Retaining Advisors

The process of retaining advisors in Collaboration and Co-ownership-based engagement strategies is an art, rather than a science. It starts before the person even accepts the role and continues over the course of the time they are involved. Like any relationship, it requires an investment of time, respectful interaction and resources in order to build and maintain trust.

The single most important way to retain advisors is to provide them with meaningful and important work. Advisors can readily tell if they are just “window-dressing” or a means to satisfy externally imposed requirements for consumer engagement. They can also tell if they are being asked for input on, for example, issues that have already been decided upon or communications materials that are about to go to print. Systems should employ the principles of “co-design” in their engagement activities, – the inclusion of consumer advisors as equal partners from the get-go. While the topics of advisors take on may vary, health care organizations should seek to tackle some of the most complex challenges they face, such as the elimination of persistent health disparities, by working with advisors from historically excluded communities.

There are many concrete steps a health care organization can take to promote these relationships while getting the feedback needed to improve the organization’s operations, policies and procedures.

• Set expectations for responsibilities and time commitments. Advisors must understand, from the outset, what they are getting into. Be clear what the expected time commitment will be and make sure it is appropriately matched with the stipend and/or other supports you provide them. Include the information in your recruitment materials and, as applicable, role descriptions and the opportunity for in-person informational meetings. If you are using a Collaboration and Co-ownership-based engagement strategy, you will want to reiterate time commitments in the meeting.
• Onboarding and training.The amount of onboarding and training provided to advisors will vary depending on the strategy being used. For example, organizations developing a PFAC should take the following steps:
  • Confirmation letters. Following the face-to-face meeting, the organization should send “confirmation” letters with a brochure about the advisory panel to all the advisors selected. Included in that acceptance should be the date for a formal orientation meeting.
  • Orientation.The overarching goals of this meeting are to warmly welcome members to this new endeavor, get everyone on the same page about the organization, and begin to build camaraderie among the committee members. Topics for the formal orientation and training meeting should include:
    • An explanation of the organization
    • Introduction of the relevant organization staff and explanation of their roles
    • Introduction of each PFAC member and their reason for joining the panel
    • The purpose of the PFAC
    • The role of the PFAC and how they will contribute to the ongoing quality improvement efforts of the organization 
    • Examples of how other similar panels have operated and the kinds of outcomes they have achieved
    • The vision for partnership between the organization and the PFAC

    Develop an orientation folder with a basic set of materials relevant to the purpose of the PFAC. Organizations should strive to use plain language.
    
    In addition to sharing this information, health organizations should also spend time at the orientation getting to know the committee members and understanding what they hope to bring to (and get out of) the experience of serving on the PFAC.

    Pro Tip: Mini-Evaluations

    Conduct a mini-evaluation after each PFAC or Board meeting to learn from advisors what went well in the meeting and what could be improved in future meetings. This can be done in a group by using a “plus/delta” exercise or by asking advisors to each fill out a postcard-sized evaluation form.

    • Notes from the Field

      • Children’s Mercy Hospital offers individualized trainings, written training materials and ongoing mentoring to all PFAs.
        SEE THE CASE STUDY
      • SJMHS Has the Experience Advisor Program, in which potential advisors participate in orientation trainings in order to understand expectations.
        SEE THE CASE STUDY
        
      • At HRHCare, Community Advisory Board members are continually offered training opportunities, with the organization even paying registration fees as needed.
        SEE THE CASE STUDY
      Training. Depending on the engagement strategy, a health organization should invest in training for advisors in skills and substantive topics that will help them both feel comfortable and be effective in their roles. Training also provides an incentive for volunteering their time. Training topics should be identified in direct partnership with advisors, but commonly include topics relevant to the organization’s strategic priorities, payer requirements, patient demographics, provider licensing requirements, and quality metrics and improvement efforts. In addition, trainings often include topics that are helpful to the advisory role, such as developing agendas, effective facilitation and communication strategies, conducting presentations, and conflict management. It is essential to ensure trainings are tailored to the needs of advisors who have varying types of experiences, learning styles (e.g., visual, and auditory learners), languages, and levels of education.

• Pro Tip: Ongoing Training

  Training is not necessarily a one-time event. Providing ongoing training opportunities helps to build leadership among your advisors, demonstrates your commitment to meaningful engagement and helps to retain them over time.

  Supporting participation. Organizations should offer incentives to advisors to encourage participation in any engagement structure. Offering supports such as stipends, transportation and meals demonstrates that the organization places value on their time, perspective and experience and will do what it can to maximize participation. In addition to offering these more tangible supports, organizations can help remove barriers to active, meaningful participation. Some ways to overcome barriers are:
  • During the recruitment process, ask about whether there are barriers that would make participation difficult, and how your organization could help to remove them. These barriers may relate to the advisor’s life circumstances, cultural background and/or logistical needs.
  • Use meeting locations that are fully accessible for all abilities
  • Ensure meeting room arrangements are compatible with assistive technology
  • Allow adequate time for consumers or family members using augmented or assistive technology
  • Allow caregivers to accompany patients
  • Assign friendly staff to greet consumer/family advisors at the entrance and escort them to the meeting room
  • Allow for “virtual” participation via video (e.g., Skype or Zoom) or telephone conference call and make sure the advisor has access to the technology they need to participate.
• Get leadership engaged. Having organizational leadership interact directly with advisors is an important form of recognition and appreciation. Members of senior leadership should attend meetings to hear directly from advisors.
• Maintaining regular communication with advisors. For Collaboration and Co-ownership-based engagement strategies, it is important to stay in touch with members in between meetings to foster their sense of connection, build trust and convey progress. For example, it is important to:
  • Communicate before meetings or events (with reminders) about attendance, logistics including things like transportation, and to send agendas and materials at least one week in advance. At Saint Alphonsus, staff hold one-on-one meetings, in-person or by phone in order to answer questions for new members and share information.
  • Communicate after meetings to thank them for their participation and to outline next steps, including what will happen with their feedback and the timeline. Make sure to send out written summaries, or make post-meeting phone calls, to advisors who were unable to attend so they are kept in the loop and have an opportunity to contribute.
  • Communicate what happened with their feedback, explaining which suggestions were accepted and the timeline for implementation; and which suggestions were not approved for implementation and the reasons why they were not approved.

  • Pro Tip: Defining Terms

    Health care is complicated, especially for those who do not work in it day-in and day-out, and it has its own language. Place commonly used terms and acronyms relevant to the topic on the back of each meeting agenda so advisors can easily refer to them. Make it clear at every meeting that advisors should ask for a definition whenever they do not understand a term. You can even provide them with a “Jargon sign” to hold up when they need a definition.

    Periodically, the point person should conduct individual “check-in” meetings with advisors to understand their experience participating in the strategy and to better understand what they might need to help make them more comfortable or effective in their roles.
• Make Necessary Course Corrections. Advisors do not expect everything to go perfectly. However, they do expect that when things go wrong, the organization is able to learn and make course corrections. Make sure advisors know that they are being heard by making clear the steps you have taken to address their concerns or needs.
• Promote leadership development.For longer-term engagement strategies, there are many ways to foster the development of leadership among your advisors. These include:
  • Have the advisors elect co-chairs
  • Share agenda-setting responsibilities
  • Offer additional opportunities for training, public speaking and/or other committee assignments
• Internal communication. As consistently as possible, communicate with the larger organization about the consumer engagement activities and their outcomes – this helps to build the case for ongoing investment in engagement structures, greater understanding of the return on investment (ROI) and helps with ongoing recruitment (as noted above). Children’s Mercy does this by using consistent communication strategies, including sending out monthly emails from PFAC leaders featuring updates on projects and progress and hosting calls with the Patient and Family Engagement Team.
• External communication. As often as possible, communicate with the larger community you serve about your consumer engagement activities and their outcomes – this helps to convey the value the organization places on consumer engagement and provides an opportunity to recruit new advisors.
• Recognizing and appreciating consumer and family contributions. Key to maintaining buy-in from your advisors and from leadership is recognition and appreciation. This can include monetary incentives such as gift cards, stipends and food. However, it can also include nonmonetary forms of gratitude such as certificates of appreciation, public recognition (e.g., in a newsletter).

Resources

1. Foundational Resources
   • Institute for Healthcare Improvement: Co-Design -- With Your Patients and Your Staff
   • Hertl, et al.: Engaging Patients in Primary Care Design: An Evaluation of a Novel Approach to Codesigning Care 
2. Tips and Tools
   • Institute for Patient- and Family-Centered Care: Preparing and Supporting Patient and Family Advisors
   • Aligning Forces for Quality: Sustained Support
   • Health Quality Ontario: A Plain Language Checklist for Health Care Professionals