Steps to Creating a Patient Safety Advisory Council

Chapter 3. Steps for Creating a Patient Safety Advisory Council

Step 1—Determine the Scope of the Council

The first steps in creating a patient advisory council are often the toughest. The concept of bringing patients to the table as part of the team can be intimidating to health care providers, and patients feel the same way. Organizing your project according to the steps identified in this guide will help the process go smoothly. However, don't let the planning prevent you from moving forward. At some point, you need to take that first step, and soon after you will see the benefits of partnering with your patients.

What: Define the Council's Goals and Objectives

Organizations that are just beginning to bring patients to the table should start with a small, narrowly focused project. This gives both providers and patients a chance to become familiar with a partnership collaboration, work out logistics, and introduce the concept to organizational leaders. A small, successful project creates the confidence to move toward a larger council with broader goals.

Even with larger councils, it is important to continually reinforce the focus on the goals and objectives established at the beginning of the project. To do that, organizations should:

• Select a specific process or aspect of care that is focused and clear.
• Conduct a patient focus group to identify the primary safety concerns of the organization's target audience.
• Conduct a staff focus group to identify the primary safety concerns of the organization's staff.
• Select a topic the organization has addressed but has not successfully resolved.
• Identify a safety concern from data and metrics available in the organization.
• Define objectives that are achievable and measurable within the project parameters.
• Focus on a particular site in which the process or aspect of care occurs, e.g., hospital-based, outpatient clinic, retail pharmacy, home, or another site.
• Select a target population to be the focus of the project goals.
• Select specific goals and objectives for the council to address.

Go to Appendix A for an example of project goals and objectives.

How: Define the Council's Parameters

The council's limitations and restrictions should be clearly established and defined for its members. Parameters that should be defined include:

• Timeframe. A specific timeframe should be developed and followed to keep the council moving forward. For teams that are just beginning to initiate patient involvement, the project timeframe should be kept very short, e.g., less than 6 months.
• Budget. Financial resources available for the council and its project should be clear. In addition to the sponsoring health care organization's providing financial support for the project, other organizations, including vendors, pharmaceutical companies, and product manufacturers, may wish to lend support as well. However, these other sources of support may have restrictions or associated requirements. For example, if a vendor or manufacturer is willing to provide financial support or contribute products, it may control the rights for advertising or insist that its logo be displayed on the final products. The project team should decide initially from what sources they are willing or legally able to accept support, either financial or otherwise.
• Organizational support. In addition to financial support, the organization may provide other resources, including staff time, meeting rooms, and office supplies.
• Technology. The availability and capability of technology support for the council, as well as the project, should be defined.
• Meeting logistics. Time, place, frequency, and length of meetings, and total duration of the project period should be established.
• Roles and responsibilities of team members.
• Evaluation and outcome measurements. Data collection methods and the analysis plan should be included.
• Scope of project. Clarify what the council will not be addressing.

Who: Define Council Membership

A patient advisory council should be a multidisciplinary team and include representation from the targeted patient population and the providers who care for these patients. Overall elements to keep in mind include:

• Council size. Start small. If this is the first project that includes patients, consider including just a few (e.g., less than five) patients on the team. A larger council may be established after staff members are comfortable with the process of working collaboratively with patients on a project team. Patient advisory councils should be kept to 20 total members. This size allows for diverse representation but is small enough for effective communication and consensus development.

• Council membership. At least half of the council's members should be patients. This allows for equal representation of patient and provider perspective. Patients feel more comfortable sharing when there are other patients present and when they are not outnumbered by providers. To create a diverse patient membership for the council, consider patients' ages, genders, medical conditions, and cultural or racial backgrounds.

  Health care providers and community members comprise the remaining membership of the council. Representatives from the following groups may be considered:

  • Caregivers who provide primary assistance to patients in their homes.
  • Physicians, including primary care providers and consultants.
  • Nurses.
  • Pharmacists.
  • Ancillary service staff, including insurance benefits specialists and parish nurses.

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Step 2—Select the Team

The membership of the council is critical to successfully building a partnership between providers and patients. The roles of the council members in this project should be explicit. Recommended members, their key characteristics, and their specific roles and responsibilities follow.

Patients

Patient members on the council provide the consumer perspective to the project goal. They do this through sharing their own opinions and expertise as well as experiential knowledge from personal, family member, or friends' encounters with the health care issue being addressed. Key characteristics of the patient representative include:

• Good communication skills.
• The ability to collaborate with diverse individuals in a group setting.
• Representation of the consumer base in which the council exists, including cultural, racial, or ethnic communities.
• Firsthand knowledge of the topic at hand. For example, if the council represents a group of clinics, patient representatives should receive care from one of the clinics. If the focus is on a clinical condition, patient representatives should either have the condition or have family members who have it.

Roles and responsibilities of the patient representative include:

• A focus on the specific project goals and objectives.
• Commitment to improving care related to the project goals.
• The ability to maintain confidentiality.
• A willingness to communicate relevant information with family, friends, and the community to contribute to the successful achievement of the project goals and objectives.

Recruiting patients is often the most intimidating step of establishing an advisory council. Remembering that patients are friends, neighbors, community members, and sometimes family keeps this in perspective. To successfully recruit potential consumer council members:

• Obtain referrals from health care providers. The project coordinator and on-site leads, both of which are described below, should talk with staff about the council project, describe the eligibility criteria, and ask staff to make recommendations from their patient population.
• Establish initial contact with the patient through their health care provider (physician, nurse, or pharmacist). A direct request from the provider demonstrates to the patient that his or her participation and opinion is valued. The initial call is to request participation and to obtain permission to have the project coordinator contact the patient with additional details.
• Provide followup by having the project coordinator call patients who agree to learn more about the project. This interview should provide specifics on the project, including roles and responsibilities of the patient representatives on the council. Sufficient time, up to 1 week, should be allowed for patients to consider the opportunity to participate.

Health Care Providers

A range of providers should participate to represent the complete health care team. Depending on the scope of the council project, representatives may include doctors, nurses, pharmacists, social workers, and parish nurses. A key component of a provider representative is willingness to work collaboratively with patients and other disciplines. Health care provider representatives on the council should be accepting of collaboration in a patient-centered care model.

Project Lead

The project lead is the coach of the team. He or she develops the project concept, acquires the necessary funding and organizational support, selects the project coordinator, and manages the entire project. Key characteristics for a project lead include:

• A leadership position in the organization.
• Expertise with the content of the project goal and objectives.
• Time available to devote to the project.
• Communication skills to work comfortably with a diverse group of organizational leaders, professionals, patients, and community members.
• Knowledge of project evaluation and data analysis.

Project lead roles and responsibilities include:

• Developing project goals and objectives.
• Defining the council's role in the organization and in relation to the project goals and objectives.
• Obtaining organizational support for the council and project.
• Acquiring financial support for the council and project.
• Recruiting, orienting, and supervising the project coordinator.
• Being a member of the council and participating in meetings.
• Participating in project activities.
• Overseeing project evaluation and data analysis.
• Ensuring the project is completed on time.
• Committing 1 to 5 hours a week, depending on the size of the project.

Project Coordinator

A critical person for successful implementation of a patient advisory council, the project coordinator is responsible for the day-to-day management of the council and its activities. The project coordinator should be the first staff member identified and engaged in the project. A project coordinator should be:

• A personable individual with excellent communication skills who is sensitive to individual council member needs; respects diversity; is able to interact with different personalities and professions; and is able to build a team based on trust, honesty, and respect.
• Connected to the community. For an outpatient-based council, the project coordinator must have established relations with community organizations. This helps build trust with council members and facilitates the introduction of the project into other community groups.
• A member of the project site staff. Depending on what site (hospital, clinic, pharmacy) the council represents, the project coordinator should be a staff member of that facility. The project coordinator's established relationships and trust with staff will facilitate staff engagement in and adoption of the council concept.
• Committed to the council project. The project coordinator needs to have sufficient time devoted to the project.

Project coordinator roles and responsibilities include:

• Working directly with the project lead.
• Recruiting and orienting staff members.
• Recruiting and orienting council members.
• Serving as the primary liaison to the council members; providing communication with council members via individual communications, meeting agendas and minutes; and addressing individual concerns or needs.
• Chairing all council meetings.
• Communicating with internal staff and leaders by attending department and staff meetings, individual meetings, and presentations.
• Working with external community organizations through communications, meetings, and presentations.
• Coordinating and participating in public relations and media activities, including press releases, media presentations, and public events.
• Developing and implementing project strategies and interventions in conjunction with other team members.
• Monitoring the project budget.
• Monitoring the quality of the project.
• Committing 5 to 20 hours per week, depending on the size of the project.

Physician Champion

If a council activity involves a site that includes physicians, a physician champion is an important staff member to identify. A physician champion should:

• Be a recognized leader among staff physicians, though he or she may not necessarily hold a formal title.
• Be a respected physician who works directly with the physician staff and has a vested interest in the work of the council.
• Understand and support the project.
• Be recruited at the earliest stage of the project, prior to the council being established.
• Be able to attend most council meetings. Another physician should be identified who can alternate with the physician champion at council meetings to ensure the physician perspective is represented.

Roles and responsibilities for a physician champion include:

• Encouraging other physicians to participate in the council and their activities.
• Leading other physicians to adopt patient-centered care.
• Representing the council and the physician group at professional meetings and public relations events.
• Providing the physician perspective to the council and project goals.
• Being a member of the council and participating in meetings.
• Communicating with other physicians about the council and their activities.
• Committing 1 hour per week to the project.

On-Site Staff Leads

Staff leads are the primary points of contact at the work site. If the council is representing more than multiple clinics or hospitals, each site should have an on-site lead. Staff leads may also represent a discipline or profession, e.g., nurse lead or physician lead. On-site staff leads should:

• Hold a leadership position, such as supervisor or manager, at their site.
• Have excellent communication with all staff and professions at their site.
• Be able to work and communicate effectively with the project coordinator.

Roles and responsibilities for the on-site staff lead include:

• Serving as the point of contact for project coordinator and project leader at their work site.
• Communicating with other staff at their site, providing updates on council activities and the project, collecting information from staff to share with the project coordinator, and identifying site-based barriers and opportunities for the project.
• Participating in recruiting council members.
• Serving as a member of the council by participating in meetings.
• Committing 1 to 2 hours per week, depending on the size of the project.

Other Health Care Providers

Depending on the project goals and objectives, other health care providers may need to be included on the council. For example, if the project addresses medication issues in the outpatient setting, a retail pharmacist should be included. If the project focuses on health care services provided in the home, a home health nurse should be a council member.

Community Representatives

Community members may represent a community-based organization that includes patients and providers in a separate component of care. Including community representatives broadens the scope of perspectives beyond the traditional one-on-one health care relationship between patient and doctor. The inclusion of other community members recognizes the role community organizations play in the health of an individual as well as a community. Community representatives may not be necessary for a small project or an organization's initial effort to involve patients. Examples of community organizations to consider for representation in the council include:

• Community-based organizations, such as Kiwanis, Rotary Club, Lions, Elks.
• Churches.
• Local government health and social service programs.
• Social service agencies.
• Community meal sites.
• Senior apartments.
• Women's clubs.
• Social clubs.
• Public libraries.

Community representatives should:

• Represent a community organization that is a stakeholder in the project goal or represent a community organization that has significant membership from patients and providers who are affected by the project goals and objectives.
• Be willing to exchange information between council and their community organization.
• Accept the concept of collaboration among diverse participants.

Roles and responsibilities for a community representative include:

• Focusing the work on the specific project goals and objectives.
• Committing to improving care within the community related to the specific project goals.
• Maintaining confidentiality.
• Communicating and sharing relevant information between the council and the community.
• Committing 1 to 2 hours per month, depending on the size of the project.

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Step 3—Determine a Budget

Establishing a patient advisory council does not require significant funds. Many small projects can be completed with minimal staff time, voluntary patient representatives, and use of existing facilities and supplies. However, an organization that wants to establish a larger council, both in members and role, may need to commit resources to ensure its success. Go to Table 1 for suggested annual budgets.

Table 1. Suggested Annual Budget

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Step 4—Confirm Team Members

Each person who agrees to participate on the council should complete an application form and sign a confidentiality statement. The application should provide eligibility criteria for and details on council membership. Go to Appendix B for a sample application form. The form should include at a minimum:

• A description of project, goals, and objectives.
• The criteria for membership.
• The responsibilities and roles of members.
• Time commitment expected for project completion.
• Supportive services.
• The specific participation requirements that vary for patients, health care providers, and community member representatives.

The confidentiality statement should comply with Health Insurance Portability and Accountability Act, or HIPAA, requirements. The form that hospital volunteers sign can serve as a template for the confidentiality statement. The organization's compliance officer should review the any confidentiality statement council members will be asked to sign. Go to Appendix C for a sample confidentiality statement.

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