Better Together Pledge Form

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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:

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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:

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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.

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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

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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

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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

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:

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!