Houses of worship/religious organizations Patient satisfaction surveys Promotional efforts within institution to patients or families Promotional efforts within institution to providers or staff Recruitment brochures Word of mouth/through existing members Other (Please describe): N/A – we did not recruit new members in FY 2018 8. Total number of staff members on the PFAC: 9. Total number of patient or family member advisors on the PFAC: 10. The name of the hospital department supporting the PFAC is: 11. The hospital position of the PFAC Staff Liaison/Coordinator is: 12. The hospital provides the following for PFAC members to encourage their participation in meetings (check all that apply): Annual gifts of appreciation Assistive services for those with disabilities Conference call numbers or “virtual meeting” options Meetings outside 9am-5pm office Parking, mileage, or meals Payment for attendance at annual PFAC conference Payment for attendance at other conferences or trainings Provision/reimbursement for child care or elder care Stipends Translator or interpreter services Other (Please describe): N/A Section 3: Community Representation The PFAC regulations require that patient and family members in your PFAC be “representative of the community served by the hospital.” If you are not sure how to answer the following questions, contact your community relations office or check “don’t know.” 13. Our hospital’s catchment area is geographically defined as: Don’t know 14. Tell us about racial and ethnic groups in these areas (please provide percentages; if you are unsure of the percentages check “don’t know”): RACE ETHNICITY % American Indian or % % Black or African % Native Hawaiian or other % White % Other % Hispanic, Latino, or
Alaska Native Pacific Islander Spanish origin 14a. Our defined catchment area Don’t know 14b. Patients the hospital provided care to in FY 2018 Don’t know 14c. The PFAC patient and family advisors in FY 2018 Don’t know 15. Tell us about languages spoken in these areas (please provide percentages; if you are unsure of the percentages select “don’t know”): Limited English Proficiency (LEP) % 15a. Patients the hospital provided care to in FY 2018 Don’t know 15b. PFAC patient and family advisors in FY 2018 Don’t know 15c. What percentage of patients that the hospital provided care to in FY 2018 spoke the following as their primary language? % Spanish Portuguese Chinese
The following information only concerns PFAC activities in the fiscal year 2018. 26. The five greatest accomplishments of the PFAC were: Accomplishment Idea came from (choose one) PFAC role can be best described as (choose one) 26a. Accomplishment 1: Patient/family advisors of the PFAC Department, committee, or unit that requested PFAC input Being informed about topic Providing feedback or perspective Discussing and influencing decisions/agenda Leading/co leading 26b. Accomplishment 2: Patient/family advisors of the PFAC Department, committee, or unit that requested PFAC Being informed about topic Providing feedback or perspective Discussing and influencing decisions/agenda Leading/co leading 26c. Accomplishment 3: Patient/family advisors of the PFAC Department, committee, or unit that requested PFAC input Being informed about topic Providing feedback or perspective Discussing and influencing decisions/agenda Leading/co leading 26d. Accomplishment 4: Patient/family advisors of the PFAC Department, committee, or unit that requested PFAC Being informed about topic Providing feedback or perspective Discussing and influencing decisions/agenda Leading/co leading 26e. Accomplishment 5: Patient/family advisors of the PFAC Department, committee, or unit that requested PFAC input Being informed about topic Providing feedback or perspective Discussing and influencing decisions/agenda Leading/co leading 27. The five greatest challenges the PFAC had in FY 2018: 27a. Challenge 1: 27b. Challenge 2: 27c. Challenge 3: