Patient Family-Centered Care Champion Award Nomination Form

Any St. Jude employee or patient family member may nominate a St. Jude employee who exemplifies the core concepts, values, and philosophies of Patient Family-Centered Care (PFCC). Nominees will be honored at the annual Breakfast of Champions celebration hosted by the St. Jude Patient Family Advisory Council (PFAC).

Asterisk (*) indicates a required field.

Nominee Information

Nominee Name*

This exceptional St. Jude employee demonstrates the following (choose all that apply).

Yes

Actively recommends patient-families to get involved in PFCC initiatives.

Please provide an example.

Yes

Supports PFCC initiatives by providing exceptional support through technology advancement, services, or by other means that directly improve patient care or the patient experience.

Please provide an example.

Yes

Embraces and demonstrates the core concepts of PFCC on a regular basis when working with patient-families. These core concepts are: Dignity and Respect, Information Sharing, Involvement, and Collaboration.

Please provide an example.

Yes

Has engaged parent advisers in the decision-making process in their department or area of work. This nominee makes an effort to listen and gain feedback from St. Jude parents and caregivers.

Please provide an example.

Yes

Has engaged the PFAC or other parent advisers in planning, implementing and evaluating department or area-based policies, processes, or operations for the purpose of patient experience improvement.

Please provide an example.

In 3-4 sentences, please share any additional examples or stories of how this staff member practices PFCC at St. Jude.

Nominator Information

Name*

Email Address*

I am a*

St. Jude patient parent/caregiver St. Jude employee

I agree to share this information with St. Jude*
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