Step 5—Conduct the Orientation Meeting

Because of the sensitivity of both patients and providers in participating in this new model, all council members should receive orientation. For a small project that includes a few patients on a team, the orientation can occur with one-on-one discussions at the first meeting. For larger councils with broader goals and objectives, 1 to 1½ days should be devoted to orientation.

The focus of the orientation for small or large projects is to ensure that both patients and providers understand the process of collaboration as well as the specific project goals. Potential barriers for a successful collaboration between patients and providers should be addressed at the initial meeting. Go to Tables 2 and 3 for barriers that meeting planners should consider and actions that can be taken to remedy the barriers.

Holding the meeting in a special location, such as a hotel meeting room or conference center rather a hospital's meeting room, provides an atmosphere of excitement and attention to the importance of the council. A facilitator or outside speaker may help lead the council, especially if no one has previously participated in a collaboration with patients and providers. An outside speaker who has experience in consumer advocacy can relate the importance of the project.

The orientation meeting can also be a forum to build rapport and trust among council members. Sharing personal experiences related to the project goal helps create an environment of trust, and ice-breaker exercises that have patients and providers working together can initiate relationship building.

For a long-term council with a broad assignment, developing vision and mission statements as a team can be a constructive process of team building. The vision statement describes how the council views the ideal future for the health care system. The mission statement describes the primary objective of what the council is trying to achieve as an organization. See Appendix D for a sample mission and vision statement document.

Table 2. Patient Barriers to Successful Collaborative Meetings

Potential Patient Barriers	Recommended Actions
Concerns about damaging their relationships with health care providers if their comments are negative.	Select patient representatives who have trusting relationships with one or more provider representatives or the project coordinator. Use first names and no titles during council meetings. Ensure ground rules define respectful listening. Clearly identify and provide access to the project coordinator.
Concerns that their opinion may not be valued or respected	Project leader and coordinator should discuss goals and objectives with patient representatives individually and at council meetings. Explain that the primary goal is the inclusion of patients in the process but not all patient and provider recommendations will be incorporated. Demonstrate commitment by incorporating a patient recommendation early in the project. Hold regular, frequent meetings, especially at the beginning of the project, to build trust in the process.
Unfamiliarity with health care systems and the medical world; belief that they do not have enough medical knowledge to participate constructively.	Provide educational materials, such as articles and presentations, on relevant information for the project. Conduct all council meetings using nonmedical terminology or jargon.
Logistical complications limiting their availability to participate in meetings.	Select a meeting time and location to meet the needs of the patient representatives. Provide support, such as childcare and translator services, if necessary and possible. Provide a financial stipend to cover patients' costs, and reimburse them for their time commitment.
Concerns about being active participants and contributors.	Define initial project goals and objectives that the staff developed but allow flexibility to accommodate council input and direction. Assign council members homework and responsibilities to actively engage them.

Table 3. Provider Barriers to Successful Collaborative Meetings

Potential Patient Barriers	Recommended Actions
Concerns about revealing problems and mistakes in the system with their patients.	Review literature and examples from other organizations that undertook similar councils. Obtain confidentiality statements from council members. Limit the scope of the project. Remind staff that patient volunteers may already be part of the organization.
Concerns that patients will use the council as an opportunity to vent complaints.	Select appropriate patient representatives for council. Limit the scope, focus, and duration of project. Select a project coordinator with meeting facilitation skills to keep the council on track.
Concerns that a small number of patients will not be representative of all patients, including their own.	Recognize the limitations of representatives. Highlight the current lack of any patient perspective without their involvement. Propose to expand patient number if initial project is beneficial.
Cost of project.	Start with a small project. Explain the limited funding needs. Explain that many patient representatives do not expect payment or costly services for participating.
Inexperience with patient collaboration models.	Provide one-on-one education and a project description by project leader with leadership and provider representatives. Select a project coordinator who is familiar to and trusted by provider representatives. Select a small, short-term project for initial patient involvement. Select provider representatives who are not resistant to innovative ideas.
Concerns about negative repercussions—legal or otherwise—on the staff and organization.	Share stories from other organizations that demonstrate positive repercussions without negative impact. Have compliance officer review forms and membership applications. Identify how the creation of the council is part of cultural transformation toward patient-centered care.

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Step 6—Conduct Regular Council Meetings

Organization, planning, and preparation are key elements of an effective council meeting.

Ground Rules

• Define the ground rules, which should include respect and honesty, to set the tone for all meetings. See Appendix E for sample ground rules.
• Honor the ground rules, using the facilitator to ensure they are followed.
• Speak in nonmedical terminology.
• Agree to address all council members in the same manner (i.e., by their first names) to avoid an authority gradient between patients and providers.

Logistics

• Meeting times. Set meeting times so they are convenient for members. Consider any special needs council members have. For example, older patient representatives may prefer meetings to be held during daylight.
• Location. Set a meeting location that is centrally located for all council members. If there are political or community issues that could influence the council, consider a neutral location where all members are comfortable. This may be in a location that is not owned by the sponsoring health care organization. Meeting in a community-based organization's site may demonstrate community involvement in the project.
• Project commitment. Define the time commitment of the project, such as number, frequency, and duration of meetings, and the duration of project period. Meetings that are too long may not be productive. A specific project period keeps the council committed to completing its objectives within a defined timeframe. Meetings that are held less often than every month may lead to a loss of enthusiasm for the project. Months with multiple holidays may cause scheduling conflicts for council participants; consider not holding meetings during those months.
• Stipends. A stipend may be offered to council members for their time and effort. Patients often do not accept the stipend, but the offer of one reflects the value that an organization puts on their contributions to the project. A stipend may range from $25 to $100, depending on available resources, duration of meetings, and length of the project.
• Support services. Detail the services that will be offered for council meeting participation, such as food, childcare, transportation, and parking.
• Room setup. Arranging tables and chairs in a circle is most conducive to discussion and visually associated with no hierarchical relationship among the team members.
• Binders. Provide each council member a binder to maintain their materials. Include a list of members' names and contact information (after getting approval from the members to share this information); the project coordinator's contact information; a description of the project mission, including the vision, goals, and objectives; and the minutes from the last meeting.

Aurora Health Care Project Frequency: Monthly meetings Duration of meetings: 3 hours (includes 15-minute breaks) Support services: Free parking; muffins, coffee, and water provided; financial stipend for patient representatives Meeting time: 9 a.m. to noon (daylight driving) Location: Local health department meeting room (neutral location, centrally located within the community) Project period: 2 years

Standing Agenda Items

Regular agenda items that facilitate an organized project completion and build trust among the members include:

• Check in. At the beginning of every meeting, ask council members if they have a story to share that is related to the project goal. This may include a demonstration of the problem being addressed, a suggested intervention, or a celebration of a success that is attributed to the council's efforts.
• Check out. At the close of every meeting, ask each council member how he or she felt about the meeting. Did they learn something? What was most interesting? What could have been done differently? How do they feel the council is doing toward meeting its goals and objectives?
• Meeting evaluations. Each council member should be asked to complete an evaluation after each meeting. Share the results of these evaluations at every meeting. If evaluations address specific concerns or recommendations, take action to incorporate changes at the subsequent meetings. See Appendix F for a sample meeting evaluation.

Assignments and Homework

Council members should receive assignments when appropriate. Assignments help to get tasks done in a timely manner by spreading the work, and they also give members a sense of participation in and ownership of the project.

Use the expertise and connections of the council members. For example, if one of the council members belongs to a community organization, ask him or her to introduce the project to fellow members or to invite the project coordinator to the organization's next meeting.

Educational Presentations

Continuing education is especially important at the beginning of council development. This may include sharing written materials, articles, and professional literature. Presentations by experts from within and outside the organization provide diverse perspectives on the project goals.

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Step 7—Elicit Public Relations Support and Community Engagement

Public relations and marketing may be beneficial, especially for projects that involve community members and organizations beyond the health care system. Raising awareness in the community that the council exists highlights the organization's commitment to patient-centered care and meeting the needs of consumers. Community engagement may be a powerful mechanism for promoting and achieving behavior-based healthy outcomes. By collaborating with community-based organizations, consistent education and best practices can be shared with those who provide patient care. Although the primary objective for a health care system may be to take care of their own patients, the impact from a project may reach beyond those individuals and positively affect the health of the larger community.

Recommended public relations and community engagement strategies include:

• Creating a brochure that explains the council's role and goals. A sample brochure can be found at Appendix G.
• Using advertisements to promote a project or intervention. A sample of an advertisement can be found at Appendix H.
• Media reports through newspapers, radio programs, and television spots to spread the word to and beyond the community. Holding a media event, at which reporters are invited to attend part of a council meeting and interview patient and provider representatives, can further enhance community awareness and engagement.
• Engaging a photographer to document the work—and the fun—the group had in achieving success.
• Communicating with the internal organization through newsletters, E-mail, and presentations at committee and staff meetings.
• Keeping the board of directors aware of the project by addressing some of the barriers and concerns as well as opportunities for the organization.
• Engaging local government to heighten awareness among community members. A presentation to the local board of supervisors can be made. Participating in annual Patient Safety Awareness Week activities connects the council's efforts to national programs.
• Accessing community groups and social service agencies through council members who are active in these organizations. These groups may provide perspective on the project goals and assist in dissemination of the interventions.

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Step 8—Conclude With a Meeting

At the conclusion of the project time period, the council should evaluate its progress on the project and reflect on the council itself. A final meeting should be devoted to evaluation, reflection, conclusions, and recommendations for the future role of the council. Components of the final meeting may include:

• Review of the council's history from initial planning through implementation.
• Report to the council on project goals, measured outcomes, and evaluation metrics.
• Reiteration of the council's purpose: Bringing patients into the organization's infrastructure and moving toward a more patient-centered approach to health care.
• Identification of barriers and opportunities for continuation and replication of the council.
• Celebration of successes, even if project goals were not entirely met.
• Recognition of council members and their efforts from organizational and community leadership.
• Completion of the final report for organizational leadership with recommendations for continuation or replication.

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Step 9—Measure Success

Several evaluation methods can be used to quantify the success of a council. Both process and outcome measures can demonstrate how the organization has met its goals for involving patients.

Suggested process measures include:

• Number of project teams that include patients as team members.
• Number of patients that have been included on project teams.
• Number of meetings in which patients participated.
• Number of patient advisory councils an organization established.
• Number of patients on the patient advisory councils.
• Number of meetings of the patient advisory council in which patients have participated.
• Number of focus groups conducted.
• Number of patient and provider interviews completed.
• Number of interventions, tools, and materials created by the council to meet the project goals and objectives.
• Number of interventions, tools, and materials disseminated to patients and the community to meet the project goals and objectives.

Suggested outcome measures include:

• Evaluation scores from each patient advisory council meeting that meet or exceed the target.
• Meeting or exceeding specific project goals and objectives.
• Impact of project on patient behaviors and practices, measured through surveys (mail, phone, or E-mail), observational studies (at clinics, pharmacies, or hospitals), and chart reviews.
• Penetration of project impact beyond targeted population (community penetration beyond the organization's patient population), measured through surveys (mail, phone, or E-mail).
• Patient satisfaction survey results meet or exceed target.
• Employee satisfaction survey results meet or exceed target.

Go to Appendix I for measurement examples.

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Step 10—Sustain the Partnership Model

The initial excitement and passion generated by the collaboration between patients and providers can dissipate over time and with the practicality of completing a project. Although council members often feel changed by working in a partnership model, others in the organization may not experience an emotional response. Therefore, both the council members and the organization may lose the enthusiasm needed to continue and promote replication after a project has been completed.

Steps to continue cultural transformation toward patient involvement include:

• Inviting key organizational leaders to a council meeting.
• Including one or more of the patients from the council on a different project. With their experience and comfort, these patients can demonstrate to other staff how effective their involvement can be.
• Sharing the experience with other providers and staff at meetings and conferences. Council members, with a patient representative, if possible, should make the presentations.
• Obtaining funding from "nontraditional" sources, such as grants, foundations, and affiliated groups of the health care organization.
• Replicating patient involvement in small projects throughout the organization, allowing other staff to experience the benefits of working collaboratively with patients.
• Reporting on the successes of the council's efforts to organizational leadership.

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