Independent Health Advocates: Threat or Opportunity?
As an independent health advocate, I recently had a puzzling experience while working with a client in an acute rehabilitation center. My client, Mrs. Jones, was recovering from a very difficult cancer surgery. After returning to the hospital twice in two weeks for related complications, her family enlisted my services to assess Mrs. Jones’ needs, monitor her progress, coordinate her care among physicians/providers across different specialties and health care institutions, and help with discharge planning to ensure that the necessary information and support resources were in place.
To achieve these goals, it was important for me to work collaboratively with the rehabilitation and surgical team providers. Given our shared goals of safe, high quality patient care, it was difficult to understand the reason for the resistance and in some cases outright hostility from the direct care providers. While there were certainly some providers who completely understood the importance of our collaborative work, there were others who viewed my advocacy role as useless and threatening. In fact, one physician told my client that she was “wasting her money on hiring a health advocate”. Of note, this same physician at the time of my client’s discharge from acute rehabilitation praised me for my work in facilitating communication with the surgical team, resolving clinical problems and accelerating discharge to home for this very complicated client.
So the question becomes, how best to educate health care providers that independent health advocates are not a threat, but rather an opportunity to assist providers to achieve patient care goals? There are many ways in which the services of independent advocates can help both direct care providers and health care institutions to meet the needs of their patients and improve clinical outcomes. As a point of role clarification, an independent health advocate is directly employed by a client and/or family and works on their behalf to achieve the goals of the client. This role differs from a health advocate, employed for example by a hospital or insurance company, who works with clients within the employment institution’s mission and goals.
Advocacy has described as “the kind of power that removes obstacles or stands alongside and enables” (Benner, 2001). In situations of vulnerability, powerlessness, or being involved in difficult circumstances, such as an acute hospitalization, an individual needs advocates. The core condition which demands advocacy action is the vulnerability of the client in two respects: personal vulnerability from illness and also vulnerability to risks inherent in the institutional processes to which the client is exposed in the health care system (Mallick,1997).
During complicated illnesses, with many specialty providers involved, it is very easy to lose track of the patient’s multi-system needs. As Marram et al. (1976) caution; the patient’s humanism can become mechanized, her organic whole fractured into parts, her basic physiological and technical needs reduced to a checklist on paper. Thus, she becomes an automated patient.
Health advocates empower patients to make their needs known and voices heard in a fragmented health care system. The primary role of independent health advocates is to provide comprehensive, client-centered, evidence-based services to support client autonomy, provide care coordination/management and healthcare information. As the AMA (American Medical Association, 2012) notes, the central goals of “patient advocates” are to enhance patients and families’ ability to manage complex medical conditions and to support appropriate health care decision-making.
In sum, independent health advocates can play an important role in assisting direct care providers with patient care coordination, education and support. Developing respectful, collaborative professional relationships with health advocates can be mutually beneficial to attain high quality patient outcomes.
AMA (American Medical Association), 2012. Position Statement: Goals of safe, high quality patient care: Patient navigators. http://www.ama-assn.org/resources/doc/market-reforms/patient-navigators.pdf
Benner P. (2001). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Englewood Cliffs, NJ: Prentice Hall.
Mallik M. (1997). Advocacy in nursing: Perceptions of practicing nurses. Journal of Clinical Nursing; 6 (4):303-313.
Marram, G., Flynn, K., Abaravich, W., & Carey (Grossman), Sheila. (1976). Cost-effectiveness of primary and team nursing. Wakefield, MA: Contemporary Publishers, Inc.