Application form: Practice profiles for advancing authentic community engagement in healthcare
Apply here for INSPIRE to consider highlighting your organization’s community engagement work in one of our practice profiles. Practice profiles will be disseminated nationally as implementation tools to help advance the practice of community engagement in healthcare. For this project we are interested in working with healthcare entities that have a formal mechanism for partnering with people with lived experience (PWLE) in an ongoing group structure to inform and support the development, implementation, and/or evaluation of policies, programs, and services. This could be through a Patient and Family Advisory Council (PFAC), Member or Beneficiary Advisory Council, Community Advisory Board, or other similar body that brings together community members, patients, families, consumers, and/or PWLE. Applications are due September 16, 2024.
Application contact information:
Contact person name
*
First Name
Last Name
Professional role/title
*
Email
*
example@example.com
Phone number
*
Please enter a valid phone number.
Organization information:
Name of organization
*
Organization type
*
Hospital/health system
FQHC/health center/free clinic
Other healthcare provider
Health insurance company/payer
Local/state/federal government with healthcare focus
Community based organization with healthcare focus
Other
Organization's website
*
Organization's location
*
Approximate number of staff/organization size
*
1-50
51-100
101-500
501-1,000
1,001+
Information about your Patient/Family/Community Advisory Committee (AC):
For this project we are interested in working with healthcare entities that have a formal mechanism for partnering with people with lived experience (PWLE) in an ongoing group structure to inform and support the development, implementation, and/or evaluation of policies, programs, and services. This could be through a Patient and Family Advisory Council (PFAC), Member or Beneficiary Advisory Council, Community Advisory Board, or other similar body that brings together community members, patients, families, consumers, and/or PWLE.
How many Advisory Committees (that are primarily/exclusively made up of community members, patients, families, consumers, and/or people with lived experience) does your organization have?
*
Please provide the following information about your organization’s primary Advisory Committee that is made up of community members, patients, families, consumers, and/or people with lived experience:
How many years has your primary Advisory Committee (AC) been in existence?
*
How many times per year does your primary AC meet?
*
On average, how many community members/advisors/people with lived experience routinely attend each meeting of your primary AC?
*
Approximately how many community members/advisors/people with lived experience who routinely attend meetings have been active with your primary AC for more than a year?
*
Are there dedicated staff who manage/work with your primary AC?
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Yes
No
How many dedicated staff manage/work with your primary AC?
For meetings, do you provide any kind of accommodations (e.g., transportation, childcare, language supports, etc.) to meet the needs of your primary AC members?
*
Yes
No
What accommodations/supports do you provide?
To what degree does the demographic makeup of your primary AC represent the community you serve in terms of race/ethnicity, age, socio-economic status, health conditions, etc.?
*
Our AC largely reflects the diversity of our community
Our AC mostly reflects the diversity of our community with some minor gaps
Our AC somewhat reflects the diversity of our community with some significant gaps
Our AC is not very reflective of the diversity of our community
Would you like to add any context or additional details about your answer to the previous question? (optional)
Describe any direct benefits the members of your primary AC receive from participating (e.g., compensation, personal/professional development opportunities/training, personal fulfillment, etc.).
*
How do you measure the success/impact of your AC?
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How does your AC fit into the strategic priorities and/or decisions making structures of your organization?
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Beyond working with your AC, how else does your organization undertake community engagement (CE)?
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Is there anything else you would like to share about your AC(s) and/or organization’s CE work?
Please add any publications/resources/links related to AC(s) or organization’s CE work:
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