The Developing Group Agreements with PFACs tool is designed to help PFAC coordinators engage PFAC members in co-developing agreements for working together.

Group agreements help establish a welcoming environment by promoting community, participation, accountability, and a shared responsibility for effective and productive meetings. Group agreements should include plans for handling situations when differences and conflicts arise, including how issues will be addressed, who is responsible, and what happens if the situation is not resolved. When developing agreements, make space to hear from all PFAs about what is important to them, particularly individuals from communities that may not always have felt welcomed and included in healthcare spaces.

Prior to developing group agreements, PFAC staff liaisons and coordinators should reflect on the following questions to identify areas that may be helpful to address in group agreements:

1. Do PFAs engage with each other respectfully and in culturally sensitive ways, even when sharing different opinions or points of view? When someone expresses a different perspective, how do PFAs typically respond?
2. Do PFAs “share the air”? Are there PFAs (besides designated leaders) who tend to speak first or lead the discussion? Are there PFAs who dominate the discussion or who are reluctant to speak up?
3. Does the PFAC have guidelines about respectful interactions? How have these guidelines been adhered to or reinforced in the past?
4. What has helped facilitate positive PFAC interactions in the past? If there have been challenging interactions, what led to these situations? Are there any patterns in the environment, circumstances, or participants?

Facilitation is another important component of ensuring productive, welcoming, and engaging meetings. As needed, the PFAC meeting facilitator should remind PFAC members of the group agreements, particularly in situations where conflict arises. A good facilitator will also help build a cohesive PFAC where everyone feels valued and respected by ensuring that everyone has the opportunity to participate in meetings, providing clear direction to guide the group toward meeting objectives, managing the agenda and time, and promoting a positive and collaborative atmosphere.

Further information:

Planning and Facilitating Effective Meetings. During this group discussion facilitated by the Institute for Patient- and Family-Centered Care, staff and PFAs from various hospitals shared their organizations’ experiences and practical tips for welcoming meeting practices.

Navigating conflict in community engagement programs. During this presentation members of INSPIRE's Community Engagement Learning Network discuss navigating and resolving conflict in community engagement programs.

Example: PFAC Core Principles and Meeting Expectations

At one children’s hospital, PFAC members co-developed core principles for creating a welcoming, supportive environment in PFAC meetings. The principles, which are listed on every meeting agenda and reviewed at the beginning of each meeting, include:

• Be as present as possible.
• Focus on solutions.
• Treat everyone with respect.
• Assume positive intentions - approach differences with curiosity rather than judgment.
• Listen actively and without interrupting.
• Question ideas, not individuals.
• Embrace a learning and growth mindset.

Example: Advisory Board Agreements for Interactions

A Consumer Advisory Board (CAB) in Boston developed the following group agreements to govern interactions:

• Respect, care about, and support each person in the group. The more confidence each person feels, the more deeply we can work toward our goals.
• Find common ground and areas of agreement before setting forth points of difference.
• Express disagreement as your idea, not the absolute truth.
• Fruitful discussions require openness to change.
• Speak for yourself. Avoid using “we” when you mean “I.”
• Meetings that are run constructively help us achieve goals. We will follow the agenda and focus on our goals of improving health care.

Further information: Consumer Advisory Board Manual

Example: Respectful Meeting Agreements

A hospital PFAC developed agreements for meetings that are reviewed twice a year. During this process, PFAC members re-commit to the agreements and can also suggest changes, edits, or additions. The agreements include:

• Step up, step back: once you have contributed to the conversation, give space for others to share.
• Respect personal experience and opinions.
• Welcome respectful disagreement.
• Assume positive intent while acknowledging impact.
• Acknowledge that we all have valuable information and experiences to contribute.
• Encourage brave spaces. Brave spaces encourage us to respectfully address conflict directly, especially with difficult topics.

Example: Traditional Ways of Knowing

A group in Canada has worked to create meaningful partnerships between healthcare systems and patient and family leaders to improve health outcomes for First Nations and Métis people. Fundamental values underlying interactions and relationships include truth and reconciliation, multiple ways of knowing, leading from where you stand, and leaning into the unknown. The group strives to be culturally responsive and create safe spaces. A guiding question for the group is, "How are we in ‘right relationship’ with each other?” The group also seeks to integrate traditions of the past with work of the present and lean into non-colonial ways. In recognition of the importance of nature to First Nations and Métis people, the group uses seasons as an organizing framework for their operational plan and has adopted the imagery of geese flying in a “V” to describe how they will look out for and take care of each other.