The goal of this study is to strengthen rural hospitals’ efforts in patient and family engagement by demonstrating the impact of such engagement on communication and trust. In the first phase of the study, the researchers will survey rural hospitals in Colorado to assess their use of patient and family engagement (PFE) strategies in three major domains: organizational practices, including hosting a Patient and Family Advisory Council (PFAC); bedside practices; and access to information and shared decision making. Based on the survey results, the researchers will create a composite PFE score and a PFAC score for each hospital and prepare benchmarked reports that let each hospital review its composite and subdomain data as compared to the group. In the second phase of the study, the researchers will partner with the University of Colorado School of Medicine to implement the Communication Climate Assessment Toolkit (C-CAT) – a coordinated set of patient and staff surveys and leadership interviews – at a subset of participating hospitals. The researchers will then analyze results, prepare benchmarked reports for participating hospitals, and share findings with relevant audiences in Colorado and other states. Deliverables will include a project work plan, annual and final narrative reports, and financial reports. The grantee will also produce paper(s) suitable for publication and present findings at conferences and professional meetings and to other stakeholder audiences as appropriate as part of the deliverables for this grant.