Milestone 5 Summary

Description: Practice has a formal approach to obtaining patient and family feedback and incorporating this into the QI system, as well as the strategic and operational decisions made by the practice.


What does success look like?


1 2


Practice does not have a formal system for obtaining patient feedback.
Practice has a limited system for obtaining patient and family feedback and does not have a system for acting on the information received.
Practice has a formal system for obtaining patient and family feedback but does not consistently incorporate the information received into the QI and overall management systems of the practice. Practice has a formal system for obtaining patient and family feedback and can document operational or strategic decisions made in response to this feedback.

Note: numbers are PAT scores

Why is this important?


Patient and family centered care is a key focus of modern healthcare change efforts. Increasingly, health systems and medical practices are authentically engaging patients and families as partners in their own healthcare decisions and in quality improvement efforts.  These practices report better patient-provider relationships, greater patient satisfaction and empowerment, improved patient safety and enhanced alignment with requirements of the patient centered medical home.1,2  Active patient or family participation, such as through the development of a Patient Advisory Council, can influence diverse areas of practice operations: facility policies, clinical workflow, patient access, prioritizing improvement opportunities, hiring and training new staff, issue-specific committees and peer-to-peer patient engagement, to name a few.2  Many practices are also embracing digital tools that help them systematically capture and act on patient feedback.  By including the voice of patients (and family members or caregivers) on advisory councils, QI teams, and other formal committees, practices obtain rich insights into how to better serve their target populations.  A commitment to ensure that patients’ perspectives are not only heard, but result in change, has great potential to improve quality, satisfaction, safety and outcomes.3

Potential Tactics

  • All frontline staff complete IHI Open School modules on person- and family-centered care (PFC 101, PFC 102, PFC 201, PFC 202)
  • Identify points of contact at which you can collect patient and family feedback via surveys or other methods
  • Use technology, internet-based and/or social media outlets to collect patient feedback
  • Regularly review patient feedback and identify opportunities for change
  • Hold open board meetings and add a patient as a board member
  • Gather patient stories and incorporate into new employee orientation and continuing education

Tools and Resources

What might this look like in practice?


Patient and Family Advisory Councils

A large primary care practice decided to develop a patient and family advisory council (PFAC) after receiving an unusually high volume of patient complaints in one quarter. A social worker, nurse practitioner, medical assistant and physician formed a workgroup to form clearly defined roles and expectations for advisors, as well as attributes of a successful advisor. Recruitment was done via flyers and nominations from practice staff. Interested participants submitted applications and selections were made to reflect the overall practice’s demographics (race, ethnicity, age, income, payer, geographic residence, and conditions). Once established, the PFAC met quarterly, with its first focus on reviewing patient education materials and patient access. The chair of the PFAC (elected by PFAC members) now attends the practice’s board meetings as a PFAC liaison.


Patient and Family Focus Groups & Patient Surveys

A small, rural primary care practice hosts patient focus groups twice a year to gather information from patients and/or their family members who received services at their clinic during the previous six months. Flyers are hung one month prior to the focus group, and the clinic front desk manager informs all patients upon check-in that this opportunity to provide feedback existed. The office manager also solicited suggestions from nurses for patients whom they believed may have had both exceptional and unpleasant or negative experiences, to be sure to have a range of opinions represented. Ten patients and/or family members attend the focus group and are asked questions like “what do you like about the services here? What don’t you like? How can we improve?” The focus groups are held on a Tuesday evening after work hours. The practice partners with the church next door, which provides a volunteer to offer free childcare and its church van to provide rides for patients if needed. The focus groups last one hour and participants receive $10 Subway or Walmart gift cards. A summary of the proceedings and specific recommendations are presented at each Board of Director’s meeting for discussion. Additionally, the practice routinely collects patient satisfaction surveys. Aggregated data and specific feedback are incorporated into the practice’s publicly available score cards, as well as posted on its website.


Technology and Online Tools

Another practice integrated a feature on its website homepage for patients to provide feedback. Bold text near the top of the page reads “Did you recently have an appointment with us? How did we do?” accompanied by a “thumbs up” or “thumbs down” clickable icon. If “thumbs up” is selected, the patient is redirected to the practice’s public Yelp page and asked to submit a positive review. If “thumbs down” is selected, the patient is redirected to an internal survey to submit more detailed information about their negative experience. The front desk staff receives an email notification when new survey entrees are submitted so they can be forwarded to the appropriate QI review committee.        


  1. Johnson KE, Mroz TM, Abraham M et al. Promoting patient and family partnerships in ambulatory care improvement: A narrative review and focus group findings. Adv Ther. 2016;33:1417-1439
  2. Sharma AE, Willard-Grace R, Willis A et al. “How can we talk about patient-centered care without patients at the Table?” Lessons learned from patient advisory councils. J Am Board Fam Med. 2016;26(6):775-784
  3. Halm MA, Sabo J, Rudiger M. The patient-family advisory council: Keeping a pulse on our customers. Crit Care Nurse. 2006;26(5):58-67