HAP Resource Center

HIIN Presentation: The Nation's First State Hospital Association-Sponsored Person and Family Advisory Council

THE PENNSYLVANIA EXPERIENCE: The Development and Impact of the Nation’s First State Hospital Association-Sponsored Person and Family Advisory Council (PFAC)

Driving Person and Family EngagementBackground:

Driven by a strategic imperative to improve quality and patient safety, wellness, and clinical integration of health care, The Hospital and Healthsystem Association of Pennsylvania (HAP) developed the nation’s first state hospital association-sponsored Person and Family Advisory Council (PFAC) during 2013.

This enables HAP and Pennsylvania hospitals to benefit from the guidance of a diverse group of patients, family members, community leaders, and health care providers, as they work to improve the patient experience of care.


HAP was awarded the Centers for Medicare & Medicaid Services (CMS) Partnership for Patients Hospital Engagement Network (HEN) contract during 2012 in order to work with Pennsylvania hospitals on ten hospital-acquired conditions plus readmissions. CMS demonstrated commitment to patient- and family-centered care from the onset of the collaborative by developing five Patient and Family Engagment (PFE) Metrics with the intent that HEN and Hospital Improvement Innovation Network (HIIN) contractors work with hospitals to engage patients in their own health care. All HIIN hospital-acquired conditions project designs include a PFE component for 100 percent participation in this subject matter.

Future Plans:

Focus Group Collaborative—40 hospitals and health systems are collaborating to implement the five CMS PFE Metrics. Each of the five focus groups began to meet during September 2018 and offer:

  • Regular group networking calls
  • Problem-solving and learning
  • Sharing of tools and resources
  • Individual coaching and targeted assistance
  • Evidence-based best practices and strategies
  • Written Action Plans to close performance gaps
  • Guidance from the HAP PFAC

Smart Phone App—HAP is developing a PFE smart phone mobile app designed to empower patients and family caregivers as they navigate the health care system. The app will be beta tested by the HAP PFAC and HIIN PFE Leadership Council.

Public release is scheduled for late 2018.

Percent of PA Network Hospitals Implementing Patient and Family Engagement MetricsCreating a Business Case—In an effort to create a clear business case for developing a PFE culture in acute care hospital settings, HAP is drilling down into several data resources to uncover a direct link between PFE and:

  • Hospital-acquired conditions such as infections
  • Readmissions
  • Hospital 5 Star Ratings
  • HCAHPS scores

Information of this type will encourage the allocation of hospital resources as the financial benefits related to the avoidance of medical utilization and cost avoidance are made clear.

Key Achievements:


  • HAP establishes patient safety learning network for Pennsylvania hospitals to improve quality and safety and develops strategies to listen to and engage patients and families in care improvement


  • HAP receives CMS’ Partnership for Patients HEN contract for 2012–2015 to decrease preventable hospital-acquired conditions and readmissions
  • HAP holds annual statewide Patient Safety & Quality Symposium and includes programming to involve patients and families in decisions regarding care


  • HAP incorporates patient and family engagement into its HEN projects to accelerate improvement efforts and to engage hospital leaders, staff, patients, and communities
  • HAP adds individuals to its Board of Directors to assure the presence of patient voices in policy deliberations
  • HAP steps into the public arena regarding person-centered health care when its CEO participates in a national convening of the Gordon and Betty Moore Foundation. HAP was the only hospital association invited to attend
  • HAP establishes the nation’s first state hospital association-sponsored PFAC with patients, family members, community leaders, and health care professionals
  • HAP establishes a patient-and-family-only subgroup of the larger PFAC to be sure that the voice of the patient is always heard
  • HAP’s PFAC leads the development of an electronic tool for hospitals to assess their success in patient and family engagement
  • HAP’s PFAC develops guidebook to assist hospitals in developing PFE councils


  • HAP Board of Directors includes PFE as a key part of HAP’s Strategic Plan
  • HAP’s PFAC adds community leaders to represent the variety of health care consumers living and working in Pennsylvania
  • HAP receives recognition from the Caregiver Action Network for Outstanding Best Practices in Patient and Family Engagement


  • HAP’s PFAC holds four regional workshops across the state focused on effective two-way provider-patient communication
  • HAP’s PFAC develops consumer videos
  • HAP named finalist for John Q. Sherman Award for Excellence in Patient Engagement
  • HAP receives honorable mention for Dick Davidson Quality Milestone Award for Allied Association Leadership


  • HAP receives CMS’ Partnership for Patients contract to continue its work to reduce preventable hospital-acquired conditions and readmissions under the HIIN for 2016–2018 with specific PFE metrics
  • Three of HAP’s PFAC hospitals were featured in a national research document called Patient Experience 2.0: Expanding Your Horizons
  • HAP recognizes the essential nature of physician engagement in creating a culture of PFE by developing education for health care providers
  • HAP recognized by the Agency for Healthcare Quality and Research via its Healthcare Innovations Exchange Best Practice


  • HAP develops HIIN PFE Leadership Council, comprised of HAP HIIN PFE hospital leaders
  • HAP’s PFAC and HIIN PFE Leadership Council collaborates with the American Institutes for Research to develop a preadmission checklist for nationwide distribution


  • HAP leads the development of Action Plans to comply with HIIN PFE metrics
  • HAP’s PFAC and HIIN PFE Leadership Council collaborates with HAP HIIN sepsis and behavioral health projects in the development of patient education tools
  • HAP holds PFE conference, “Person and Family Engagement: How Do We Get There from Here? Tackling 5 PFE Metrics to Improve the Value of Patient Care
  • HAP HIIN develops Focus Group Collaborative for CMS PFE Metrics

Action Plans for 5 PFE Metrics:

HAP HIIN has formed a focus group collaborative which assists hospitals on the implementation of 5 Person and Family Engagement (PFE) interventions (Metrics) that the Centers for Medicare & Medicaid Services (CMS) encourages acute care hospitals to implement.

Written Action Plans for each Metric have been developed by HAP to close performance gaps. Feel free to download the action plans for your use.

Metric #1: Hospital has a physical planning checklist that is discussed with every patient who has a scheduled admission.

Metric #2: Hospital conducts shift change huddles OR bedside reporting with patients and family members in all feasible cases.

Metric #3: Hospital has a designated individual or individuals with leadership responsibility and accountability for PFE.

Metric #4: Hospital has an active Patient and Family Advisory Council (PFAC) OR at least one patient who serves on a patient safety or quality improvement committee or team.

Metric #5: Hospital has one or more patient(s) who serve on a governing AND/OR leadership board as a patient representative.

How to Create Your Own Patient & Family Advisory Council:

A patient and family advisory council (PFAC) is an effective way for hospitals and health systems to engage consumers in improving the quality of care provided. The PFAC platform enables providers, patients, and families to work side-by-side to discuss and test ways to enhance service delivery in order to provide safe, high quality, patient-centric health care.

Where to Find PFAC Members:

  • Former hospital patients
  • Posters and brochures
  • Local publications and newspapers
  • Advocacy and support groups
  • Physician offices
  • Hospital patient portal or website
  • Post-acute care providers
  • Community and church groups
  • Social media
  • Email or print mail
  • Colleges and universities
  • Nursing, medical, and ancillary caregiver schools
  • Patient safety and quality organizations
  • Professional organizations

Tip: It’s important that PFAC members reflect the diversity and population of the local community. Members should come from a variety of neighborhoods; socioeconomic, racial, gender, religious, age, educational backgrounds; and a variety of family structures.

Selecting Patients and Family Members to Serve as Advisors:

  • Identify individuals with knowledge of or firsthand experience in utilizing health care services
  • Look for candidates who are willing to use their experiences constructively and focus on improvement
  • Be sure to understand a candidate’s motivation to join the PFAC, and avoid those with a personal agenda or a grievance to air
  • Select individuals who are comfortable speaking in a group setting, or those who are willing to be coached
  • Select candidates who are able to listen to and respect differing opinions
  • Choose candidates who are able to make a commitment of time and energy

Tip: No more than 2-3 staff should have a permanent place on the council. Other staff can attend depending on discussion topics.

Selecting Health Care Practitioners to Serve on a PFAC:

  • Choose individuals with a working knowledge of PFE, but don’t overlook candidates who have more enthusiasm than experience
  • Select members who are able to devote time to working with a PFAC
  • Hospital PFAC members should reflect multiple layers of employment—ideally, a board member or senior leader should attend meetings. Encourage direct care givers to join. Break down silos.
  • Identify individuals with good communication skills
  • Candidates should be able to work with a diverse group of professionals, patients, families, and community members

Developing a PFAC:

  • Attend PFAC meetings at organizations that have had long-term success
  • Build a business case for your PFAC to help you demonstrate value to patients, staff, and leadership
  • Ensure senior leadership commitment and ongoing support
  • Recruit a physician liaison

Tip: A PFAC of 14–20 patient and family members is considered a manageable size. Task force or ad hoc committees may be identified to work on a specific topic or short-term project.

  • Encourage transparency in quality and safety performance
  • Select an organizational champion (leader) with a clear understanding of the benefits of patient-centered health care, good leadership and communication skills, and a passion for the topic
  • Solicit a patient or family member to serve as the PFAC co- lead
  • Provide orientation and training to new members regarding roles and expectations
  • Offer HIPAA training and discuss honoring privacy and confidentiality
  • Create a patient-and-family-only subcommittee so that the voice of the patient is never overlooked
  • Define and establish the mission, vision, and goals of the PFAC
  • Think through the logistics of PFAC meetings: frequency, location, and general agenda
  • Decide if participants will be reimbursed for travel, parking, or other expenses (PFAC meetings are often well attended if a meal is served, and parking and babysitting are provided)
  • Allocate adequate staff time and resources
  • Ensure that the PFAC represents the diversity of health care consumers in the local community
  • Model a culture of inclusion, trust, and partnership
  • Provide coaching for advisors on how to use their story to promote change
  • Avoid speaking in health care acronyms; use plain language familiar to all
  • Identify opportunities for meaningful work that will generate practical and measurable results
  • Frequently and broadly share PFAC successes and goals met with hospital senior leadership, hospital staff, and the community at large
  • Be steadfast and persistent. Strive for progress, not perfection

Tip: Work with senior leadership to create a hospital culture recognizing that patient and family engagement is not a separate initiative. It is a critical part of what your hospital is already doing to improve quality and safety.

Sustaining a PFAC:

  • Recognize and acknowledge that progress may be slow, especially if a PFAC is new to your organization
  • Identify ways to share efforts and successes of the PFAC
  • Routinely provide feedback, evaluation, reflections, and lessons learned to senior leadership, staff, and the community
  • Be proactive and creative in discovering issues to address
  • Challenges and lessons learned are not barriers to future success; learn from them
  • Continually demonstrate appreciation for the hard work and commitment shown by PFAC members

Tip: The most important factor for ensuring the success of a PFAC is the belief that partnering with patients and families is absolutely essential to improving quality and safety.

Links to Additional Resources:

Working with Patients and Families as Advisors Implementation Handbook (AHRQ)

Forming a Patient and Family Advisory Panel (AMA)

Creating Patient and Family Advisory Councils (IPFCC) 


Topics: Patient and Family Engagement, Quality Initiatives

Revision Date: 10/1/2018

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