Better Together Pledge Form

Hospital Information

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* 1. Hospital Information

Name of Hospital:

If unit-specific initiative, name of unit and/or speciality:

Street Address:

City:

Province:

Postal Code:

Organizational Champions

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* 2. Organizational Champions

Name of Executive Sponsor:

Title of Executive Sponsor:

Email Address of Executive Sponsor:

Name of Unit Champion:

Email Address of Unit Champion:

Name of Patient/Family Advisor:

Email Address of Patient/Family Advisor:

Pledge

Our organization (or unit, if applicable) recognizes family members, as designated by the patient, as partners in care. As one concrete step toward creating a culture of patient- and family-centered care, we commit to:

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* 3. Pledge

Our organization (or unit, if applicable) recognizes family members, as designated by the patient, as partners in care. As one concrete step toward creating a culture of patient- and family-centered care, we commit to:

Undertake initial leadership action steps to:
• Review our organization's policy and website, with input from patients, families, clinicians, and other staff.
• Elicit input from patients and families about their experience of hospital "visiting" policies.
• Complete the Better Together Organizational Self-Assessment
• Review other Better Together resources on CFHI’s website
• Other relevant steps that become apparent during the process

Develop a family presence policy that enables patients to designate one or more partners in care who are welcome in the hospital 24 hours a day.

Implement a family presence policy and monitor the impacts of this change in practice.

Submit your organization's logo by clicking on 'Choose File' below.

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* 4. Submit your organization's logo by clicking on 'Choose File' below.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

No file chosen

Social Media

Does your organization have a Twitter, or LinkedIn account? Let's connect!

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* 5. Social Media

Does your organization have a Twitter, or LinkedIn account? Let's connect!

LinkedIn URL

Twitter handle

Facebook account

Instagram account

How did you hear about the Better Together campaign?

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* 6. How did you hear about the Better Together campaign?

CFHI newsletter

CFHI OnCall

CFHI Website

CFHI LinkedIn

Twitter

IPFCC

Friend/Colleague

Other (please specify)

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* 1. Hospital Information

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* 2. Organizational Champions

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* 3. Pledge Our organization (or unit, if applicable) recognizes family members, as designated by the patient, as partners in care. As one concrete step toward creating a culture of patient- and family-centered care, we commit to:

Question Title

* 4. Submit your organization's logo by clicking on 'Choose File' below.

Question Title

* 5. Social MediaDoes your organization have a Twitter, or LinkedIn account? Let's connect!

Question Title

* 6. How did you hear about the Better Together campaign?

* 3. Pledge

Our organization (or unit, if applicable) recognizes family members, as designated by the patient, as partners in care. As one concrete step toward creating a culture of patient- and family-centered care, we commit to:

* 5. Social Media

Does your organization have a Twitter, or LinkedIn account? Let's connect!