Patient and Public Council
The only accreditation body in the world where patients hold formal governance rights that the Board cannot override. Every standard ASF writes is reviewed by the people those standards exist to protect.
Core principle: Any accreditation body that writes standards without structured patient input is measuring what providers think matters — not what patients live. The ASF Patient and Public Council is not a consultation gesture. It holds formal rights that are written into the ASF Charter and cannot be suspended, overridden, or reduced by the Board of Directors or the Standards Council.
What Is a Patient Council?
A Patient Council is a formally constituted body of patient representatives, family advocates, and patient-experience experts that acts as the organised voice of patients within a healthcare organisation or accreditation system. Unlike informal feedback mechanisms — suggestion boxes, satisfaction surveys, occasional focus groups — a Patient Council has a defined mandate, a regular meeting schedule, formal standing in governance, and documented rights that the institution is legally obligated to respect.
At the facility level, Patient Councils review care policies, investigate complaints, monitor quality indicators, and advise hospital management on patient experience priorities. At the accreditation level — as in the ASF model — the Council reviews and approves standards before adoption, manages the public concern channel, and publishes independent patient perspectives that cannot be edited by management.
Voice
Patients shape the standards that govern the care they receive — not as observers but as decision-makers with formal rights.
Accountability
Councils create a documented, transparent link between patient experience and institutional action. What is raised must be answered.
Safety culture
Patients and families identify safety failures that clinicians and administrators routinely miss. Structured voice prevents systematic blindness.
ASF Patient Council — Formal Governance Rights
These rights are Charter-level, not policy-level. They require a supermajority Charter amendment to modify and cannot be suspended by Board resolution or management decision.
| Right | Mechanism | Consequence if Violated |
|---|---|---|
| Pre-adoption review | Minimum 30-day public comment window — managed and closed by the Council, not ASF staff — before any standard change may be formally adopted | Standard adoption is void; must re-open comment period |
| ADC panel representation | At least one Council-nominated patient advocate must sit on every Accreditation Decision Committee panel | Panel decision may be challenged and referred for re-hearing |
| Complaints channel ownership | The Council — not ASF operations — owns and reviews the public concern and complaint reporting channel; all substantive concerns are acknowledged directly by the Council Chair | Facility in question is suspended from accreditation renewal pending investigation |
| Independent annual note | The Council publishes an unedited Patient Perspective Note in the ASF Annual Accountability Report; ASF management has no editorial right over this document | Report cannot be published without the Note; Council Chair co-signs the annual report |
| Standards revision trigger | The Council may formally propose a standards revision if it identifies a systematic patient safety concern not addressed in current criteria | Standards Council must respond with written decision within 90 days |
| Ombudsman referral | Council may escalate unresolved facility complaints to an independent Patient Ombudsman for binding investigation | Findings of the Ombudsman are binding on the facility and on ASF |
Composition and Terms
| Rule | Detail |
|---|---|
| Minimum size | 5 members |
| Composition | Patient advocates, patient experience researchers, representatives of registered patient organisations, and carer/family representatives |
| Conflict of interest exclusion | No current employees or contractors of ASF-accredited facilities; no current ASF staff or Board members |
| Chair | Elected by Council members; serves 2-year term; co-signs ASF annual report |
| Geographic diversity | Minimum 3 different countries represented at all times |
| Terms | 2 years, renewable once without break (max 4 consecutive years); then minimum 1-year cooling off |
| Language | Council operates in English; translation support provided for members in other languages |
| Meetings | Minimum quarterly; extraordinary meetings may be called by the Chair or by any 3 members |
| Remuneration | Unpaid volunteer role; travel and accommodation for in-person meetings reimbursed by ASF at economy rate |
The Patient Ombudsman
The Patient Ombudsman is an independent officer — not employed by ASF, not employed by any accredited facility — appointed jointly by the Patient Council and the Board of Directors for a non-renewable 3-year term. The Ombudsman is the final escalation point for patient complaints that have not been resolved through the standard complaint channel.
- Receives escalated cases from the Council Chair after 30-day standard process is exhausted
- Has independent right of access to all ASF facility records, survey reports, and monitor visit notes relating to the case
- May conduct direct interviews with facility staff, patients, and families
- Publishes findings within 60 days of case acceptance
- Findings are binding: facilities must implement remediation within 90 days or face suspension from accreditation
- Annual Ombudsman summary is published in the ASF Accountability Report alongside the Council’s Patient Perspective Note
How It Works — All Contact and Input Channels
The Patient Council operates through multiple parallel channels to ensure that no patient or family is excluded due to language, digital access, ability, or geographic location. Every channel leads to the same documented follow-up process.
The main public-facing reporting channel at france-asf.fr/about/governance/complaints/. Available 24/7, in English and Georgian. Structured fields capture the facility name, nature of concern, dates, and preferred contact method.
- Identity is optional — anonymous reports are accepted and processed
- Automated acknowledgement within 24 hours
- Council Chair reviews all submissions weekly
- Substantive concerns trigger a formal case reference number within 5 business days
- File attachment supported (photos, documents, discharge summaries)
ASF maintains a patient concern telephone line staffed during business hours (09:00–18:00 CET, Monday–Friday). Calls are logged, summarised by staff, and forwarded to the Council queue within 24 hours.
- Callers may remain anonymous
- Interpreter services available upon request (48-hour notice preferred)
- Voicemail accepted outside business hours; returned within 1 business day
- For acute patient safety emergencies: caller is directed to national emergency services; case opened in parallel
Direct email to the Patient Council at info@accreditation.ge. This inbox is managed by the Council Chair and is not accessible to ASF operations staff, ensuring confidentiality.
- Encrypted inbox; PGP key available on request
- Response within 5 business days for all substantive emails
- Used for complex cases, multi-document submissions, or where the reporter prefers a personal response from the Council Chair
Written submissions by post are accepted at all three ASF offices and are digitalised and entered into the case management system within 3 business days of receipt.
- Paris: ASF Patient Council, 75009 Paris, France
- Geneva: ASF Patient Council, Geneva, Switzerland
- Tbilisi: ASF Patient Council, 3 Betlemi Rise, Tbilisi, Georgia
- No envelope or postage barrier — ASF covers return postage for written responses
- Downloadable paper form available (see Forms section below)
Each quarterly Patient Council meeting includes a 30-minute open session where patients, family members, and members of the public may speak directly to the Council. Open sessions are held in hybrid format (in-person + Zoom).
- Agenda published 14 days in advance on this page
- Registration required (name and contact only; anonymous attendance not possible for security of the session, but all content remains confidential)
- Simultaneous interpretation available for Georgian and French
- Written submissions accepted in lieu of oral participation
- Minutes of the open session are published within 21 days; personal identifying information removed
For patients in Georgia and the Caucasus region, the Council operates a Georgian-language WhatsApp support line coordinated through PHIG Tbilisi. This channel is specifically designed for patients who are more comfortable communicating by mobile message and may not have reliable computer access.
- Georgian-language messages accepted; responses in Georgian within 1 business day
- Photos and documents can be sent directly through WhatsApp
- Voice messages accepted and transcribed
- Cases are formally logged in the same case management system as all other channels
- WhatsApp: +995 577 41 63 14 (PHIG Tbilisi office — Georgian language)
- Strictly no commercial or promotional use of this line
When ASF publishes proposed changes to accreditation standards, the Patient Council opens a structured 30-day public comment period. Any member of the public — not only patients — may submit comments.
- Comment template provided (structured response encourages substantive, actionable feedback)
- All comments are acknowledged; substantive comments receive a written response explaining whether and how they were incorporated
- Anonymous comments accepted for the public comment period
- Summary of all comments and ASF/Council responses published alongside the adopted standard
What Happens After You Submit a Concern
Automated or personal acknowledgement confirming receipt. A case reference number is assigned. If you provided contact details, the Council Secretary will confirm receipt personally within 2 business days.
The Council Chair or designated reviewer classifies the concern: Patient Safety (priority — immediate facility contact), Patient Rights (standard 30-day process), Standards Feedback (routed to next comment period), or Out of Scope (concern is about a non-ASF facility or a matter outside ASF’s mandate — written explanation and appropriate referral provided).
ASF notifies the accredited facility in writing. The facility must acknowledge receipt within 5 business days and submit a written response to the Council within 20 business days, explaining what happened and what corrective action has been or will be taken.
For patient safety concerns, a Monitor may be dispatched for an unannounced verification visit. For patient rights concerns, the Council reviews the facility’s written response and may request additional evidence or a meeting with facility management.
The Council Chair issues a written Resolution Notice to the reporter (if contact details were provided) and to the facility, documenting findings, the facility’s response, and any required ongoing actions. The concern is closed in the case register.
If the reporter is not satisfied with the Resolution Notice, or if the facility has not responded within the required timeframe, the case is escalated to the Patient Ombudsman. The Ombudsman’s findings are binding.
Every concern (anonymised) is included in the Council’s Annual Case Summary, which is published in the ASF Accountability Report alongside the Patient Perspective Note. Patterns are identified and, where systematic, trigger a formal standards review.
Patient Councils in Healthcare Facilities — The ASF Standard
ASF accreditation standards require all accredited healthcare facilities to have a functioning internal Patient and Family Advisory Council (PFAC). This is a facility-level body — distinct from the ASF governance-level Council — that gives patients and families a structured voice within their own hospital or clinic.
Accreditation standard reference: ASF Hospital Standard 4 (Care and Treatment) and Standard 7 (Governance and Management) both contain mandatory criteria related to patient engagement structures. A facility without a functioning PFAC cannot achieve Accredited or Accredited with Excellence status.
Minimum Requirements for a Hospital PFAC
| Element | ASF Minimum Standard |
|---|---|
| Composition | ≥5 patient/family representatives (not employees of the facility); ≥1 representative per major clinical service area |
| Chair | Must be a patient/family representative — not a clinician, administrator, or facility employee. Chair elected by the Council. |
| Meeting frequency | Minimum quarterly; emergency extraordinary meetings within 5 business days if a patient safety concern is raised |
| Mandate documentation | Written Terms of Reference, approved by both the hospital Board and the PFAC membership; reviewed annually |
| Reporting line | Council Chair has direct reporting access to the Hospital Board/CEO, not only to the Quality or Patient Safety department |
| Complaint channel | Independently managed complaint log accessible to the PFAC but not editable by facility management |
| Policy review rights | All patient-facing policies (consent, discharge, visiting hours, restraint, privacy) must be submitted to the PFAC before adoption |
| Annual report | PFAC publishes an independent annual patient experience report; submitted to the Board and to ASF as part of the accreditation cycle |
Patient Council Forms and Tools
All ASF Patient Council forms are available for download in English and Georgian. Facilities implementing a PFAC under ASF standards may adapt these templates with appropriate attribution.
F-PC-01 — Public Concern Report Form
| Purpose | Reporting a concern about an ASF-accredited facility |
| Who completes it | Patient, family member, staff, or any member of the public |
| Fields | Reporter identity (optional); facility name; date of event; description of concern; outcome sought; supporting documents |
| Submission | Online form, email, postal, or WhatsApp |
| Retention | 7 years from case closure |
F-PC-02 — PFAC Terms of Reference Template
| Purpose | Governance charter for a hospital-level Patient and Family Advisory Council |
| Who uses it | Hospitals establishing or renewing their PFAC under ASF standards |
| Fields | Council mandate; composition rules; chair election procedure; quorum; meeting schedule; reporting lines; conflict of interest; amendment process |
| Review cycle | Annual; signed by PFAC Chair and Hospital Board Chair |
| Format | Editable Word document |
F-PC-03 — PFAC Meeting Minutes Template
| Purpose | Structured record of Patient Council or PFAC meetings |
| Sections | Attendance and quorum; previous minutes review; patient concern updates; policy review items; quality indicator review; action items with owner and deadline; next meeting date |
| Retention | 5 years; submitted to ASF Monitor at each annual survey |
| Who approves | Signed by PFAC Chair and distributed to all members within 14 days |
F-PC-04 — PFAC Member Application Form
| Purpose | Recruitment of patient and family representatives to hospital-level PFAC |
| Fields | Applicant background; patient/family experience description; relevant expertise; conflict of interest declaration; availability confirmation |
| Process | Applications reviewed by existing PFAC members; new member approved by majority vote; hospital management has no veto |
| Induction | Mandatory orientation session covering rights, confidentiality, and meeting structure |
F-PC-05 — PFAC Annual Patient Experience Report Template
| Purpose | Independent annual report from the hospital PFAC to the Board and to ASF |
| Sections | Chair’s statement; concerns received and resolved; patient satisfaction themes; policy changes influenced; unresolved issues raised to hospital Board; recommendations for next year |
| Submission | To hospital Board and to ASF by 31 January each year for the preceding calendar year |
| Editorial independence | Hospital management may not edit or suppress; submitted directly by PFAC Chair |
F-PC-06 — Patient Concern Escalation Form (to Ombudsman)
| Purpose | Formal escalation of an unresolved concern from the standard 30-day process to the Patient Ombudsman |
| Who completes it | Council Chair (on behalf of the reporter) or directly by the reporter |
| Fields | Original case reference number; summary of concern; facility response (attach); reason resolution is deemed inadequate; desired outcome |
| Trigger | Available after 30 days from initial submission if concern remains unresolved to the reporter’s satisfaction |
Training Programmes Coming Soon
ASF — in partnership with GMJ Academy — is developing two dedicated training programmes on Patient Councils. Both courses are delivered online, fully accredited, and available in English and Georgian. Certificates are issued by GMJ Academy (academy.gmj.ge) and carry ASF recognition.
Course 1: Patient Council Chair Training Opening 2025
Designed for elected or appointed Chairs of hospital-level Patient and Family Advisory Councils. Covers the Chair’s legal mandate, how to run effective meetings, how to manage complex complaints, how to report to a Board, and how to build a culture of genuine patient partnership rather than institutional compliance. Developed in collaboration with patient advocacy organisations across Georgia and the WHO Health and Migration programme.
Duration: 6 hours · 4 modules · self-paced with live tutor session
Certificate: GMJ Academy — Patient Council Chair (ASF-recognised)
CPD: 6 CPD hours
Course 2: How to Establish a Patient Council in Your Hospital Opening 2025
A practical, step-by-step programme for hospital Quality Managers, CEOs, Patient Safety Officers, and Accreditation Coordinators who are responsible for establishing — or reforming — a Patient and Family Advisory Council to meet ASF accreditation standards. Covers legal framework, recruitment, Terms of Reference drafting, first-year workplan, complaint system setup, and integration with the accreditation survey cycle.
Duration: 8 hours · 5 modules · includes a practical facility self-assessment tool
Certificate: GMJ Academy — Patient Council Implementation (ASF-recognised)
CPD: 8 CPD hours
Academic partnership: Both courses are developed in collaboration with the School of Public Health at David Tvildiani Medical University (DTMU) and draw on clinical expertise from the Georgian Medical Journal (gmj.ge). For institutional subscriptions or group enrolment of 10+ participants, contact info@accreditation.ge.
Report a Concern Now
Any person — patient, family member, staff member, regulator, or member of the public — may report a concern about any ASF-accredited facility. You may remain anonymous. ASF responds to all substantive concerns within 30 days.
Submit a Concern →
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Standards Council
The expert body that drafts ASF standards — patient-reviewed before adoption.
Complaints Channel
Submit a concern about an accredited facility through the secure reporting form.