What’s the Difference Between Hospital Patient Advocates and Independent Advocates?

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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 repeated hundreds (or thousands) of times a day. The details vary from patient to patient, but the part we’re going to focus on here is – how helpful could the hospital’s patient advocate be? And what could Francine have done differently?

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. I have my own opinions on how they have done that (As in – hospital experience just means a different kind of marketing. “Let’s improve the food, then patients won’t complain as loudly when no one answer the buzzer!) One way to improve the patient’s experience is to be sure there is someone who can listen to complaints. That person would be the hospital’s 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… 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.

Before I explain that twist to you, let me make sure you understand something important:  hospital patient advocates do what they can to help their “customers”. They are a good liaison to the hospital, and to the hospital’s medical and financial personnel. They can often run interference, mediate, or satisfy a complaint about the hospital. Knowing the constraints they are under, I have a lot of respect for these hospital customer service folks.

So What’s the Twist?

But that’s where the twist comes in.  That is, that in most cases, the hospital’s patient advocate works for the Risk Management Department of the hospital. Let me repeat that:  the patient advocate works for the hospital (meaning, not for you!) and in the vast majority of hospitals in the US, works for the Risk Management Department – which is the legal department. Risk Management is the euphemism for “make sure we don’t get sued.” In other words, the patient advocate is only there to cover the backside of the hospital. If they happen to help a patient or two along the way – well then – that’s nice, too.

What does this mean to you?

When the hospital’s patient advocate couldn’t get the surgeon to answer Francine’s questions, then Francine had only one recourse:  an independent, private patient advocate. The hospital advocate’s allegiance meant she could not cross that line – the line that was so necessarily crossed to “encourage” the surgeon to connect with Francine.

The Allegiance Factor is an important concept – the point of today’s post. When an advocate is employed by a hospital, or by an insurance company, and because they have a financial stake in your care, then they cannot and will not be able to provide all the help you need because 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 knowing the surgeon would subsequently have taken it up with her bosses in the Risk Management Department.

On the other hand, the independence of a private advocate means she isn’t trying to cover anyone else’s backside except YOURs because she works directly for you – her allegiance is solely focused on 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 if you’re smart, you’ll have already hired an independent advocate to be part of your team. If you need answers or action, then it will be the allegiance of your private advocate who gets them answered.

 
 

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Comments

  1. Audrey Schellhammer  July 23, 2019

    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.

    reply
    • AdvoConnection  July 24, 2019

      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.

      reply

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