Identify and Address Barriers to Recruitment and Participation

The Identifying and Addressing Barriers to PFA Participation worksheet can be used by the PFAC team to identify and address potential barriers to recruiting and partnering with a diverse group of PFAs.

Tool: Identifying and Addressing Barriers to PFA Participation

The PFAC recruitment and application process should be:

  • Inclusive: People understand what it means to be a PFA, believe that the hospital values their lived experiences and perspectives, and can see themselves contributing in meaningful ways as a PFA.
  • Transparent: People understand how to apply to be a PFA, what to expect at each step of the application process, how PFAs are selected, and who to contact if they have questions.
  • Accessible: Recruitment practices and requirements for serving as a PFA support the ability of a diverse group of people to participate.

The PFAC team should discuss, identify, and address potential barriers to participating as a PFA. These barriers may include:

  • Participation requirements, such as passing a criminal background check, having a state or federal ID or social security number, or having certain vaccinations.
  • Logistics associated with serving as a PFA, including meeting times that conflict with working hours, meeting locations that require significant travel in terms of mileage or time, attendance requirements, and lack of reimbursement for costs associated with being a PFA (e.g., transportation, childcare).
  • Absence of support, including compensation for time, translation and interpretation services, accommodations that support accessibility, and access to technology needed to participate effectively in virtual meetings.
  • Lack of information, such as not providing orientation and training for PFAs and written materials that do not follow plain language guidelines or use best practices for people with lower literacy levels.
  • People’s beliefs about and experiences with health care, including mistrust of the healthcare system and prior negative experiences.
  • Current lack of PFAC representativeness, including challenges associated with joining a PFAC that is not fully reflective of the patient population and concerns about the extent to which the current PFAC is a welcoming space.

Review the examples below to learn how healthcare organizations have addressed common barriers to PFAC representativeness. Some barriers are more easily addressed, while others may take time and involve a process of collaborative work with hospital leaders, staff, and community partners.

Example: Alternatives to Background Checks

Recognizing that criminal records disproportionately impact people of color and lower-income individuals, staff at an academic medical center with a large PFAC program expressed concern about the effect of required background checks on PFA representativeness. They also had concerns about mixed evidence regarding the effectiveness of background checks for harm and risk reduction, incomplete or inaccurate background check data, and vendors that could only provide background checks in English.

PFAC coordinators worked with their Office of Equity to revisit required background checks that might deter qualified applicants. Their arguments against background checks included the following:

  • Many PFAC members are patients and families who are already at the hospital regularly to receive care without being subject to criminal background checks.
  • PFAs should be treated like patients and family members of patients admitted to the hospital who are not routinely subjected to criminal background checks.
  • The requirement for background checks hinders representativeness efforts and results in the exclusion of certain voices.
  • Most PFAs do not interact with patients and families as part of their role and do not have access to Protected Health Information (PHI).
  • Most PFAs do not volunteer in the hospital without a staff member present and supervising.

Staff discussed various ideas, including the option to continue conducting criminal background checks on PFAs, keep the results on file, but not automatically dismiss applicants with criminal backgrounds. However, PFAC coordinators felt that this option still presented challenges for the large number of undocumented patients and families served by the hospital.

Ultimately, under the new plan developed by the organization, the decision was that most PFA applicants would be screened through the Patient Relations department without needing to undergo a background check. The Patient Relations department would check records to identify any red flags for participation (e.g., abusive interactions with staff). PFAs in roles with a higher “tier” of participation would be subject to the same requirements as formal hospital volunteers, including criminal background checks. This includes PFAs who serve in roles that involve shadowing or direct contact with patients and families; sit on a workgroup or committee that has access to PHI; or have an organizational email address.

Further information: Background Checks and the Health Workforce: Practices, Policies, and Equity

Example: Flexible Participation Options

One hospital learned that time and availability were major barriers to PFAC participation for specific populations, including individuals from lower socioeconomic backgrounds and fathers. The hospital established a virtual Advisory Council for patients and families who are unable to commit to serving on a full PFAC but who still wish to provide input and feedback. PFAs contribute by providing feedback through surveys, focus groups, or virtual meetings.

Example: Options for Vaccine Requirements

After talking with local community groups about goals for increasing PFAC representativeness, PFAC staff at a children's hospital learned that requirements around vaccines were a deterrent for some potential PFAs. PFAC staff initiated an internal conversation about volunteer vaccine requirements but recognized the need for a more immediate solution. During COVID, the children's hospital had successfully transitioned to virtual PFAC meetings. While many PFAs had returned for in-person meetings, the hospital decided to develop a dedicated virtual advisor program as an option for individuals who prefer to meet virtually, are unable to travel, or do not meet vaccination requirements.

Example: Translation and Interpretation to Support Inclusion

A hospital system identified a need to learn from and partner with patients and families who prefer languages other than English. Strategic partnerships and conversations led to the creation of a Multilingual PFAC designed to bring together PFAs who speak various languages, including Spanish, French, Haitian Creole, and English. The PFAC team partnered with leaders at the hospital's Office of Language Access to design interpretation solutions for the Multilingual PFAC that support participation from a broad group of PFAs. During PFAC meetings, the Office of Language Access provides simultaneous interpretation for PFAs who prefer a language other than English. PFA needs for interpretation services are identified as part of the recruitment process. Initial efforts to recruit PFAs for the Multilingual PFAC have been successful, which the team credits to partnerships with staff, including physicians and social workers with connections in multilingual communities.

Example: Compensation for PFAs

Volunteering is a privilege that not everyone can afford. As a result, some hospitals compensate PFAs to support more equitable PFACs. Hospitals have used a variety of methods to compensate PFAs including:

  • Honorarium per meeting or event. One children's hospital in the US pays parent PFAs an honorarium per meeting. The hospital calculates the amount per meeting to ensure PFAs do not receive more than $600 per calendar year so that they do not have to report or pay taxes on earnings. Another healthcare organization in Canada pays PFAs an honorarium for specific events or engagements, up to $100 per day.
  • Yearly stipends for selected PFAs. A children's hospital in the US provides a $600 annual payment for PFAC co-chairs only. The amount is capped to ensure PFAs do not have to report or pay taxes on the stipend.
  • Quarterly honorarium. A hospital in Canada pays a quarterly honorarium to PFAs. Regular members receive $500 annually. Members who participate in working groups receive an additional $250. PFAC co-chairs, who also participate in workgroups and the governance structure, receive $1500 for the year.
  • Hourly contract employees. A children's hospital in the Midwestern US pays their PFAs as contract employees. Most PFAs receive $35 per hour. PFAs with roles that involve more effort (e.g., PFAC co-leads) receive a slightly higher level of compensation.

Compensation that counts as financial income may impact access to certain benefits. When developing compensation policies, get input from PFAs and community members about their preferences and potential restrictions. Some hospitals provide PFAs with non-monetary acknowledgments of their service. It may be helpful to consult with the financial department to ensure PFAs fully understand the implications of any compensation or acknowledgment of their service. Ideas for non-monetary compensation include the following:

  • pre-paid phones
  • technology access (e.g., providing an internet hotspot or iPad)
  • meals at meetings and events
  • Uber or Lyft gift cards
  • baby supplies (e.g., formula and diapers)
  • household supplies
  • mental health support sessions
  • complimentary tickets to community or sports events
  • complimentary photographer for a family photo
  • conference registration and attendance
  • trainings to develop skills

For hospitals with minimal budgets or large numbers of PFAs, identifying resources to support compensation can be challenging. In some cases, hospitals have sought internal or external grants for PFA compensation. Other hospitals have explored solutions such as requiring departments or projects that ask for PFA input to cover PFA payments through their budgets.