Recruiting and Engaging Virtual Patient and Family Advisors for Rapid,Robust Feedback to Support a Large,Geographically Dispersed Clinical Practice

Abstract

A large clinical practice group sought to create a unique Patient and Family Advisory Council (PFAC) recruitment and engagement model to support shifts in advisor expectations and support a medical group spread out across a large geographic area by providing rapid, custom patient and family feedback for quality, safety, and experience improvement. Patients are actively recruited through an online, automated application process linked to our patient surveys. Within 6 months of automated recruitment, the PFAC grew to over 200 members representing all clinical specialties and a variety of patient demographics, skills, and experiences. Rapid patient feedback through PFACs has elevated the voice of patients in dozens of projects and within specialties that have not utilized patient feedback or engaged a traditional PFAC in the past. Patients who may not have participated in a traditional PFAC have shared their perspectives on a variety of topics not captured in traditional patient surveys. Underrepresented patient populations are engaging in virtual PFAC opportunities much more than traditional PFACs.

Patient and family advisory councils (PFACs) provide safe places for healthcare organizations to listen and gather input from patients and family members. PFACs enhance a patient-centered approach, improve quality of care, support effective patient communication and education, increase patient satisfaction and engagement, and support continuous improvement and innovation. Traditional patient and family advisory councils have historically been location-specific, in-person, and ongoing. PFAC members may have had a recent hospital experience and are invited to monthly or quarterly meetings to provide input on quality, safety, and experience challenges. Traditional PFACs require significant commitment by both the organization and the advisor. Unfortunately, pandemic policies limited the participation of many traditional PFAC members in healthcare organizations across the US Patient advisor participation expectations have shifted. Many patients and family members no longer wish to travel to a hospital or clinic for in-person meetings. Accommodating varied schedules for in-person meetings is challenging. Travel and scheduling can also limit participation from underrepresented patient populations. The traditional structure of PFACs and the recent shift in advisor expectations present unique challenges for healthcare organizations today.

Emory Healthcare, part of Emory University, is the most comprehensive academic health system in the state of Georgia. Emory is made up of 11 hospitals and over 490 ambulatory clinics and surgical center locations across 45 Georgia counties. The Emory Clinic is Emory Healthcare's physician practice of more than 2800 specialists, sub-specialists, and primary care physicians, plus more than 1100 advanced practice providers and over 1200 nurses.

The Emory Clinic patient experience team developed a unique PFAC recruitment and engagement model to support shifts in advisor expectations and support a large clinical practice group spread out across a large geographic area. The clinical practice group PFAC charter established a virtual membership option and a specialty, in-person membership option. Virtual members have received care anywhere within the clinical practice group in the last two years, participate virtually via ad hoc questionnaires and/or virtual listening sessions, and serve two years with the option to withdraw at any time. Specialty in-person members have received care within the specific specialty in the last two years and participate a minimum of six times per year in-person and/or virtually (as needed) within two years, with the option to withdraw at any time. Virtual members are required to review the charter and sign the consent and confidentiality form. Specialty members are required to be onboarded as volunteer, including healthcare volunteer orientation, background checks, and medical screenings.

Patients are recruited through an automated process built into our patient experience surveys. Patients are asked on the survey if they would like information about PFAC participation. If they select yes, they automatically receive a link with details and an online application. Advisor applications are stored using a secure data collection tool that meets HIPAA compliance standards. All patient information is protected. Once they submit the application, they automatically receive a PDF handbook with the charter, participation requirements, and consent and confidentiality forms to review, sign, and return to a monitored email. Each week, a member of the patient experience team reviews the applications of those who have returned the confidentiality forms to ensure the patients meet the requirements of virtual participation. They receive a confirmation email welcoming them to the virtual PFAC. If they have expressed interest in a specialty in-person PFAC, we contact that specialty to recommend creating an in-person PFAC or if they wish to onboard a new member.

One of the primary concerns regarding this recruitment strategy was applicant volume. Over 12 months, our clinical practice group can receive over 350 000 surveys. What percentage of patients would indicate PFAC interest and how would we communicate with them to process their requests with limited human resources? Automating much of the communication process helped us to prepare for a surge in PFAC interest. Creating a few steps for interested patients to follow created positive operational friction. This friction helped weed out potential non-commitment. Over 64 000 patients indicated they were interested in a patient and family advisory council. Of those, 2000 completed an application. After 10 months, we welcomed 270 virtual advisors and 7 specialty advisors representing all clinical specialties and a variety of patient demographics, skills, and experiences. We now average 5–6 new applicants a week. Patients are also recruited through clinician recommendations and flyers with QR codes that can be distributed locally. Specialties who wish to start an in-person PFAC contact the patient experience team to recruit from the virtual PFAC or locally through provider recommendations or flyers.

By expanding PFAC participation to include a virtual option and actively recruiting from patient surveys, we saw increases in participation from a variety of patients who were not represented in some of our historical in-person PFACs. Capturing and monitoring advisor demographics helps ensure councils represent our patient population. Supplementary chart 1 compares race/ethnicity percentages for our PFAC and our patient population. Though skewed toward White patients, we also see much higher participation among Black patients and opportunities for recruitment among Hispanic patients. Supplementary chart 2 compares gender percentages for our PFAC and our patient population. Though skewed towards women, we see much higher participation among men, and we have some non-binary patient representation. There are opportunities for recruitment among non-binary and trans patients. Supplementary chart 3 compares primary payer percentages for our PFAC and our patient population. There is even representation between governmental payers (Medicare, Medicaid, VA, etc) and commercial payers (Aetna, BCBS, etc); we lack representation from self-pay patients. Supplementary chart 4 compares age percentages for our PFAC and our patient population. Though heavily skewed toward 60–74-year-old patients, we have a healthy representation of 75 + patients. This is encouraging as we were concerned whether virtual options might unintentionally exclude older patients. There are recruitment opportunities for 18–30-year-old patients.

By recruiting directly and automatically from patient surveys, we hoped to reduce potential selection bias that may occur in advisor recommendations from clinic staff. Though our patient survey returns skew slightly towards white, female, and 65–74-year-old patients, almost all our patients are offered an after-visit survey to complete via SMS or email, promoting PFAC opportunities to a much larger set of patients. By collecting and tracking advisor demographic information, our team can work with clinics to help recruit from specific patient populations. It will be important to provide options for patients who may lack access to the digital resources necessary to communicate interest and participate virtually.

As the virtual PFAC grew rapidly, we promoted virtual PFAC options and recommended clinical divisions establish in-person PFACs. Clinical practices can request virtual advisor feedback through custom questionnaires and virtual listening sessions. The full virtual PFAC can be engaged or just patients within select specialties or representing specific demographics. Virtual advisor feedback is often returned to us within 48 h of the request. This rapid feedback helps keep pace with the rate of change that occurs in large healthcare organizations. Virtual advisors have shared their perspectives on a variety of initiatives including patient education materials, patient portal features, quality/safety initiatives, patient experience, and access initiatives. For example, the Emory Healthcare Virtual Nursing team engaged 25 virtual advisors through 6 listening sessions before preparing for a period of team growth and restructuring. Advisors were asked a set of questions sparking wonderful dialogue about portal message management, nurse triage support, and more. The patient experience team created a custom questionnaire for advisors to gather their perspectives on appointment self-arrival via smartphone or kiosk. This questionnaire showed patient perspectives on customer service, convenience, safety, and likelihood of utilization. Results were shared with operational teams prior to piloting which reinforced commitments to check-in employee training, not only on technical components, but also on service expectations. Emory physician leadership requested patient perspectives on physician attire. Using a formal instrument from prior published research, patients provided their perspectives on casual to formal attire, with or without white coats, across a variety of care settings. This helped physician leadership understand localized perspectives.

Patient advisors have expressed appreciation for the opportunity to participate and provide feedback in ways that accommodate their schedules and stages of life. One advisor stated, “Many thanks for the opportunity to serve Emory from the patient's perspective, in planning for quality medical care in the future. Was very nice to meet everyone and share input. In the day and age of doctor shortages, I greatly appreciate all that the Emory teams do to facilitate access to care and access to physicians, as best able.” Another advisor stated, “I would just like to say that I so appreciate you making it possible to get feedback from us. Most of my medical providers are with Emory. I really appreciate you asking for our input.”

Automating recruitment through patient surveys is scalable to large academic medical center clinical practices. Organizations can capitalize on third-party survey vendor platforms for assistance in automating advisor application collection and storage, as well as internal IT resources. Smaller practices may opt to collect applications manually, in their clinic. Emory found that offering virtual participation opportunities was the primary draw for advisor participation, rather than the application collection method.

Emory did face some challenges through this process. Initial volume of applications was significant and required additional time and resources to review and process applications at the beginning of automated recruitment. At one point, the automated recruitment process through our survey vendor went down for a period which led to frustrated patients who expressed interest but follow up was delayed. Keeping virtual advisors engaged with regular meaningful participation opportunities was initially challenging. Some advisors wanted more frequent virtual opportunities than we could provide. The patient experience team heavily promoted virtual advisor feedback across all ambulatory specialties who may not have been accustomed to engaging patients early in change management or were unfamiliar with how to engage patients in this new way. Automated patient recruitment and participation focused on the ambulatory clinic setting throughout this pilot. The next step will be to expand across Emory hospital care settings as well.

Rapid patient feedback through virtual PFACs has elevated the voice of patients in dozens of projects and within specialties that have not utilized patient feedback or engaged a traditional PFAC in the past. Virtual PFACs also expand the number of patients who are introduced to organizational changes, helping them understand both the “what” and the “why,” and potentially move them from late adopters to early adopters. Patients and family members who may not have participated in a traditional PFAC have shared their perspectives on a variety of topics not captured in traditional patient surveys. Historical advisor demographic information and lack of external benchmarking made it challenging to trend or compare Emory PFAC participation. However, it appears underrepresented patient populations are engaging in virtual PFAC opportunities more than traditional PFACs.

By creating convenience for both patients and clinical staff, traditional plus virtual PFACs allow patients to provide their perspectives faster and for a greater variety of clinical specialties and projects that support quality, safety, and experience. We will continue to recruit advisors through patient surveys, staff recommendations, and flyers. We will continue to monitor PFAC participation against the general patient population and adjust recruitment to balance representation. We will also incorporate PFAC engagement goals into our annual action plans. Though patients continually become more inclined to engage with healthcare organizations virtually, questions remain about how to recruit and include patients with limited access to technology or who may prefer to engage in other ways. Other questions that remain include when to pause passive recruitment for the growing virtual PFAC, how can we continually engage clinical specialties to include PFAC feedback in their initiatives, and how can we encourage in-person PFACs where patients can provide deeper insights into their experiences. Balancing passive, virtual PFAC recruitment and engagement with intentional, in-person options will remain important for balanced patient perspectives.

Supplemental Material

sj-docx-1-jpx-10.1177_23743735241310092 - Supplemental material for Recruiting and Engaging Virtual Patient and Family Advisors for Rapid, Robust Feedback to Support a Large, Geographically Dispersed Clinical Practice

Supplemental material, sj-docx-1-jpx-10.1177_23743735241310092 for Recruiting and Engaging Virtual Patient and Family Advisors for Rapid, Robust Feedback to Support a Large, Geographically Dispersed Clinical Practice by Kevin Phipps in Journal of Patient Experience