How BILH Primary Care Is Changing the Patient Experience

BILH Primary Care’s PFAC Engages Patients and Families To Improve Care

Bobbi’s first reaction after receiving an invitation to join the Beth Israel Lahey Health Primary Care (BILHPC) Patient and Family Advisory Council (PFAC) was, “They really care about feedback!” The packet of information sent to her spurred enough curiosity that she decided to join, even though she was not sure about using Zoom for the meetings.

After a few interviews, paperwork and a practice session on Zoom, Bobbi became a member of the inaugural BILH Primary Care PFAC. In doing so, she joined 14 other patient advisors united by a mission to engage patients, family members and care teams to co-produce, design and gather feedback on initiatives to improve the patient experience.

After the first few meetings, Bobbi’s excitement was palpable. “The extremely smart, diverse, insightful and committed people who showed up at the first meeting had me totally impressed, if a little intimidated. The topics were always current to patient experiences and emphasized to me how sincerely concerned the BILHPC organization is with improving patient care.“

An Innovative Way To Engage Patients

With 90 practices, a patient panel of 430,000, and 475 clinical providers, BILH Primary Care aspires to be the premier primary care provider in Eastern Massachusetts and Southern New Hampshire. The development of a system-wide PFAC was crucial to that goal — it was also innovative.

Despite the popularity of PFACs in hospital settings, they are less common in ambulatory care settings. This is likely due to a lack of infrastructure, resources and regulatory requirements to maintain and sustain a PFAC. Given that most patient care is delivered in the ambulatory setting, the voice of the patient is vital to gather feedback and drive improvements.

The journey to developing a robust patient engagement program began shortly after the establishment of the BILHPC system in 2019. Following a merger, BILH Primary Care was formed through the integration of community primary care practices from three legacy systems: Beth Israel Deaconess Health Care, Mount Auburn and Lahey Health System. The PFAC was one of the very first BILHPC-wide initiatives, representing a cultural shift as the three legacy groups united as one integrated system.

“The patient voice is essential to our success at BILHPC,” reflects Kayla Tremblay, Director of Quality and Safety Operations for BILHPC and co-chair of the PFAC. “Our model of coproduction with patients has built a strong foundation for numerous improvement initiatives.”

In a coproduction model, patients are engaged in improvement work from the beginning and remain part of the team throughout. One of the first outputs of the PFAC was the development of an exam room poster. Rather than asking patients for feedback on a mock-up of a poster, BILH Primary Care invited the PFAC to design the poster based on what they felt was most important to convey. The outcome was a poster describing how patients can make the most of their visit — a concept that the BILHPC team had not considered previously.

Starting a PFAC

To support other systems interested in developing a PFAC, the BILH Primary Care team developed a Guidebook for Developing a Patient and Family Advisory Council. Outlining their journey from conception to implementation, the guidebook includes a step-by-step summary of the process with templates for everything from gaining senior leadership buy-in to council by-laws.

While starting a PFAC can seem like a heavy lift, the BILHPC team feels that the reward is worth the effort. They share the following advice for other organizations interested in establishing a PFAC:

• Engage stakeholders. The planning team gained approval and support not only from the senior leadership team, but also from stakeholders throughout the BILH system. For example, leaders from other PFACs within the system were invited. Bringing together leaders who were supportive of the concept and had an interest in patient engagement helped shape the construction and acceptance of the PFAC from the beginning.
• Develop a structured recruitment process. Early on, establish a recruitment process which should include communication efforts, interviews and onboarding requirements to recruit patients that represent the patient population and are committed to improvement. Working closely with marketing, human resources and compliance colleagues allows for a comprehensive process from start to finish.
• Create a feedback loop between the PFAC and the organization. Key to the continued success of the PFAC is ensuring the entire organization is aware of the discussions and feedback from the patient advisors. BILH Primary Care includes a summary of each PFAC meeting in a monthly newsletter sent to all employees and regularly shares updates at leadership meetings. Sharing feedback back to the PFAC is crucial as well. It’s important for the PFAC members to see how their feedback is shaping the organization so they can feel the value they bring.

Driving Improvements in Patient Care

Now entering its third year, the PFAC has become the go-to resource for patient feedback throughout BILH Primary Care. Each meeting features a variety of presenters from throughout the organization seeking patient and family input. As one presenter shared, “We engaged with PFAC to discuss our nurse visit initiative and the overwhelming endorsement from the committee gave us confidence to continue moving forward with our efforts. It was a reassurance for leadership to hear the current perspective from our patients.” During that meeting, the advisors shared that they would be willing — and happy — to have a visit with a nurse instead of their primary care provider.

The experience has been positive for PFAC members as well. In a recent survey, 100% of advisors agreed or strongly agreed that their opinion as a patient advisor is valued.

The PFAC has spurred additional patient engagements programs for BILH Primary Care, including an Embedded Patient Advisor Program that places advisors in committee and project teams to represent the patient voice. Currently, 14 advisors are standing members of 10 BILHPC committees.

After a rewarding two years on the PFAC, Bobbi’s term limit ended, and she moved on from her position as a patient advisor. “Now that I have participated in this ongoing effort, I realize that having input from patients is critically important. I have the sincerest admiration and respect for BILHPC for making the commitment to this essential feedback loop.”