Executive decision support • 90-day operating plan

Leave the meeting with decisions, owners, measures, and a 90-day plan.

This brief is the executive entry point to the PFAC toolkit. It converts the evidence review, Dartmouth Health benchmark, local Upper Valley analysis, and leadership tools into a short sequence of decisions that can be assigned and monitored without claiming outcomes the evidence does not establish.

Open the decision brief Download 90-day plan Open working tools

How the APE problem was defined

From care experience and access to a deployable PFAC leadership system.

The APE began within Dartmouth's Learning Health System and Care Experience Improvement Collaborative context, where patient experience, access, and the practical use of patient-reported information were recurring improvement concerns.

Across fellowship and preceptor discussions, the project narrowed to CMS Patient Safety Structural Measure, Domain 5: Patient and Family Engagement and to a specific implementation question: what would make PFAC work genuinely useful and practical for health-system leadership? Those discussions repeatedly surfaced leadership buy-in, role clarity, advisor orientation and training, mentoring, measurement, and the need for a practical handbook or playbook.

The toolkit responds to those host-derived requirements with a current-state assessment, representation check, action tracker, measurement plan, Domain 5 traceability, and a 90-day operating plan. The design intent is not to create another meeting structure; it is to give leaders a repeatable way to move patient and family input into accountable decisions, action, measurement, report-back, and learning.

Executive decision brief

Six decisions to make before calling a PFAC operational.

Decision	Leadership question	Evidence to bring	Required output
1. Purpose	What specific system problem or decision will patient and family partners help address?	CHNA, safety, experience, access, complaint, quality, and strategic-priority signals.	One defined workstream with a bounded problem statement.
2. Authority	Where can PFAC input influence policy, safety, design, operations, or resource decisions?	Charter, committee map, escalation pathway, executive sponsorship.	Named sponsor, decision rights, escalation route, and report-back expectation.
3. Representation	Who is affected, who is currently missing, and what prevents participation?	Local population context, PFAC composition, language, disability, geography, compensation, transportation, scheduling, and digital-access information.	Recruitment and participation plan tied to identified barriers.
4. Work	What substantive decisions reach the PFAC before they are final?	Project pipeline, planned policies, safety priorities, redesign initiatives, service-access problems.	Standing agenda pipeline and project intake rule.
5. Measurement	How will leaders know whether patient and family input is being used?	Meeting records, recommendations, dispositions, action tracker, project measures.	Structure, process, implementation, and project-specific measures with owners and cadence.
6. Accountability	How will patients, families, and leaders know what changed, what did not, and why?	Action log, leadership disposition, evidence of change, communications.	Closed-loop report-back process with due dates and unresolved-item escalation.

Current Dartmouth Health use case

Start with access and navigation because the local evidence is already actionable.

The 2025 Upper Valley CHNA provides a defensible starting problem: primary-care access, system navigation, capacity, wait times, rurality, isolation, and participation barriers. The APE local analysis already translates those signals into a populated PFAC implementation case.

Open the populated Upper Valley implementation case Use the representation and access check Use the closed-loop action tracker

90-day operating plan

Move from current state to one measurable PFAC workstream.

Days 0–30

Validate the operating conditions.

Confirm executive sponsor, PFAC purpose, charter and authority, current composition, participation barriers, committee interfaces, existing agenda pipeline, and available measures. Do not score unknowns as failures; document evidence state and gaps.

Days 31–60

Launch one bounded workstream.

Select one current problem, recruit the needed perspectives, bring the issue to the PFAC before decisions are final, document recommendations and leadership disposition, and assign accountable owners and due dates.

Days 61–90

Close the first learning loop.

Review action status, implementation evidence, unresolved barriers, and report-back completion. Adjust the workstream and PFAC operating model based on what was learned before expanding scope.

Download the 90-day operating plan

Executive dashboard minimum

Track contribution before claiming impact.

Project-development discussions organized measurement around structure, process, and outcomes. The toolkit adds implementation measures so leaders can verify that PFAC input entered accountable work before interpreting changes in patient experience or downstream outcomes.

Signal	Minimum measure	Why it matters	Caution
Governance	Named sponsor, charter, decision pathway, meeting cadence.	Shows whether PFAC input has an operating route into leadership decisions.	Structure alone does not establish effectiveness.
Representation	Priority populations represented; barriers identified and mitigated.	Tests whether participation reflects the people affected by the workstream.	Presence of members does not prove equitable influence.
Decision involvement	Number and proportion of substantive items brought before final decision.	Distinguishes consultation from meaningful involvement.	Volume does not establish quality of influence.
Action	Recommendations, dispositions, owners, due dates, closure rate.	Shows whether patient and family input enters accountable work.	Action closure does not by itself prove clinical benefit.
Report-back	Proportion of closed or deferred items reported back with rationale.	Creates visible accountability and supports trust.	Report-back quality should be reviewed, not only completion.
Project result	Workstream-specific operational, safety, PREM, PROM, Press Ganey, or other appropriate experience/outcome measure.	Connects the PFAC-informed workstream to the measure already used to understand the problem.	Do not attribute change in a downstream measure to PFAC activity without an appropriate evaluation design.

Learning-system principle

A PFAC should create inspectable decisions, not just meetings.

The practical test is whether a leader can trace a patient or family signal to a decision pathway, accountable owner, documented disposition, implementation evidence, measurement, report-back, and adaptation. The toolkit is designed to make that learning loop visible.