Governance starter • decision-rights control
Define what the PFAC can influence before asking patients and families to participate.
This starter turns executive sponsorship into an inspectable operating agreement. It is designed for adaptation by a health system, not as a claim that any specific governance element has already been adopted locally.
Governance charter
Minimum elements for a PFAC operating agreement.
| Charter element | Decision to document | Evidence or source | Accountable role | Review trigger |
|---|---|---|---|---|
| Purpose and scope | Define the problems, services, or decision types the PFAC is expected to inform. | Strategic priorities, safety priorities, experience and access signals, local needs assessment. | Executive sponsor | Annual review or material scope change |
| Decision rights | Specify where PFAC input is advisory, where response is required, and where formal approval authority remains elsewhere. | Committee charters, governance map, policy workflow. | Executive sponsor and governance lead | Committee or governance redesign |
| Agenda intake | Define how substantive projects reach the PFAC before final decisions are made. | Project intake process, annual work plan, safety and quality pipeline. | PFAC staff lead | Quarterly utilization review |
| Representation | Define who should be represented and how participation barriers will be identified and mitigated. | Local population context, current membership, access and participation data. | PFAC staff lead with equity/access partner | Semiannual review and workstream change |
| Member support | Define orientation, training, accessibility, compensation or reimbursement, interpretation, and participation supports. | Local policy, member feedback, participation barriers. | PFAC staff lead | Annual review or barrier identified |
| Leadership disposition | Require accepted, modified, deferred, or declined recommendations to have an owner and documented rationale. | Action tracker, meeting minutes, decision records. | Decision owner | Each substantive recommendation |
| Escalation | Define where unresolved safety, access, equity, or governance concerns move when they cannot be closed at the PFAC level. | Governance structure, safety escalation policy, executive pathways. | Executive sponsor | Unresolved or high-risk issue |
| Measurement | Define structure, process, implementation, report-back, and project-specific measures. | PFAC measurement plan and project data sources. | Named measurement owner | Quarterly review |
| Report-back | Define how patients and families will be told what changed, what did not, why, and what remains open. | Action tracker, communications, meeting records. | PFAC staff lead and decision owner | Each closed, deferred, or declined item |
| Charter review | Set a cadence for reviewing whether governance remains fit for purpose. | PFAC performance signals, member feedback, organizational changes. | Executive sponsor | At least annually |
Decision-rights test
Do not invite participation into a black box.
Before a substantive topic reaches the PFAC, leaders should be able to state who owns the decision, what influence patient and family input can have, how disposition will be documented, and how the result will be reported back.
Boundary
Governance design is not evidence of adoption.
This charter starter is a reusable implementation tool. Local roles, authorities, compensation practices, committee relationships, escalation pathways, and reporting requirements must be validated by the host health system before use.