 Well, this is Sarah Miller, Director of Partnerships at the Patient Safety Movement Foundation, and today we're going to talk about the topic of person and family advisory councils, also known as PFACS. And so we're so excited to be joined today by two very valued individuals within our network here, Edwin Lofton and Armando Nalm. So before we get started, I'd like to turn it over to first Edwin to have you introduce yourself. Well, Sarah, thank you so much, and it's such an honor to be here, especially to be able to share the audience with Armando. My name is Edwin Lofton. I am the Senior Vice President of Integrated and Acute Care and Chief Nursing Officer at Parish Medical Center in Titusville, Florida. We're in the Space Coast of Florida. And we've been fortunate to be a member of the Patient Safety Movement Foundation since 2015. Great. Thank you. And I'll pass it over to Armando. Yes. Good afternoon or good morning, depending on what you are. My name is Armando Nalm. I do live in Atlanta, Georgia, and I'm honored to be here and participate, especially because I have such regards, high regards for Edwin. We were at his organization a little while back and we were really impressed with the work that they're doing. So thank you very much. Great. Well, we'll start off by just asking the two of you, you know, what is a PFAC and what are the typical expectations and objectives for PFAC? I'll give it a start here. So really, you have to go back to the definition of person and family-centered care. Health care today cannot be the way it was 10, 15, 20 years ago where the physician or the clinicians told the patient what their plan of care was. We have learned the hard way that we have got to have the person in their family integrated into and really leading the direction of care. By using a PFAC or patient and family advisory committee, we actually get input from members of our community, people that we've had the honor to serve that allows us to design systems that are safer, more integrated, and focused on what that person's individual goals are. Great. Armando, is there anything you'd like to add? Yeah. I think that patient and family advisory councils are just one component in the delivery of care. As one component in the all overarching methodology of high reliability organization. And unfortunately, in health care, we're a little bit behind when it comes to that. Now, many organizations have reached that high reliability level that, say, for instance, the airline industry or the nuclear industry has. And so bringing the patient's voice, we're behind. And I was very thankful under the Affordable Care Act when CMS or the Center for Medicare and Medicaid Services announced that this work should start and be meaningful because you need to bring the patient's voice and everything that you do. And otherwise, you really can't move forward. And you cannot deliver great health care unless you bring the patient's voice into next. Because we have a different viewpoint. We see it from a different lens than you do. Absolutely. And who's typically involved in a feedback? So when we get into this kind of work and we work with an organization like Edwin, where they want to embark on to this kind of work and establish a patient family advisory council, the number one, what I think sets us a little bit apart from other organizations that do the same kind of work is that we base it on quality and safety. I've always believed that quality and safety should be at the forefront because when it's all said and done, if we were to go out in the street and ask anybody out in the street, any patients at large, what is important to you is that if I need to have any kind of surgery or knee replacement or hip replacement, is that I come in, you perform that surgery and I go back home safe and sound to my family. That is the first and foremost thing in everybody's mind as a patient. I don't want to be readmitted with complications. And so quality and safety to me is at the forefront of this kind of work. And the people that, you know, when we establish a PFAC, not only we want a even number of staff members into that council and community members, but we encourage the organization to look into these community members that have received back care, that have had an adverse event under your watch. Perfect example is what happened to my son. I lost my son under your watch. And so bringing this, you know, I always say the good, the bad and the ugly, right? It's good to have a person that says, well, you know, your food is great and your nurses are great and your docs are the best in the world. Okay, does that person really help you move the bar forward? Not really. And then there's the so-and-so person who's the complainer. And then there's the ugly person that is me that you really, you killed my son. And so bringing somebody like me, not obviously at the beginning when I'm grieving, but down the road, as Edwin has done so wonderfully, is to have that voice that says, hey, wait a minute. Yes, you did hurt my son. It was under your watch. But I saw certain things and I can help you. I can help you so this doesn't happen to another family. And that's really the goal. As I follow up, Armando is exactly, I agree 100%. In our case back, we have built it primarily with people that we could have done better with. Our founding member, Patty, her son was a quadriplegic. And we were not providing the basic nursing care. And when she confronted me with who is my son, what's his name, when's his birthday, what does he like to wake up to? And I could not answer a single one of those questions. I was embarrassed. I was embarrassed for my organization. I was embarrassed for ourselves. But because I was willing to stop and listen to Patty, we gained trust from her. And she and others have helped us as an organization truly make a difference in that quality and safety. And one example is we were initiating Care Team Rounds, which is where we bring the physician, case manager, nurse, and a variety of people together to discuss the plan of care. And we started off by doing it in the room with the patient. And so we had our PFAC members join us after about six months and watch it. And the feedback we got from them was invaluable. They said, it looks like a herd of cattle going in and stampeding into a patient's room. We need to do it so that it is not such a large number of people. It needs to be soft. It needs to be a sit-down conversation. So we've been able to make some meaningful improvements in those Care Team Rounds involving the patient and the family differently and more and really improve the outcomes. Yeah, Sarah, can I add one more thing to that? Of course. Yeah. You know, I talked about bringing the patient's voice, but it's equally important from the staff side to have the voice, even of the people who are the critics, the ones that, why are you doing this? It's a waste of time. So you have to have that buy-in, not only from leadership, but for instance, legal needs to be involved. And communications and marketing needs to be involved because otherwise, if you don't embed this whole process and this whole idea of patient and family advisory councils into the fabric of your organization, again, you're not going to go forward. And we've seen so many PFACs that started by checking the box because, you know, they said, okay, everybody has to have a PFAC. Yes, we have one. But when we go and really check what their PFAC structure is all about, we see just that, they just check the box. They don't really do any meaningful work. And so it becomes like a focus group. And a year later, it's dismantled. It's no longer in operation. Mm-hmm, great. And Ed, when I know that you gave a few examples to kind of elaborate a little bit more on the feedback that you all have received, but, you know, what successes have you seen from your PFACs? And how have you measured impact in the past? Well, as I said, with the care team rounds, we've had strong measures of that, patients achieving goals as we've set them. We have also used them in some of our clinical processes. One of them is, when do we get the meal tray to a diabetic patient before we give insulin? And so, you know, from clinicians, we know what steps one, two, and three are. But when we brought the dietician, the patient, the family, the son, the daughter into the process itself, we made changes. And actually we have measured clinical outcomes to hypoglycemia as compared to those changes that we've made, and we've improved care measurably within that process. Also in how we set up discharge appointments with our primary care physician, by listening to the PFAC, instead of telling the patient and the family member when their appointment is, we need to stop and listen. We need them to tell us when they have the transportation, when it's convenient for them to go. And the rate of misappointments has dropped by greater than 50% because we chose to listen to the patient and the family. Wow, that's so great. That's great. Next question for you, Edwin, is what recommendations do you have for organizations that would like to start a PFAC? Don't wait, start, listen to your community. Stop the madness. We're all busy. I mean, coming here, I just left a meeting with leadership and where we are trying to balance nursing staffing out in our med-surg areas. We're really challenged right now. We have a high volume of COVID patients and a high volume of other acuity patients. And earlier today, we were getting into a frenzy. And this is a time where we have to stop, slow down, go into a person's room, ask permission, have a seat, have a conversation with that person about who they are and what their goals are. When we as healthcare experts, and I say that laughingly, stop and listen to what our community needs and what the person needs, our job gets so much easier and we can see remarkable results. But for organizations, make the choice to do this. Do not wait, don't put excuses up, listen to your community. Good, thank you. And Armando, next question for you. What recommendations do you have for patients and families who want to get involved in a PFAC? Well, I always recommend any organization to start with what Edwin was talking about. You have to start with the conversation. You have to start by sitting down with your patients and find out, and really, you have to be in a whole different mode. You have to be in listening mode because you have to give that time and the respect of the things that the patient's family members want. Once you have that and it's really, you have it embedded into the organization where you have total buy-in from your leaders, your leadership, then people always say to me, how do I find patients? How do I find people like you? Well, I guarantee you, they're already in your hospital and Edwin will attest to that. They're already there, so you don't have to work hard. What is difficult, and I will say this, is that I can count in my fingers how many hospitals are like Edwin's hospital which will bring a person like me into clinical work. Most organizations shy away from that and I will attest to the work that I did at MedStar Health where they knew that my son died ultimately of sepsis and they said, how would you like to lead the sepsis system-wide initiative? And I freaked out to tell you the truth because what do I know about sepsis except that I lost my son to it? But clinically, I know nothing. Well, I didn't have to know everything about sepsis. In fact, I had to know nothing. All I had to do is watch and then give my perspective of how I sell things. And I don't need to tell you at MedStar One all kinds of awards on the sepsis initiative but we have organizations that call us now and say, how do you do it? How do you bring the patient's voice into clinical work? It's not difficult. In fact, I was just asked this yesterday, can you think of any project that you don't bring the patient's voice? And guess what? Zero, none. There's no project that you cannot have the patient's voice on it. I can't think of one. Maybe Edwin could think of something ever but I've yet to find one. So finding the patients is the last thing that should be on your mind. It's what Edwin mentioned. Start with a conversation and start talking about it and don't waste time. Don't wait because the organizations that have done it, they always say the same thing. Why didn't I think of this three years ago? Why didn't I do this five years ago? Great, well, we thank you both so much for the great insights and for taking the time to speak with us today and with that, I'll close this out and thank you again. Really appreciate it. Sure, thank you. Thank you very much. Always good to see you all.