Application for Membership


Madera Community Hospital is committed to engaging with the community it serves by establishing a Community Advisory Committee (CAC). The CAC will provide valuable insights and recommendations to ensure that hospital policies, programs, and services meet the needs of the community, enhance patient safety, and improve the quality of care.

This is an unpaid, voluntary position.

Responsibilities:

1. Hospital Board of Trustees:
· Appoint CAC members.
· Bring forth CAC recommendations in decision-making processes.

2. Community Advisory Committee Members:
· Attend and participate in meetings.
· Provide feedback on hospital policies, programs, and services.
· Represent the views and needs of the community.

3. CAC Chairperson:
· Lead CAC meetings.
· Coordinate with hospital administration.
· Ensure that meeting agendas are prepared and followed.

4. Hospital Administration:
· Facilitate meetings and provide necessary resources to record minutes.
· Ensure that meeting agendas are created and delivered to CAC chairperson timely.
· Ensure confidentiality forms are signed and collected.



Membership:
The CAC shall consist of 5 members representing diverse community interest, which may include patients, family members, local leaders, and representatives from the community. The members selected need to be ambassadors for the hospital as well as utilize the hospital services for their healthcare needs.

Term:
Members will serve a term of two years, with the possibility of reappointment for two additional terms.

Meetings:
The CAC will meet quarterly, with additional meetings scheduled as needed.
Meeting agendas will be distributed at least two business days in advance.
Minutes will be recorded and shared with CAC members, hospital administration, and the Board.

Residency:
Only residents of the County of Madera, CA will be eligible for membership to the CAC.

Procedure:
1. Establishment of CAC:
Hospital administration will solicit interest from the community. The Board of Trustees and will review interested community members and make final selection.

2. Meeting Preparation:
The Chairperson, in collaboration with hospital administration, will prepare the agenda.
Relevant documents and reports will be provided to CAC members at the meeting.

3. Conducting Meetings:
Meetings will be conducted in a structured manner, following the agenda.
Members will have the opportunity to provide input and ask questions.

4. Reporting and Feedback:
Advisory Community meetings will be documented, and minutes recorded. The hospital CEO will give quarterly updates of the meeting to the Board.

5. Evaluation:
The effectiveness of the CAC will be evaluated annually.
Surveys and feedback from CAC members and hospital administration will be used to assess performance and identify areas for improvement.

Confidentiality:
CAC members must adhere to hospital confidentiality policies and sign a confidentiality agreement.

Conflict of Interest:
CAC members must disclose any potential conflicts of interest and recuse themselves from discussions or decisions where a conflict exists. Conflict of interest include current employees, family members of employees, vendors, etc. Any conflict of interest may be cause to be denied appointment to the CAC.

Termination:
Committee Members may be terminated for non-attendance, breach of confidentiality, failure to adhere to the CAC's code of conduct, or an unmitigated conflict of interest arises.

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* 1. Please Enter the Following:

The MCH Board of Directors are committed to create a CAC that is inclusive and diverse, so please provide the following optional information.

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* 2. Gender:

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* 3. Ethnicity:

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* 4. Please explain your interest in serving on the CAC. Why does this work seem interesting, exciting, or important to you?

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* 5. Tell us about any skills, experiences, or resources you believe you would bring to the CAC.

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