San Francisco Health Network (SFHN) is the public healthcare system for the City and County of San Francisco. Included among its comprehensive health care services are 14 primary care health centers; four are hospital-based and ten are community-based.

Over time, SFHN has integrated patient partners in almost all of its clinics. Seven years ago, with a grant from the California Health Foundation and technical assistance from IPFCC, the first Patient Advisory Council (PAC), for Spanish-speaking diabetic patients, started in the Family Health Center at Zuckerberg San Francisco General Hospital. Three years later, a second PAC began in the General Medicine Clinic, also at SF General. A third Council began three years later at SFHN’s Silver Avenue Family Health Center. With the advent of each new Council, SFHN built on past experience and resources.

A year ago, in April 2015, as part of an effort to better integrate the goals and services of all its clinics, SFHN designated patient partnerships and Advisory Councils as strategic priorities. A Care Experience Lead for Primary Care position was created to support the development of Councils and to partner with patients in quality improvement. To gather information about the current state of patient engagement and any potential barriers, the Care Experience Lead met with management teams from all 14 health centers. Each health center without an existing Council was asked to appoint or solicit volunteers to serve as staff coordinator and to allocate resources for PAC meetings, and those with existing councils received support to reinvigorate their patient partnerships and standardize roles.

Centralized support was offered to all health centers over the next 10 months during what was called the “PAC Collaborative.” Each health center’s PAC coordinator received SFHN’s Patient Advisory Council Health Center Team Champion and Coordinator Handbook with chapters on issues like recruitment of advisors, PAC meetings, appreciation of advisors, and additional opportunities for advisor involvement. This handbook is now part of the standard onboarding for new PAC team members. Several resources are available on SFHN’s Patient Advisory Council Collaborative website. Three full day training sessions were held for PAC coordinators and existing Patient Advisors. The central Care Experience Team provided ongoing technical support and consultation. System-wide, SFHN now has ten established Patient Advisory Councils and 89 patient advisors.

Over the years, SFHN has also involved patients in focus groups for specific issues. These include:

  • Patient understanding of team-based care
  • Cultural competency for Chinese-speaking patients
  • Retention of prenatal patients (with women from SFHN’s homeless prenatal program)
  • Experience at the San Francisco General Hospital birth center

In addition to the spread of Patient Advisory Councils across the SFHN, the purpose of the Councils has also evolved. The focus of the first PAC at the Family Health Center was patients’ engagement in their own diabetes care; now the focus has shifted to patient partnership in a wide range of quality improvement efforts. Not only has partnership happened at the health center level in specific improvement projects, but also the SFHN Primary Care leadership has involved patients in network-wide improvement—patients were part of a network-wide interdisciplinary team that addressed telephone and appointment access improvement for all patients. The investment and commitment made by SFHN leadership to support patient partnerships built Councils at health centers across the SFHN. A year later, these Councils are now providing a platform to access the patient voice and partner with patients for patient-centered care improvement.