Do You Know the Difference Between a Hospital Patient Advocate and an Independent 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 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.

Reproduced with permission: Torry, Trisha, (March, 2017), What’s the Difference Between Hospital Patient Advocates and Independent Advocates?, Retrieved from

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