able to establish a relationship with them, get them to understand that we're learning and growing too, and the only way we can do it effectively for our community is with their direct involvement. And they are still our strongest supporters to this day. Bando, any comments? No, I did know what Edwin says, and my wish out there is that more hospitals follow Edwin's way of recruiting because he nailed it. He just nailed it. They do it right. And Marty, let me just add one thing to that, too. When you think about the patients that have gone through your grievance process, you've already seen them at their worst. You've already seen how they talk with you, how they present their side of the story. You've already worked with them. You know them. So, you know, people are a little bit afraid of going through the patients that have gone through the grievance process. But, you know, those are the people you kind of know best. Yeah. And Kelly, when we visited the high performing hospitals like Edwin's, I mean, we saw a lot of sort of counterintuitive appreciation of that from hospital executives. Like, we thought that we'd be getting more people complaining. We thought that, or we found people in our PFAC recruiting process that we didn't know we're out there who really wanted to help us, things like that. I just want to emphasize also there's quite a bit of risk management built into this, and by that I mean the charter really states a purpose. So, Armando mentioned before that, you know, this is not a place to come and gripe. This is a, you know, there's another place for that. You could file a grievance. You can, you can, you know, write a letter. This is a place to come to contribute. Taking your experience and contribute to the hospital being well done. And it's important to have that in the charter, and a charter is essentially a fancy word for basically the purposes that really you want to align with the mission of your organization. And then covenants is just the role of the road. One of the things that we look for when we recruit are people that are not only experienced, but team players, good listeners, they can kind of look beyond their own experience to what they can do to help the hospital in a number of ways. So that kind of recruiting is really important. And as Kelly emphasized, there's a lot of really good free online resources out there from organizations that have learned lessons along the way. Yeah, Marty, could I quickly add something here? Yes. I think there's a the main, I find that the main reason that some hospitals, some organization shy away from the grievance database that Kelly has mentioned is because there's a notion that, hey, if we share the data, if we are transparent, if we tell everybody what happened in the hospital, our patients will go across the street. They'll go to the competitors and actually through our, you know, study analysis that we did with Visient, we found it to be the opposite. It's not true. And to prove that, we also know about the program called Candor, right, which actually proves that. So, you know, don't shy away from going to your grievance database after a year or two has passed because it's the best way to help you with your PFAC. Before we leave this, too, I do want to just come in a little, once more, about Parish Medical Center. When we walked in, I mean, I'm on Kelly and I were doing this tour of high-performing hospitals with PFE. And we walked into Parish Medical Center and there was safety messaging everywhere. You could tell that that was something that you were using to communicate to your patients and family and employees that this was the number one priority for your organization. So, it was, I mean, that leadership really shown through. And I also want to say that everyone stepped out of a vaccine clinic where he's actually putting shots of people's arms today. So, the phone ring in the background is probably people, why don't you back it? But thank you for taking time today with us and thank you for for doing what you're doing on the vaccine clinic. Wow. Let's move on. I think we're still in good shape on time. We want to cover a couple more issues with you. Before we get to this, let's have a little discussion about this, about this question we're about to ask you. What do PFACs work on? Or the people that you kind of bring into your PFAC and use as a place to orient and train them. How do you use them, Edwin? We, at Parrish, we use them in every way possible. We took off the veil early on in only using them for satisfaction and engagement there. A couple of examples. I answered one example in the chat session already. When I was working in my doctoral thesis, which was to create zero harm in transitions of care from the ED to med surge, I pulled the PFAC team directly in there and I showed them what process we had. I then showed them what process I had hypothesized and allowed them to have direct input into what we actually trialed and what came out from there. In addition, in several years ago in our care team rounds, which are looking at the plan for the day, plan for the stay, plan for the wait every day, I brought them in directly to observe how we have those conversations and their input was absolutely phenomenal. We as clinicians we're talking clinical talk to patients which is the wrong thing to do. We had to relearn our language of humans talking to humans, persons talking to persons, not talking at them, but talking with them and using our ears to listen to what they're saying and what they were asking for. So everything from and you're going to you're seeing on the screen right now, we have used them in infection prevention. Our infection prevention is in hand hygiene coordinator have worked with that. We have used them for fall reduction for medication safety and primarily in how do we communicate to make sure you have a healthy process of care. And Armando, you know, I didn't mention this in your introduction, but you came to patient safety after the loss of your son, Josh, to infection in that happened in a nursing home and a hospital. So I know you've been a champion of hand hygiene. What else have we seen hospitals really focus on in clinical improvement working using their PFACs and PFAs? Sure. Thanks, Marty. You know, I find it still puzzling that no matter how many papers get published and how many studies are done to show that embedding your PFAC community members into clinical work, not only is the right thing to do, but actually works. And so I'm going to tell a little story here as a member of the system PFAC and MedStar Health with their 10 hospitals and each hospital has their own PFAC. I was asked by Dr. David Mayer to be part of the Sepsis initiative from the patient perspective. Obviously not, you know, from the clinical side. And I can't begin to tell everyone here how successful the program was from reducing emergency department wait time to almost zero to a unified Sepsis protocol across the system to the involvement of each of their PFACs to bring awareness and community education across Maryland and the District of Columbia and even past legislation in a state of Maryland which requires every hospital to have a Sepsis public awareness campaign. And, you know, we even won the Sherman award for patient engagement. So why did it work? Well, certainly not because of me, but rather because of the partnership embedded into their PFACs and the fact that they removed the biggest challenge that I think exists in most organization that I mentioned earlier that shy away from bringing someone like me into clinical work. And that is transparency. They have to be able to share data or it will never work. Right. Right. And we've seen, I mean, this list, it's interesting to see this listing came in like Kelly, I'd love your thoughts on this too before we move on because I know you've been involved in a lot of these issues, but it's interesting to see the other so big. So there is it in our sample here in our audience, a number of people that are using PFACs in a number of ways. Yeah, actually just typing in the chat a response to a question, but I mean, there are some in our study, we found that topics like falls and readmissions are sort of the top areas that hospitals have patient and family advisory councils involved. So there are some that are more popular than others, but really the sky's the limit on how you want to use your patient family advisory council. They are very much up for helping with anything. You'll find that they are, they can have input on things that they don't even think they're familiar with. And also, we'll reiterate a chat comment that Dr. David Mayer just made a few minutes ago. Yes, we can bring in patients who have had agreements and that sort of thing, but there are many persons and members of the community who have had very positive experiences with healthcare organizations or health systems and they have a sense of wanting to give back. So make sure your search is broad and wide and accepting the help and knowing that they have a good feel for what the community is. Okay, good. The evidence base here is still growing. So Kelly's share with you some of the evidence, but we also just in, you know, I think the story is yet is just starting to be told. I mean, we saw PFACs that had been very successful in making progress in some of these areas that gave a lot of credit to their PFA members. Emory, for example, talks a lot about the ways in which their PFAC members have helped them reduce infections. We have one hospital that tells a famous story of how the PFAC kicked their butt and getting them to focus on hand hygiene. Really prioritizing that for them. So by bringing this voice of your user into your improvement work and giving them the right orientation, you do really see that change in perspective that Armando talked about and the idea is that you get from your users of care that you don't necessarily get from your providers or that's heard in a different way. It might be heard by your board, for example, your leadership if it comes from patients and families more than it's heard from your QI team. Excuse me, Marty. There was a private message that someone is interested if we had a minute or two to discuss maybe how PFACs can help you in COVID. Okay. Do you want to take that now? We've got time. We have time. Who wants to jump into that? I will. I'm not bashing on these things. We actually had a several meetings with our PFAC through the COVID process. We, as I'm sure many healthcare organizations had to cut back on visitation, had to cut back on some general surgery or selective surgery at some times. And so early on, we engaged our PFAC team and when family members are not at the bedside as frequently, how do we make sure we don't have misses in communication and misses in care? And so they helped us develop our bedside televisitation how to frequently to do it. They were sort of our measure of when we allowed real-time visitation to come back in. And so that's been a very effective way in looking at the human nature of this pandemic. You know, when I take a look at my mom, my mom who is 93-year-old as an assisted living facility in North Carolina and until yesterday since March of last year, we were not allowed to touch her. And that is a that's a human tragedy. And so we've got to use our PFAC teams to help us bring the human factor, human relationship back to the table. Oh, I'm moved to hear that. I mean, we're back with these stories, but I didn't expect it to come through live with you this morning. Kelly, I know you've reached out to do some research about PFACs with PFAs about when and why patients and families are ready to return to a hospital or when and why they're not. Yes. And I just also typed in the chat just to share that PFAC members have actually been on Incident Command Committees for big health systems. Intermountain, I'll mention is one of them. Yeah. And, and Visio, we reached out to through our our members, our hospitals, their PFACs. We've talked to patients and families and had them help us, you know, give insight to our hospital members across the board. Across the country. And how to, you know, talk with patients during this time, how to get them to understand how they feel about the safety of returning to care. So there's just so many things that patients and families are just willing to talk to you about. You just have to ask. Amandu, did you want to jump in? Yeah, actually, part of the question was also what innovative way, you know, do we know or have experience doing COVID. And one of them you know, Zoom has taught us many things, right? And other platforms like Zoom. But I can honestly say that both Marty and I were involved in creating an entire PFAC from scratch. Totally virtually. We never went to their organization and it worked beautifully because I think what COVID allowed us to do is to be able to organize meetings in a way that we probably were not going to be able to do it as effectively by setting up in-person meetings. So it worked extremely well and it can be done, obviously. And we're seeing more and more PFACs meet virtually now, too. And even interviewing members virtually. Other things that I know that are kind of on the bubble, Edwin alluded to this, but it's visitation. I mean, visitation policies change so much during COVID. And I think PFACs are a great resource for really thinking through how are we going to navigate that going forward. Telemedicine. I mean, everything I read is telemedicine is getting a new wave for a number of reasons. And I think, you know, how our patients and families are using that with it, you know, what they like about it, what they don't, what works for them, what doesn't is something that we hear PFACs talking about. Mental illness, mental, and just the stresses, maybe not even mental illness, but just the stresses that we've all been living under for a year is increasing hospitalizations of behavioral health patients. I know quite a bit. So I think we see PFACs working on those issues as well. And then I'm curious about, you know, long haul COVID patients if we're going to, you know, I think PFACs could be a great resource there. I haven't really heard of that happening yet, but if anyone's using your PFAC that way, please let us know in the chat box. Any other thoughts from the panel before we move on? COVID related. Okay. Then let's, we've already kind of addressed this question, but how do you identify good PFAC members before we get to this slide? When we go back to, well, we can, we can leave that up. Well, yeah, let's leave that drivers of success slide up. That's going to be our next question. But how do we recruit members? And when you already talked about that, we talked about throwing the net wide and also going to your people who filed grievances or brought a constructive problem to you. But how do you onboard them? Let's go on to the next step. How do you, once you get this great group of people who really want to help you be the best hospital you can be, or the best clinic you can be? What's important in the onboarding process? And when I think you were going to take this first too. Yeah, for the onboarding process, just like any other relationship is probably the most critical time. I've seen a couple of questions in the chat about how do you keep them engaged for long times? And it does start with the onboarding. It is again, being completely transparent, talking with them, engaging with them, that you want their expertise, you want their console, and to do so, we have to take the veil off and show every work that we have. We have to show where we have needs for improvements, where we've gotten stuck in some of our performance improvement, and educate them on how we do and why we do certain things, and then stop and really listen to their feedback. Once they know that they're being heard, that is a recipe for long term engagement. When they know they're being heard, they're not going to expect every idea they have for every suggestion they have to be put into place, but they know that they're going to be considered and they know their value. So onboarding with a sense of value, a sense of purpose, and a sense of transparency. Kelly, I know you've listened to a lot of hospitals and their onboarding processes. Do you want to contribute to this answer before we move on? Sure, and I'll be quick about it. I mean, the leading performers that we saw that we went to really treated the PFAC members like employees. They had them fill out applications. They interviewed them. They selected the ones that were the best fit for the organization that we're going to provide that critical crucial feedback that they need. So it was very much embedded like you would an employee. So once you got the mom aboard, you orient them to your mission, vision and values. You tell them what your strategies are, you make sure they understand deeply the organization itself, and then they can better help you. And Kelly, I remember being on meetings with you where we saw one of your members just walk them through the patient satisfaction scores and all the pieces of it and kind of say, here's what we weight really heavily. Here's what we weight not so heavily like the food in the cafeteria. There's a lot of things that go into that that and it was really helpful to me to just see them walking through their PFAC members about here's how we're evaluated, here's how we get scored in the world. And then they take what they learn and they tell their friends and family and they talk about how hard it is to improve health there. So the more you educate them, the more you get back. Yeah, we also saw some really nice examples of people that taught at an appropriate level how they do QI. So we're a lean hospital. Here's the tools we use. And then recruited PFAC members to, again, to various projects that we talked about. And Marty, along those lines, we take advantage of where we're located. Parrish Medical Center is in Titusville, Florida. We are on the Space Coast and as the past 10, 15 years have occurred and commercial space industry has come into town, we've got industries like Blue Origin and SpaceX who have engineers who understand lean Six Sigma better than anybody and we have brought them into our organization to use their expertise as part of the PFAC. Matt, when I'm glad you raised you shared that insight because I think from a hospital perspective, we tend to think that we see people as patients and you see them as the different skill sets they have. And that comes true in the recruiting process. There's a lot of people with a lot of expertise in things like teamwork and managing risk in other sectors. You have engineers and policemen environment in your communities often who want to apply because they've had a good experience with your hospital or not so good experience with your hospital and seeing them for that expertise I think is really helpful. Okay, Kelly, let's talk about this came also out of your research project. These are the key insights we got from looking at the high performing hospitals. Do you want to walk us through these quickly? Kelly, you're muted. Thank you, sorry. After we did the first year of the project, these three primary drivers really stuck out at us and this was after conducting gap assessments and visiting 11 organizations, high performing organizations. We were able to really call all that information and put it into these three primary drivers of success. So, key facts that are high performing are managed as a strategic priority with Ford Oversight. I mean, you've heard what how high they are at Edwin's organization, how much access they have to the C-suite at his organization. That is the way to do it. They are managed with as a strategic priority with Ford Oversight and they work on quality safety and operational improvements. And the board hears about the outcome. And then secondly, patients and families are embedded in these quality and safety and operational improvement efforts. As I mentioned before, we take the time to educate them and train them to be able to partner with our clinical and operational staff and vice versa. We take the time to tell our clinical and operational staff how to work with the PFAC members. And it really becomes a co-development of improvements that are more sustainable because the patient was involved. And then lastly, which is my favorite actually, is that PFACs are leveraged to foster continuous learning and innovation. Who doesn't want to be an organization that's innovative and to be innovative, you have to continuously learn. So the PFACs are really leveraged to keep things fresh and to keep that perspective coming in from the patients and the families so that we can be better at what we do. Great, thanks. And I think the document that's sort of, this rolls up, rolled up into, you know, had a lot of sort of specific strategies for how you can do each of these three drivers. And with, with, with example. That'll be part of the handout, I believe is, we'll have the sort of H2PI version of the tactics that you can use to reach these primary drivers of success. Okay. Okay, why don't we go on to our our next slide? And I'm under, this is going to be our we've done this. We've done that. We're, we're past that. Next slide please, Donna. Well, you're going to tear it up, right? Because it's after this, correct? This is the video. Yeah, we've talked about improvement work, but organizations that build PFACs then find that they're useful in all sorts of ways. So we thought it would be helpful to hear from a couple of PFAC members that we grabbed in this little video clip and fingers crossed that it's going to play well. Donna. I am Lieutenant Colonel Stephen Coffey. I'm an Air Force officer, a patient advocate, and member of the MedStar Georgetown PFAC for Quality and Safety. So I've been there since 2014. My name is Stephen Faust, and I'm a patient family advisor at Emory Healthcare. I've been a patient at Emory for 37 years and at PFA for a little over a decade. And so one of the things we've done at MedStar Georgetown was to start these hot topics, if you will. And we recently had one when we talked about diversity and inclusion. We look at the COVID crisis that's going on now. This pandemic has a severe impact in mental health. And another one of those topics that we've brought to our PFAC, to our leadership, is to say, hey, we need to look at how mental health is impacted because of COVID. Not only from the patient perspective, but also from a provider perspective. So I think when organizations and hospitals partner with their PFACs and really value their voice, big changes can happen. You need to make sure you have the right people as PFAs. I like to tell other organizations that I talk to and even at Emory, I said, we volunteer our time, but we are not volunteers. We're advisors. We're consultants. And so we need to find people that have the right reason for wanting to be a PFA. It's not a place to moan and complain. It's a place to contribute to the change and leadership of the organization to better serve patients, to get better outcomes, better safety, and to progressively address the needs of our patients and families. When you prepared that video, do you want to say anything more about us? You know, every time I look at it and I think of how much more Stephen Faust and Stephen Coffey, Lieutenant Colonel Stephen Coffey, had to contribute. They had so much to say. And I wish we could, you know, put it all up there, but it's way too long for that. And so we had to trim it down and grab their best answers. But there are two types of projects, right? One that comes from the organization and one that comes from the PFAC members. And they're equally important, but I know Edwin, for instance, has addressed this in his PFACs, where he mentioned you have to sit and listen to what they want to contribute on it. And some of this stuff is relevant to your organization and some of this stuff is not, but it may be down the road. So you address the priorities and you go on from there. But, you know, but the bilateral work on an improvement, it's always the best way. It really makes a PFAC very rich. I want to remind people about a subtle piece of the logic model that Kelly shared too. I mean, I think a typical approach and a very good approach is to take your organizational priorities to your PFAC. So we're working on sepsis. We're working on maternal health care. We're working on pressure ulcers, do that. But also this bilateral thing that Armando just mentioned is listening to them. And we had a little dotted line there from the PFAC to the leadership because we've seen that that messaging that Steven talked about, we have two Stevens here, but Steven Coffey talked about it. Here's what the PFAC brought to the organization. So you can bring them into your brainstorming. And it goes to that third driver too, Kelly, about leveraging for continuous innovation and improvement. Okay, we have one more question again. And then we do want to just kind of open this up to handle some verbal questions from the chat box. Oh, we actually two more questions, but this one is quickly. Kelly, you're going to talk about sustainability. And one of the things we've learned are there's two kinds of keys of success. What do we want to share with them about sustainability? Kelly. Yes, sorry. That mute button's tricking me up right now. So with sustainability, we mentioned the three primary drivers. And what we really found is that the leading performers all had patient and family engagement embedded throughout the organization. So it wasn't just a standalone PFAC. It was that the HR practices of the organization built in patient and family centered care principles into their hiring of staff. PFAC members were used to interview key C-suite leader, new C-suite leader positions that were coming in. I'll never forget the gentleman, the new CMO at Emory that we talked to that we said, how did you know this organization was patient centered? And he said, well, when I was interviewed by a PFAC member, I figured that out pretty quickly. So it's embedded in what you do in your HR practices, in your quality and safety improvement practices, in your accountability up to your leadership and your board. It is just really touches every piece of your organization. That's how you sustain your PFAC and your PFE program. Look at the results here. There's a number of organizations that have PFACs, but they don't have a budget or dedicated staff. And I mean, that's something for people to take away from this webinar to go back to your leadership going, you know what, if we want to be really high performing, if we want to improve our outcomes by turning our PFAC up to the next level, let's take this a little more seriously because there's nothing like a line out of your budget to get the attention of leadership at least once a year. So just leave that for your consideration. Let's move on to our... Oh, there's one more thing about budgets. You know, we found that, you know, these aren't really costly programs to set up or maintain. You know, when it comes to out-of-pocket cash, the where it takes some time is in your staff resources and having dedicated personnel to, you know, assign to the PFAC or your PFP program. Kelly, we saw also just a lot of organizations that were making a difference without a full-time FTE. The more they made a difference, the more they kind of tended to grow into full-time FTEs for staffing, but, you know, as the program maturity. We wanted to leave you with this last slide too because we know that this has been a pretty US-centric discussion. All of our panelists are from the US. We've kind of built it around our model of hospitals here, which is not a national healthcare system, for example, it's a series of private or public healthcare systems. But the whole idea of bringing PFAs and patient and family advisors into your improvement work or into your operations work is international. And a lot of what we've learned about invoking them and engaging them in quality and safety came from leadership at the WHO, World Health Organization, in pulling together patients. And sometimes they refer to them as citizens because as taxpayers, they were amongst the stakeholders of the healthcare system. But what we learned here that I think really translates most is you get richer discussion if you bring patients and staff together. Patients, family members, and staff together to resolve problems. And not only do you get that, but you get the sense of partnership, the sense of empathy that Steven mentioned when he was talking about not just the mental health issues of patients, but the mental health issues of staff. We just see that blossom when we bring those two people together to problem-solve together. And the document that came out of the WHO is called the London Declaration and it's essentially just a pledge of partnership to work together to do everything we can to get to zero harm. Which is, of course, the mission of the Patient Safety Movement Foundation. So we have about five minutes left to handle more questions. I want to just thank all of our panels so far because we may go right up to the buzzer here, but you've been phenomenal. And let's just see if there are other questions done. Are you going to kind of tee this up from the chat? I haven't really paid attention to the chat. Yeah, there's actually been quite a lot of questions and Kelly has been on it, answering them real time. So thank you, Kelly, for doing that. Real quick, while the panelists are taking a look at some of those questions, I just wanted to reiterate that we can only provide CE for those who've come to the live webinar. Again, if you registered as a nurse, a physician, or a pharmacist, you'll get an email from MedStar Health telling you how you can collect your credits. And then for healthcare executives, you can just enter that information into your ECAG account. And for CPPS and BCPA, we'll be providing that information to you shortly. So I'm going to go ahead and stop sharing my screen for the remainder of the time that we answer some questions. One of the questions I saw that Armando briefly addressed was, you know, are there, how do you keep your PFAC membership fresh? You know, are there other positions that people can graduate into? And 100% yes. You do want to be rotating your PFAC membership to get fresh eyes and fresh experiences on there. But that doesn't mean you lose the relationship you had with those other PFAC members. There are definitely other positions, you know, within the organization that they can grow into. I also recommend getting them on national committees or things. The National Quality Forum is always looking for patients to sit in on some of their action teams and measure, you know, measure review teams. There's plenty of opportunity out there for patients and families that want to participate. Yep. And the other thing that they can do is establish more PFACs in different service units. So Marty and I experienced that at the University of Chicago where their first PFAC was on Heart and Vascular and then they went on and did, what, three, four more in various units. So you can move your PFAC members in clinical work and then set them up and they could, you know, just go into a whole new PFAC. Yeah. One question I see, Marty, that you might, that I think would be helpful to address is there's some folks that were talking about how they're not part of a hospital. Anybody, I'm not sure, Marty, who you want to have address that, but I'd like for somebody to talk about beyond the hospital walls and how this would be done. There's less penetration in ambulatory care settings, but Kelly has been involved in actually building PFACs in the ambulatory care settings. So it's growing. And I want to tie that to another comment about research. We're seeing, if you're doing research in any setting, there's a bonus you get actually if you bring patients and families into your research work and a PFAC is a way to recruit them. Kelly, do you want to kind of address both of those quickly? Advocatory and research. We saw some examples in your membership. Yes. I'm sorry. I just sort of blipped on me there. Yes. You know, their PCORI is out there really encouraging and requiring patients and families to be involved in research. So that's a great way for people to get involved. You know, in the ambulatory setting, like Marty said, there's just not as much work there and there's so much that can be done in that setting. And even taking your PFACs that were hospital based members if they've kind of grown out of the PFAC, they can help with ambulatory as well. And I'll just say, you know, organizations like Vizia, you see what we've done to get involved in this movement and it's really brought us such incredible insights and to be able to share that with our membership. And I have seen a growing number of organizations that are healthcare organizations but not necessarily hospitals start to talk about PFACs and getting patients and families involved in their work. Yeah. And Edwin, you've had experience in your thesis, right? I don't know, it might be frozen, but we have seen a number of examples. I mean, Emory has multiple ambulatory PFACs, University of New Mexico, and they have kind of overlapping membership and they help on the continuity of care issues. So if you're affiliated with the system, that's great. But if you're freestanding, there's also, I mean, we can give you some tools that are really sort of easier processes to start a PFAC. It's easier in a clinic than it is in a hospital because you just kind of know your patients better. You know who would be good to start. We have a question here about measurement that I'd just like to get to very, very quickly before we close because we didn't really address it. How do you measure the effectiveness of your PFAC? Any quick insights? I know, Kelly, you're going to say start simple. Yes, start simple. And some of the best ways that we've seen the impact of a PFAC has been through a run chart, a traditional run chart that tracks your improvement over time. And you can note in there when changes were made based on PFAC suggestions. You know, that's one of the simplest ways to do it. I will say that this measurement piece is difficult. There's annual reports that hospitals do that talk about the work that they do with PFAC members, but it's still fairly new territory to be able to truly measure the impact of the PFAC's, you know, impact on the organizational outcomes. And that's part of the study that we've really tried to do and hope to do more of. I think for those just starting, you know, counting the ideas that come out of your PFAC and go to another part of your organization, counting the number of people that you distribute through your organization, looking at the ways in which they're being appreciated. You could almost do a staff satisfaction or a staff survey, you know, did it help to have a PFAC on our RCA committee or a PFAC, did it help to have a patient rounding? That sort of thing. We're at time. Donna, I wish we could go further. I think this has been a phenomenal panel. And I can't thank you enough for all of your ideas and all of your insights today. I hope it was interesting to our attendees and I do see now that there was just a really robust chat. So thank you for all of the engagement there as well. Yes, thank you very much. And we will, as always, we'll, you know, take some time afterwards to review the Q&A in the chat. And if there's anything that we didn't feel like we addressed very well, we will make sure that we share those answers with everybody. This presentation will be available on our YouTube channel and all of the content, the PowerPoints and some of the resources that the panelists were talking about will be available through links through our YouTube page. So hopefully that'll be up in the next couple of days. Okay, great. And we can let Edwin get back to his clinic. Thanks very much.