International Community Health Services Uses a Patient Advisory Council for Engaging Patients in their Healthcare
In recognition of last May’s Asian-Pacific American Heritage Month, HRSA’s Quality Improvement website is highlighting the International Community Health Services (ICHS) for their use of a Patient Advisory Council (PAC) to increase their patients’ participation and engagement in their healthcare. ICHS is the largest Asian, Native Hawaiian, and Pacific Islander nonprofit community health center in Washington State and has successfully implemented a PAC to address challenges that patients encounter when communicating to providers about their healthcare. The effective use and focused activities of the PAC demonstrate that higher patient participation can lead to improved health outcomes and to increased quality of care.
For over 35 years, ICHS has provided culturally-appropriate and multilingual care to a diverse, multi-cultural population from the Seattle community, most of whom are publicly or privately insured. ICHS receives grants from HRSA’s Bureau of Primary Health Care (BPHC) as a Section 330 Community Health Center Grantee and offers a full range of primary medical, dental, behavioral, preventive health education services in modern sites that also include onsite laboratories and pharmacies. Since 2012, ICHS has been recognized by National Committee for Quality Assurance (NCQA) as a Level 2 Patient Centered Medical Home (PCMH).
The establishment of a Patient Advisory Council (PAC) is not unique to community health centers. Most PACs include patients or their family members who are organized into a committee structure to focus on initiatives to improve the overall quality of care for patients in their organization. ICHS’ PAC began in 2007, with a mission to promote and support patient-centered values to create respectful and effective partnerships among patients, ICHS staff, and the community. The vision was for the PAC’s work to enhance understanding and cooperation between patients and staff to ultimately increase overall patient satisfaction. ICHS has one PAC for the entire organization with 5 members; other organizations may have one PAC per site or even one PAC for each clinical department depending on their size and available resources.
The main responsibilities of PAC members include:
• Providing patient insight to the clinic;
• Partnering with staff to improve day to day operations and quality of care;
• Attending PAC regular meetings;
• Advocating for needed patient ;
• Developing patient communication tools; and
• Initiating quality improvement projects such as patient surveys.
In addition to these responsibilities, the PAC’s role is to identify and address the patients’ needs and challenges. Communication is an ongoing challenge for ICHS since 75% of the patients at ICHS prefer a language other than English. As a result, ICHS’ PAC created patient communication tools to assist patients in various languages. Below are examples of some of the communications tools developed by the PAC to help support their patient population’s needs.
Figure 1. Multi-Lingual Informational Signs: ICHS provides informational signs for patients displayed as images and in three different languages. These signs assist patients in navigating through the health center. These were developed in response to feedback directly from patients.
Figure 2. Patient Information Guide: ICHS Patient Information Guide is provided in 5 languages: English, Chinese, Vietnamese, Korean, and Tagalog . This figure represents an English and Chinese version which provides basic information about ICHS’ location, address, telephone number, and available health care services.
Figure 3. Patient Satisfaction Survey: ICHS provides a Patient Satisfaction Survey to each patient after every visit. The survey identifies patient needs and challenges, as well as overall experience within the health center. The PAC then uses the surveys to develop strategies to better address the needs and challenges of ICHS’ patients.
Members are fundamental to the PAC, so it is important to select members who represent the patient population, are willing to openly share insights, respect the perspectives of others, and can interact well with diverse populations. At any time, ICHS’ PAC is comprised of varying numbers of patients and at least one staff member.
The steps below provide guidelines in starting a PAC for your organization:
Step 1 – Secure board and management support
Step 2 – Identify staff and stakeholders
Step 3 – Define scope and purpose
Step 4 – Outline logistics, budget, guidelines
Step 5 – Begin recruitment
Step 6 – Provide member orientation
These guidelines were developed by the Institute for Patient-and-Family-Centered Care.More detailed information for starting a PAC can be found at http://www.ipfcc.org/pdf/GettingStarted-AmbulatoryCare.pdf.(PDF-331KB).
In conclusion, ICHS’ PAC has proven to be an effective strategy to involve patients in their health care and support quality improvement efforts. Since the establishment of their PAC in 2007, ICHS has identified the following key lessons;:
• Clinic staff are essential for identifying good PAC members
• Language needs and cultural barriers are a key challenge
• Staff involvement is critical
• There are always opportunities for improvement