Patient/Family Safety Advisory Panel

PATIENT/FAMILY SAFETY ADVISORY PANEL

EXPRESSION OF INTEREST

The Health Quality Council of Alberta (HQCA) is recruiting Albertans to serve on a provincial advisory panel to leverage the experiences and perspectives of patients and their families to improve and promote patient safety in Alberta’s health system. Through the HQCA, the Patient/Family Safety Advisory Panel will support the HQCA in promoting patient safety principles, concepts, and actions in all aspects of Alberta’s publicly-funded health care system.

Panel members will be appointed for a term of three years and may serve a maximum of two terms. Meetings will be held approximately six times each year.

Interested applicants are asked to complete this Expression of Interest form. Expression of Interest forms will be accepted up to 4:00 p.m. on Wednesday, July 23, 2014. The HQCA Board of Directors will appoint the Panel members following the selection process.

If you require more information related to the work of the panel, the Expression of Interest form, or the selection process, please contact the HQCA at 403-297-8162 (Calgary) or via email at .

CONTACT INFORMATION

Name:

Address:

City/Town: Postal code:

Email address: Telephone:

1.) What interests you about participating on the HQCA Patient/Family Safety Advisory Panel?

2.) What knowledge, interests, and skills would you bring that would be of value to the work of the Panel?

3.) The Patient/Family Safety Advisory Panel will focus on issues of patient safety from the system perspective (i.e., identifying and influencing health system improvement in areas of patient safety). The Panel will not focus on individual cases or issues. Is this a perspective that you would support?

Yes No

4.) Have you or a family member been involved in an adverse event in a health care system?

Yes No

5.) Are you or have you been a health care provider in Alberta’s health care system?

Yes No

Ifyes, please describe your role and/or position.

6.) Please attach a short biography describing any community leadership involvement and/or work experience you would bring that would be of value to the work of the Panel.

7.) How did you hear about the opportunity to join the Patient/Family Safety Advisory Panel?

ADDITIONAL COMMENTS:

Completed forms can be submitted by email to , fax to 403-297-8258 or by mail:

Health Quality Council of Alberta

210, 811-14 Street NW

Calgary, ABT2N 2A4