How To Know If You Can Trust Hospital Patient Advocates

When you’re in the hospital, you may encounter a hospital employee with the title of “patient advocate.” But what does a hospital patient advocate do? And who do they work for? Know what kind of help you can expect to get, and what the limitations of hospital patient advocates.

A story about a hospital patient advocate

Francine reports: 

After my husband Leonard had surgery last week, he stayed in the hospital four more days. I stayed by his side as much as I could and waited every day for the surgeon to check on him. I had a million questions! But I never saw the surgeon again once the surgery was over.

I waited patiently for the first day after the surgery. No surgeon. I called the surgeon’s office and they would not make an appointment for me, or even promise he would return my call, because it was my husband who had the surgery; they told me I would just have to hope to catch him when he visited my husband, which he would do once each day my husband was in the hospital.

I asked the nurses when the surgeon would come by. They told me he stops in every morning around 6 AM. So I got to the hospital by 5:45  and they told me I had just missed him. I would give the hospital nurses my questions and they would give them to the surgeon, but I never got the answers.

Finally, the nurses suggested I go see the hospital’s patient advocate and tell her I wanted to see the surgeon. So I did. She was very pleasant and tried to be helpful. She told me she would try to get the surgeon to contact me but that he had a reputation for avoiding patients’ family members. No promises. And still no surgeon.

I am furious! I was never able to get my questions answered, and now my husband has an appointment for follow up and I don’t know how I’ll keep my mouth shut when we get to the appointment! He has had all kinds of problems since the surgery, and I don’t feel as if he got the care he needed because I wasn’t allowed to ask questions.

Unfortunately, Francine’s story is all too common. In recent years, hospitals have begun stepping up their games to improve the patient’s hospital experience because Medicare’s rules changed, tying patient satisfaction to hospital revenue. One way to improve the patient experience is to be sure there is someone who can listen to complaints. That person would be a hospital patient advocate.

Further, the Joint Commission, which is the accreditation body for hospitals, requires a patient advocate be available at all times in a hospital. These patient advocates have different names in different systems: patient advocates, patient representatives, care managers, ombudsmen. Whatever they’re called, they are all tasked with assisting the hospital’s patients and their loved ones.

These patient advocates have become the customer service department with a twist.

Hospital patient advocates do what they can to help their “customers.” They are a liaison between patients and the hospital. They can often run interference, mediate, or satisfy a complaint about the hospital. 

But that’s where the twist comes in. In most cases, the hospital’s patient advocate works for the hospital (not for you). In many U.S. hospitals, patient advocates work for risk management or legal departments. These are functions that work to protect the hospital, especially from being sued. 

What does this mean to you?

When the hospital’s patient advocate couldn’t get the surgeon to answer Francine’s questions, she turned to a different kind of resource: an independent, private patient advocate. The hospital advocate’s allegiance meant she could not cross that line  to encourage the surgeon to connect with Francine.

The Allegiance Factor

The Allegiance Factor is an important concept. When an advocate is employed by a hospital, or by an insurance company, and because they have a financial stake in your care, they cannot always provide all the help you need. Their allegiance is to their employer. That’s why Francine wasn’t able to get the answers she needed; because the advocate could only push so far without endangering her own job.

On the other hand, the independence of a private advocate means he or she works directly for you. Their allegiance is solely to you.

If you or a loved one is hospitalized and you don’t seem to be able to get the service you need or your questions answered, then by all means, start with the hospital’s patient advocate. But do that knowing who signs their paychecks and how that may limit what they can do for you.

If you need help that you’re not getting, hire an independent patient advocate, one who will answer solely to you. Find advocates in our national directory of independent advocates.

Find a Health / Patient Advocate or Navigator

Learn more about AdvoConnection and The Alliance of Professional Health Advocates

10 thoughts on “How To Know If You Can Trust Hospital Patient Advocates”

  1. Audrey Schellhammer

    I stumbled across your blog and found your tone to be rather negative, especially the manner in which you spoke of hospital patient advocates. I am one of the “hospital advocates” you wrote about, and I strongly believe that you have not described my role, responsibilities, my “allegiance” or the concern I have for our patients accurately. Not even close.

    I have been a licensed Registered Nurse for 35 years and have been employed in my current position for the past 12 + years. I do not work in our risk management department and I do not interact with patients in a confrontational way. I am available when needed 24/7/365 days a year. My work day does not begin at 8:00 a.m. or end at 5:00 p.m. Throughout an entire night, I remained at the bedside of a dying patient to support her distraught family members. I have explained the dying process to other family members who are facing the death of a spouse or sibling. I have attended numerous funerals of patients who have passed away in our hospital or at home while receiving hospice care. I have shared in the joy new parents experience when their first child is born. I have brought staff members and patients together so that no one feels insulted, and concerns are resolved with the focus being on each patient’s best clinical outcome. I have helped a homeless man who fell onto the sidewalk by our hospital, calling EMS and local shelters to ensure he had a place to sleep at night. I have been cussed at and hugged by different patients. I have laughed and cried with different patients. I have been thanked and referred to as an “Angel” so many times, I have lost count.

    Although I am “employed” by a hospital, my “work” is truly patient focused. I respect and demonstrate sincere concern for the well-being of every patient I meet. I engage family members is discussions about individual plans of care, if given permission to do so. And, I explain a patient’s clinical situation with words that are easily understood, ensuring that all questions are answered professionally and accurately. I follow up and keep my word. In addition, I treat our physicians, nurses and every member of our staff with the same respect.

    I have read your story and understand that your education and experience is in marketing. I am sorry for the “terminal” diagnosis you received several years ago. However, please do not continue to use your own, personal, negative, patient experience to criticize those of us who strive to treat everyone with compassion, despite our being employed by a hospital or insurance company.

    I believe you would have greater success as a patient advocate if you approached your profession with a heart of kindness instead of bitterness. Imagine how effective we could be at improving the delivery of healthcare in this country if we chose to work together for the greater good of each of our patients, sharing best practices and lifting each other up.

    1. AdvoConnection

      Audrey, Thanks for sharing your perspective. Patients who encounter you during a hospital stay are lucky to do so. You must realize that you are unique among hospital advocates, and for that, I thank you.

      My post is meant to be a wake-up call for patients. And, frankly, it’s an explanation to the hundreds of patients I have heard from over 15 years who have found they were frustrated, and too often stymied by a well-meaning hospital advocate, but one who had her (because as you know, they are mostly women) hands tied by their hospital bosses.

      On one point we wholeheartedly agree; that is, that collaboration among advocates, no matter who pays them, is a key to better outcomes for patients. In fact, I have written many times on this subject (here’s one example) to show how that can happen. I have also worked directly with hospital advocates to help them understand how they can take advantage of working with independent advocates at all those difficult transition times during and after a hospital stay (shift changes, floor changes, discharge, others).

      As long as patients continue to run into problems with their hospital experiences, and complain to me (or more like “us” – meaning, independent advocates), I will continue to explain to them why that would happen.

      Thank your for your work on behalf of patients.

    2. Audrey,

      Please share with me your thoughts about how you feel during these days of covid where patient’s are not allowed loved ones to be involved in their hospital stays.

      I have taken a couple hospice classes and have been at the bedside of three of my dying parents, I have been at the birth of two of my grandchildren, and I have been at the bedside of my husband who was involved in the fatal carcrash that killed my father.

      I’m trying to understand these difficult days of our health care systems and finding out why we do not seen to be seeking a middle ground for our loved ones as it relates to patient advocates; and in this description, I’m searching for answers of advocates closely related to the patient vs your role. I feel you would have great insight with your experiences you’ve mentioned; and would love to hear your thoughts.



    3. I’m sorry ma’am but I have a spinal problem that has been going for years (3-4) and I still can’t get any relief from or for me. I still don’t know anything!! Talked to all patient advocates and it is just like the post said. They take care of theirs. FACTS!!!!!!

  2. According to Johns Hopkins Dr error and mistakes are the 3rd leading cause of death in the USA right behind cancer and heart disease . (A REAL epidemic look it up ! ) One better believe the hospital “patient advocates” know this and has seen it. The fact that a hospital “advocate” still has a job 12 years latter is telling and should be a warning to all.!

  3. I thought I was the only one who was suspicious of patient advocates. When I realized so-called patient advocates merely refer complaints to attorney offices representing these hospitals, I was severely pissed. How this misrepresentation does not constitute fraud is beyond me. Never talk to a legal department of any kind without adequate legal representation
    available, but that is certainly not how healthcare conglomerates represent it.
    Worst of all, hospital advocates have no obligation or responsibility or liability to the patient they are serving. Classically, physicians and nurses are supposed to advocate for their patients, but that has gotten in the way of making money in 21st century healthcare. Most hospital employees are wholly ignorant of patients rights, including the rules of their respective employer. So I agree that absolutely no one should talk to a “hospital advocate,” because they only effective patient advocate is a very good and well paid lawyer.

  4. With regard to Ms. Shellhammers response, what she shares tells us that she is a kind, compassionate person. Not that she is an advocate willing to confront wrongful acts of errors and omissions on the part of Hospital Staff, Contractors or Visiting Healthcare Providers, on the patients behalf. She wouldn’t last a day if that was truly who she was. She probably doesn’t realize that by coddling the patients, it makes the Hospital look better, and makes the patient sympathetic, less angry, and less likely to file a complaint. This will sound mean, but it is not. Going to a funeral does not make her a patient advocate. It just means she is a very nice RN.

  5. I had a hysterectomy on April 5th, 2021. Getting the necessary tests etc was an uphill battle which was accomplished. With every medical exam there was impatience and a lack of awareness of the doctor on my medical record. I felt like I was there to serve him. Because of COVID my spouse was at home awaiting surgery results and discharge info. The surgeon never contacted my spouse post surgery. No one gave me results post surgery. As I was recovering I bled through the wrappings and my bedding. The head nurse was called, the surgeon was contacted. He advised the nurse to contact the oncall gyno. That doctor showed, drew a line on my stomach and instructed the nurse to call him if the bruise ran past the limit line. I asked about the surgery and he would not provide results. I stopped bleeding and the recovery nurse phoned my spouse to pick me up. When I checked our phone logs there was NO contact from the surgeon. I messaged the surgeon the next day and his nurse followed up with results. I had more questions and she phoned me and I recounted my experience and asked for the Chief Admin /Chief Medical Officer contact info. I am awaiting that info. Patients require an advocate. Seniors like myself are often scared to speak up. Apparently “Do No Harm” is meaningless to some physicians. Not sharing surgical results is emotionally harmful and both inhumane and unprofessional.

    1. AdvoConnection

      What a horrible experience for you, Pat! I am so very sorry to hear it. You are very right that many people are afraid to speak up (you’ll be interested in this post: Will the Waiter Spit In Your Soup? ) which is why, as you say, patients require an advocate. I hope you are on the road to healing and improved health. Once you’re feeling better, feel free to find some of those doctor ratings websites and leave your comments about that surgeon there. (Be sure you talk only about your own experience.) You’ll be helping future patients by doing so.

  6. I am an RN working in ICU. I had an intensivist shout at a patient ( who had pneumonia) who was confronting him. He told her to follow his orders or go home and never present to the hospital again. Then he called her mother, screamed at her and told her to come to the ICU and collect her daughter. I advised the mother to see the hospital’s patient advocate which she did. Within a couple of hours the advocate told the mother that the doctor’s treatment was correct and that, rough as he was, his heart was in the right place. She refused to intervene. She refused to accept a written complaint telling the mother she already had a list of complaints about the doctor and one more wouldn’t help. The advocate told the intensivist that the mother had complained and of course, things got worse. In the previous hospital I worked in, the “patient advocate” was actually an untrained complaints officer and recorded requests from patients in their notes.
    “ When an advocate is employed by a hospital then they cannot and will not be able to provide all the help you need because their allegiance is to their employer”. Believe this.

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