The Communication Climate Assessment Toolkit (C-CAT) is an assessment tool developed by the University of Colorado Center for Bioethics that has been validated in a variety of health care settings throughout the United States. The C-CAT consists of a coordinated set of patient, staff and leadership surveys, as well as an organizational workbook. The survey assesses nine communication domains: leadership commitment, data collection, community engagement, workforce development, individual engagement, cross-cultural communication, language services, health literacy, and performance evaluation. Each of these domains contributes to the overall assessment of an organization’s communication climate and have been found to be significant predictors of quality of care and trust.1 Between 2018-20, C-CAT surveys were done in rural hospitals in Colorado to understand the impact of the communication climate of rural hospitals on patient and family engagement (PFE). The results of those surveys guided the creation of this toolkit, which focuses on four domains of the C-CAT surveys which rural hospitals can specifically address to improve PFE.