Patient Family Partner Application Form

 

At Dignity Health we believe the patient and family voice matters!      

 

Did you know that many healthcare facilities invite patients and families to advise them on how to improve in all areas of healthcare?  These individuals are called Patient and Family Partners (PFP’s).  PFP’s volunteer their time to share their thoughts, experiences, and ideas. 

When patients and families build partnerships with their healthcare team members (doctors, nurse practitioners, physician assistants, nurses, pharmacists, social workers, dietitians, etc) to improve all aspects of healthcare, everyone benefits.

Your lived experiences as a patient, caregiver, and family member are invaluable. Your time will be spent assisting your local hospital in areas such as:

  • Healthcare Team Education:  Participate on an educational planning team or share your experience and story as part of a panel of speakers. 
  • Partners in Safety: Participate on Quality Improvement Teams to increase use of evidence-based best practices and improve healthcare outcomes.
  • Patient Education:  Review patient information materials and edit for language choices, length of document, usefulness, and friendly formatting
  • Advisory Committees:  Join one of our many advisory committees and provide your insight and experience, from your unique perspective.
  • Facility Design:  Share your ideas about clinic welcome signage, process flow patterns, and waiting area spaces that aim to feel welcoming, efficient, and comfortable.  

The time you spend in these committees will depend upon the amount of time that you are willing to give.  There is no limit to the amount of projects you can work on. We value any contributions you are able to make to our work.

  

At Dignity Health, we believe that your partnership will serve as a resource to ensure person-centered care, dedicated to harm prevention and healing for the patients, caregivers, and members of our healthcare team.

 

To receive more information, we invite you to complete the application form for our Patient Family Partnership Community.

* - indicates a required item.

Contact Information

  
* Date
* Tell us how you heard about this volunteer opportunity?








* What languages do you speak?
* I/my family member has received care and I am interested in joining the Patient Family Partnership Community at:













: 
* I or my child/family member has been treated most often in: (check all that apply)



: 
* Please tell us which services you/family members have used in the last TWO years (Example: Pulmonary, Neonatal Intensive Care Unit, Pediatric Intensive Care Unit, Rheumatology, Oncology, Emergency Department, Outpatient, Etc.)
* Why are you interested in becoming a Patient Family Partner?




Please provide a few sentences to tell us the story you want to share:
* What are some ways you feel you can contribute to the organization?
* Please tell us the easiest time for you to attend meetings:




* What’s the easiest way for you to participate in meetings?


* Gender






* Ethnicity








* Please type in your birth year

 

* My preferences and contact information will be shared with other members of the healthcare team who would like to include a Patient Family Partner on their projects and teams

Dignity Health is committed to fostering a values centered culture through diversity, inclusion, equity,  and belonging throughout the organization, including the planning and delivery of healthcare to ensure a high level of quality, patient safety and satisfaction.  Through our Patient Family Partnership program, we want to ensure that we have a balanced representative voice from the diverse communities that we serve.  We are committed to advancing the mission and values of Dignity Health through integrating diversity, equity, inclusion and belonging principles and strategies into all of our work as a  way to both educate and more importantly, model what equitable leadership is within healthcare’s  diverse community.

We collect the following information to ensure that we are meeting our mission and expanding opportunities to participate in our patient family partnership program to a wide variety of people.   

 

Thank you for taking the time to tell us more about your interest in becoming a Patient Family Partner at Dignity Health.   Someone will be in contact with you in the next two weeks after receiving the application.  

 

Please contact Monica Bourke, MSN, RN at Monica.Bourke@commonspirithealth.org for any additional questions you may have regarding the Patient Family Partnership Community program.