Better Together Pledge Form Question Title * 1. Hospital Information Name of Hospital: If unit-specific initiative, name of unit and/or speciality: Street Address: City: Province: Postal Code: Question Title * 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: Question Title * 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. Question Title * 4. Submit your organization's logo by clicking on 'Choose File' below. DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File 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! LinkedIn URL Twitter handle Facebook account Instagram account Question Title * 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) Done
