Four Months Prior to Implementation

PATIENT ADVISORY COUNCIL IMPLEMENTATION CHECKLIST

FOUR MONTHS PRIOR TO IMPLEMENTATION . Initiate a conversation with Community Health Center (CHC) leadership about the implementation of patient advisory councils. ¨ Consider: what information do you need to have prepared? Why did you decide to start these groups? How will the patients benefit from these groups? How will the CHC benefit from these groups? . Identify staff to participate the patient advisory council committee at the community health center, with a clear primary point of contact. . Define the project scope. . Define outreach and recruitment tactics. . Inform CHC staff of PAC meetings and request patient nominations. . Outline and define follow-up and next steps to delegate to participating CHC staff.

ONE MONTH PRIOR TO MEETING . Recruit patients using provider nominations, posters, flyers, and targeted outreach. . Develop agenda. . Procure incentives. . Organize meeting space. . Define participating CHC staff roles.

ONE WEEK PRIOR TO MEETING . Outreach to patients to confirm participation. . Finalize agenda. . Inform frontline staff of meeting date and time.

ONE DAY PRIOR TO MEETING . Outreach to patients to confirm participation. . Print agenda, patient consent forms, and sign-in sheets. . Remind frontline staff of meeting date and time. . Coordinate snacks, if applicable. . Ensure meeting space is still available.

CONSIDERATIONS

IMPLEMENTATION □ How many staff members will participate on this committee? □ What staff members are appropriate? □ Who will be the staff lead? □ Where will these meetings be held in the CHC?

LOGISTICS ¨ Meeting Schedule, Frequency/Dates ¨ Length ¨ Size ¨ Facilitation ¨ CHC Point of Contact

PATIENT RECRUITMENT ¨ Who will lead patient recruitment efforts? ¨ Who will be responsible for reminders to patients about upcoming meetings? ¨ Who will be the primary point of contact on information flyers? ¨ Who will announce the implementation of PACs to the greater CHC staff? ¨ Who will maintain the patient attendance list? BUDGET □ What incentives are most appropriate for your health center? □ Who will organize these incentives? □ Who will keep track of the incentives as they are disseminated to patients?

CURRICULUM □ Who will lead subject matter collection efforts? This includes tracking and agenda development. □ Who will be responsible for sharing information garnered from these meetings to the greater community health center staff? □ Who will be the lead for maintaining the patient confidentiality agreements? □ Who will be responsible for ensuring these are completed at each meeting?

TRANSLATION □ Who will provide translation services? □ Will you conduct separate groups? □ What languages will be necessary to provide translation for?

SUSTAINABILITY Quality Improvement Plan □ How will these groups be incorporated into the community health center’s quality improvement plan? □ How is information shared with CHC staff? □ How staff can address social determinants of health barriers? □ Is there an on-boarding process for introducing patient advisory councils to new community health center staff? □ How are emerging themes and integrated into the CHC’s quality improvement plan?

Workflow □ How will the meetings continue be integrated into CHC workflow? □ How confident are you that these groups can be successfully and sustainably incorporated into your workflow as it currently exists?

Leadership Engagement and Commitment □ How will you continue to gauge and ensure leadership engagement and commitment? □ Do you feel confident about continued support at the executive level? □ How do you share information learned from these meetings with leadership?

Formalized Policy Maintaining written policies for how these patient advisory councils will be incorporated into the community health center’s workflow is vital for sustainability. These policies should contain information pertaining to staff FTE, incentives, recruitment logistics, and information dissemination. It is important to identify lead(s) for each of the areas below. One person should be responsible for keeping track of this information in a place that is accessible to team members. □ Who will create these policies? □ Who will maintain them? □ Where will they be stored?

Spread □ Will you spread these PACs to other clinic sites?