Patient advisory councils (PACs) may be an effective strategy for healthcare organizations to improve the patient experience and patient-centered care, according to a recent study published in the Journal of the American Board of Family Medicine.
PACs are groups of patients, family members, and caregivers who meet with clinicians about patient experience imperatives and the resulting solutions the practice could implement.
These patient-centered advisory groups are part of the National Committee for Quality Assurance criteria for patient-centered medical homes (PCMHs), and may be a generally positive step toward patient experience improvement.
However, according to a research team led by Anjana E. Sharma, MD, only a third of certified PCHMs engage their patients in PACs, potentially because of a perceived difficulty to implement these groups.
In order to describe a path toward a successful PAC, the research team conducted qualitative interviews with patient and clinician council members from eight outpatient primary care clinics in California. The interviews yielded ideas about the four fundamental qualities that add to a successful PAC.
Attention to participant recruitment
The first step for establishing a patient advisory council is recruiting members. Logistically, this process includes advertising PAC recruitment, receiving member nominations from staff, and vetting these candidates through interviews.
According to the researchers, clinic staff like to recruit patients with good communication skills. These patients are able to clearly articulate their own ideas but are also able to listen to and work with other members to reach a solution.
“The thing that is most important is not what they think so much as how they express it,” one clinician interviewer said to the researchers. “It is really critical that they are not combative, that they are able to represent a number of voices and to listen to a number of voices and that they can be representative of people who are unlike themselves.”
Clinic staff also said they want to recruit members who can represent the many patient populations at the clinic. However, the researchers found that each of the PACs were struggling to recruit various populations, including younger patients, ethnic minorities, working patients or parents, male patients, those with lower health literacy, those with chronic illness, and members of sexual minorities.
While PAC leaders do state that creating a diverse population is ideal, they are foremost concerned with creating a group of good communicators. Once they achieve that, they will focus on enlisting diverse patient populations.
Facilitating productive PAC meetings
Interview respondents also highlighted the importance of productive PAC meetings, stating that a strong leader is critical.
At all eight facilities, the groups nominated a leader to facilitate meetings.
“Facilitators were responsible for providing a safe space for all members to be involved, including reigning in members who had more dominant communication styles that could overpower meetings,” the researchers reported.
Facilitators are specifically in charge of nurturing PAC projects, getting patient member feedback, translating patient experiences into projects, and identifying projects that may not be feasible.
According to the researchers, many PAC facilitators did not have leadership experience prior to joining the group. While this shows that leaders can emerge in unlikely places, it also may highlight a need for more patient experience leadership in practices.
Clarity between PAC and staff about accountability
Each of the eight PACs interviewed expressed a need for clarity about expectations and accountability between PAC members and other facility staff. While they all agreed upon this need, they disagreed on who should be in charge of it.
Most patient PAC members thought the onus should be on clinician PAC members. This may be because clinician members have more influence within the facility or because they know the different characteristics about practice culture.
Conversely, four clinician PAC members and two patients thought patients need to take on a greater role in communicating expectations and accountability. According to these respondents, when patients are not engaged in or passionate about different initiatives, the council cannot carry out projects properly. Clinicians also alluded to being overburdened by PAC work.
Although PACs face these accountability and responsibility challenges, they still have reportedly been able to carry out patient experience improvement projects.
“Despite these challenges, the majority of respondents described a diverse array of successful clinic improvement projects implemented by PACs, including patient communication tools, clinical care, the clinic’s physical space, and clinical workflows or systems,” the research team reported.
Spreading awareness of PAC to garner physician buy-in
Overwhelmingly, respondents stated that spreading awareness about the PAC and patient experiences shared during meetings has helped improve provider buy-in for patient engagement projects. By letting providers in on patient needs, clinic culture has changed to be more accepting of patient-centered care initiatives.
“It makes a huge difference about how providers think about how they interact with the patients, how the staff think about the work that they are doing, how patients feel involved in the care that they are receiving, versus being just something or a place they come to,” one participant told the researchers.
For some clinics, PACs have become the cornerstone of patient engagement improvement and essential for providers to participate in these efforts.
“At sites that have invested in PACs, ongoing patient input was seen by staff as an essential component of achieving a culture of patient engagement,” the researchers said.
“How can we talk about patient-centered care without having patients at the table?” an interview respondent explained.
The researchers said their interviews not only suggested steps toward a better PAC, but highlighted the success they can have in improving patient experience. Going forward, the researchers suggest collecting quantitative data to assess concrete PAC achievements.
“As PACs work with practice-improvement teams, developing metrics to assess PAC success is an important future area of inquiry,” the researchers concluded. “Although respondents did not describe metrics of success, there was overarching concordance that working with a PAC was worth the time it takes.”