Required fields are marked with asterisks (*)

Patient Experience Partner Application Form

The patient and family perspective has never been more important or influential in health care than it is today. Muskoka Algonquin Healthcare is seeking to recruit Patient Experience Partners to work collaboratively with us to provide advice and recommendations on matters where the patient and family perspective is vital to advancing person-centred care.

Requirements

Patient Experience Partners can contribute to MAHC in a variety of ways that best match their interests, experience and availability. Partners can be active members of standing hospital committees and quality improvement project teams, participate in focus groups, and provide input on policies, procedures and processes.

Applicants should be those who have received care at MAHC or another hospital in the last two years or a family member of someone who has received care at MAHC or another hospital in the last two years.

Time Requirement:

The time required of a Partner will vary depending on the level of involvement desired.

Length of Term:

Partners who are interested in being an active member of the Patient and Family Advisory Council will be for a term of two years.

Qualities of a Patient Experience Partner:

Passionate about enriching the health care experience for patients and families
Share ideas and information about experiences at MAHC in ways that others can learn from them to help advance programs, services and hospital priorities
Listen well
Speak comfortably in a group with candor
Respect the perspectives of others
Interact well with people and work in partnership with others
See beyond one's own personal experiences
Show concern for more than one issue or agenda
Embody MAHC's values and behaviours, and promote the mission and values of MAHC through positive interactions with staff, physicians, volunteers and our communities
Participate in Patient and Family Advisory Council meetings (if desired by the applicant)

Applicant's Name

Home Phone

Work Phone (if applicable)

Cell Phone (if applicable)

Applicant's Address

Town

Postal Code

Email Address:

Preferred method of contact:

When is the best time to contact you?

Do you have any physical limitations or special needs?

The following best reflects me:

Currently a patient at MAHC

Patient at MAHC in the past 3 months

Patient at MAHC in the past 3-6 months

Patient at MAHC in the past 6-12 months

Patient at another hospital in the past 12 months

Family member of patient

Other, please specify:

Why would you like to serve as a Patient Experience Partner?

Do you have any specialized skills?

How did you hear about the opportunity to apply to be a Patient Experience Partner?

Newspaper

Radio

Social Media

MAHC Website

Word of mouth

Other, please specify:

Are you currently a volunteer at MAHC?

Have you ever been a volunteer at MAHC?

Conditions of Application

Our organization supports equal opportunity. We are committed to a selection process and volunteering environment that is inclusive and barrier free. Accommodation will be provided in accordance with the Ontario Human Rights Code. Any accommodation requests for the interview or selection process known in advance can be brought forward by contacting Christine Loshaw at 705-645-4404 ext. 3104 or by email to christine.loshaw@mahc.ca, which will enable you to be assessed in a fair and equitable manner.

I understand that submitting this application and/or being interviewed does not guarantee a position as a Patient Experience Partner.

I will provide proof of up-to-date immunizations for MMR, Varicella, TB, and COVID-19.

I understand that I will be required to submit the results of a criminal records check with the vulnerable sector search.

I understand that prior to beginning as a Patient Experience Partner that I must sign a confidentiality agreement.

References

Please include two references that have known you for at least 2 years and are not related to you.

Name of First Reference

Address

Phone

Occupation

Name of Second Reference