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Understanding the care experience from the perspective of our patients and their families is a key factor in delivering healthcare quality, safety and service. In our ongoing efforts to provide exceptional patient care, we are enlisting the assistance of former patients and their families to share their perspectives, insights and experiences.
We are currently in the process of selecting patients and family members to help us create a sustainable Patient and Family Advisory Council (PFAC). As a member of the Council, you will assist with the development of the structure for the PFAC (membership, frequency of meetings, length of meetings, goals, etc.).
If you would be interested in serving on the PFAC, please complete this short application, or you can pick up a hardcopy at Memorial Hermann Cypress Hospital, 27800 Northwest Freeway, Cypress, TX 77433. Selected applications will be contacted to schedule an interview. If you have any questions, please call Ashley Dubbelde at (346) 231-4127.
Are there certain topics or areas of the hospital in which you have a special interest?
In what area(s) are you interested in representing? Please check all that apply.
Why are you interested in Joining the Patient and Family Advisory Council?
If you have participated in any organizations or committees, please share some examples: (These may be from work, community, church)
What positive improvements to patient care would you like to see as a result of your participation in the Patient and Family Advisory Council?
Do you have any dietary needs we should be aware of? (i.e., vegetarian)
REMINDER: WE WILL DO BACKGROUND CHECKS ON ALL COMMITTEE MEMBERS, AND A HEALTH SCREENING (FLU AND TB) IS REQUIRED BEFORE YOU JOIN AND ANNUALLY GOING FORWARD. MEMBERS MUST SIGN A CONFIDENTIALITY AGREEMENT. WE WILL KEEP APPLICANTS IN MIND FOR POTENTIAL OPPORTUNITIES FOR FUTURE PROJECTS.