Patient and Family Advisory Councils (PFACs) provide hospitals with guidance on a wide range of initiatives aimed at improving the design and delivery of care. Typically composed of patients and family members who have recently received care at the institution, PFACs serve as a valuable consumer advisory group, offering firsthand insights to inform hospital practices. Councils may be general - addressing issues across the entire organization—or focused on specific departments, medical conditions (e.g., diabetes), or populations (e.g., pediatric or adolescent patients).
Barbara Lewis began researching PFACs in 2013 following the tragic death of her sister in the ICU, which prompted her to explore how hospitals incorporate the patient voice. Her most recent and comprehensive study culminated in 2025 with a mixed-methods dissertation that examined the characteristics of effective PFACs - an essential strategy in advancing patient-centered care, a goal championed by the Institute of Medicine to improve healthcare quality.
Although PFACs have existed since the early 1980s, they are present in only 54% of U.S. hospitals. Barbara’s dissertation contributed new empirical and primary research to the field by answering a critical question: What factors contribute to PFAC effectiveness?
Her study included a systematic literature review of 143 articles on hospital PFACs worldwide, in-depth interviews with leaders from 20 U.S. hospitals, and a validated 60-question survey completed by 203 healthcare professionals. The qualitative findings highlighted the importance of broad organizational support, systematic evaluation for sustainability, and the training of staff who collaborate with PFACs. The quantitative analysis revealed that leadership support significantly predicted key indicators of PFAC effectiveness, including richer meeting content, stronger measurement practices, and greater involvement in decision-making and policy input.
Moreover, PFACs focused on specific conditions or patient populations outperformed general councils in several areas—such as engagement, coaching and training, and measurement rigor. This groundbreaking research offers hospital leaders actionable, evidence-based guidance for launching new PFACs or strengthening existing ones to enhance patient-centered outcomes.
You can find the results of Barbara’s research published in peer-reviewed articles.
In 2014, Barbara Lewis authored the first business case explaining why hospitals should implement Patient and Family Advisory Councils (PFACs), responding to a common criticism that no such justification existed. Her report—PFACs: Where’s the Money? The Financial Impact on Hospitals—was supported by the Beryl Institute and featured compelling examples of PFACs that had saved hospitals money, improved patient safety, and enhanced the overall patient experience.
At the time, it was the first document to offer a concrete rationale for incorporating the patient voice into hospital operations.
Building on this work, and after conducting two national surveys on PFACs, Barbara developed a follow-up guide titled Starting and Strengthening a Patient and Family Advisory Council. This resource helps both new and established PFACs identify practical solutions to common challenges and strengthen their impact across healthcare settings. A poster from the Institute for Healthcare Improvement 2014 Forum highlights the results.
How Did Massachusetts Mandate a Patient and Family Advisory Council in Every Hospital?
Massachusetts is the only state in the nation that mandates a PFAC in every hospital. Read about the advocates’ journey to pass legislation in 2008.
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