As part of the work to strengthen and advance PFACs, organizations will experience success along with opportunities to learn and improve. When barriers arise that may affect progress and sustainability, the PFAC team should work collaboratively to identify the underlying causes along with ideas for moving forward.

In interviews about best practices for advancing PFACs, PFAC leaders shared the following words of wisdom about the journey:

Making Changes to Established PFACs

One specific barrier to PFAC change and progress noted by experienced PFAC leads is the challenge of making changes to existing PFACs, particularly in situations where current PFAC members do not agree with the need for change. The following examples illustrate ways to address this challenge.

Example: Discuss the Importance of Different Perspectives

In working to improve the representativeness of their PFAC, one hospital faced concerns from existing PFAs about making changes to PFAC membership. The hospital worked with their Office of Health Equity to develop a presentation and share information with PFAs about the hospital’s equity-based priorities and current health disparities and inequities. The presentation included community and hospital data along with stories from patients and families to illustrate personal experiences. The PFAC coordinator led PFAs in a discussion about the importance of new perspectives and insights and invited them to be part of developing plans for the transition and evolution of PFAC membership. As part of transition plans, PFAs were given the opportunity to join a PFAC Alumni Council that meets quarterly to provide input on PFAC policies and processes.

Example: Identify PFA Champions of Change

A PFAC lead at a children’s hospital struggled to help PFAs on the main advisory council understand the need to implement more welcoming PFAC practices. At the same time, PFAs who were aging out of the Youth Advisory Council shared ideas about how to make sure the PFAC was a safe space for everyone. The PFAC lead invited several PFAs who were graduating from the Youth Advisory Council to join the main PFAC as ambassadors of change. The new PFAs helped amplify messages about the importance of having a PFAC that was more fully representative of the patient population to other PFAs, staff, and hospital leaders. As the PFAC lead noted, “Having these engaged youth at the table was really supportive of this work."

Example: Plan for Natural Transitions

One hospital that had enacted two-year term limits for PFAs used these term limits as a natural opportunity to improve PFA representativeness over time. The PFAC coordinator identified backgrounds and perspectives missing on the PFAC and developed specific recruitment goals to address gaps. As PFAs transitioned off the PFAC, the PFAC coordinator intentionally recruited PFAs to address priorities for improving representativeness.

Example: Pause, Restructure, and Relaunch

In situations where PFAC members’ attitudes and behaviors are roadblocks to change, it may be necessary to explore other options. One hospital tried unsuccessfully over six months to engage PFAs as champions of change for improving PFAC representativeness. The hospital provided education and held conversations about the importance of learning from the full range of patients and families served by the hospital but experienced extreme resistance from many PFAs. As a result, the hospital made the decision to pause the PFAC for four months. The PFAC was then relaunched with mostly new PFAs. The PFAC coordinator described this decision as an “extreme” option, but one that was necessary to achieve goals related to PFA representation and creating a welcoming and supportive PFAC environment.