Pulling for Patients

By Christine Haran

Despite the steadfast popularity of TV melodramas set in hospitals, most of us would prefer to avoid them. First of all, being in a hospital often means that you or someone you love is in poor health. And hospital stays can also be overwhelming because of the growing numbers of people involved in the care of each patient, complex policies and intricate insurance issues.

In such a charged and busy atmosphere, communication between patients and their healthcare providers sometimes suffers and key pieces of information can fall through the cracks. Fortunately, that's where patient representatives step in to address patient concerns. These hospital staff members, who advocate for the needs patients, are also known as patient advocates, patient navigators, social workers and guest service workers.

Below, Lisa Reynolds, director of guest services and education at Christus St. Elizabeth Hospital in Beaumont, Texas and president of the Society for Healthcare Consumer Advocacy, discusses the role of patient representatives and how they facilitate doctor-patient communication and a more satisfying hospital experience.

Do most hospitals have patient representatives on staff?
All hospitals have somebody who will address patient concerns, but all hospitals may not have a patient advocate where that is their sole function. It depends on the size and the organizational structure and the needs of the hospital. Likewise, some hospitals have a big enough patient-relations staff to assign a representative to a unit who visits all new admissions. At other hospitals, the representatives are available if the patients need them.

Why did the healthcare system develop this role?
When healthcare was first delivered, the physician came into the patient's home, and they turned over all their trust to the doctor. Patients never questioned the doctor; it was very paternalistic.

Eventually healthcare moved to the institutional setting and, by the 1960s, many different social issues were being discussed, such as civil rights, student rights, women's rights. And oftentimes, patients believed that their rights weren't being respected when they entered a hospital. In 1967, the first patient-relations program was started by Ruth Ravich at Mt. Sinai Hospital in New York City. And in 1972, the American Hospital Association (AHA), in conjunction with several of the membership groups of AHA, including ours, developed the initial Patients' Bill of Rights.

How do patient representatives help make sure that patient's rights are met?
In many hospitals, the patient representative has a responsibility to make sure that the hospital has been complying with the Patients' Bill of Rights. Each hospital has to give patients a notice of their rights upon admission, and we have to have it posted. If a patient believes a right is being violated and they file a concern, generally that goes to the patient representative.

A patient representative is very familiar with what the rights are and can help explain those to patients. The rights vary from state to state, but they have the same elements. These include the right to considerate and respectful care. A patient has a right to have their pain managed and assessed. The patient has the right to voice a complaint and not be treated differently because of voicing that concern. They have the right to have an advance directive, meaning they can dictate in advance how they would like to be cared for in the event they can't make those healthcare decisions themselves. Another important right is the right to informed consent. This ensures that patients are given information about the risks, the benefits and the alternatives to any invasive procedure before that procedure is done.

What are some of the different services representatives provide?
A big component of what patient representatives do is work to resolve patient concerns or questions or unmet needs when they're in the hospital. If there is a complaint, the advocate gets the information and acts as the neutral third party to resolve that concern.

If a patient is having a problem with their doctor, the advocate can help the patient and the physician try to resolve their issues. So if patients feel, for example, that their physician is not prescribing pain medication in a timely manner, they sometimes think we can tell the physician that they have to give the patient pain medication, which we can't. But we can facilitate the discussion and help resolve the situation.

Oftentimes, patient representatives are on the ethics committee of the hospital, so if there's an ethical dilemma, the patient advocate can represent the patient's wishes and provide support for the family. For example, if a patient is on life support and had not stated in advance whether they wanted to be kept alive, and the family's struggling with those issues, they can discuss it with the representative.

A lot of patient advocates are also involved in administering patient satisfaction surveys and then improving care based on results of those surveys. Representatives do customer service training with the staff to help them understand the patient perspective. And representatives might do community education about what to expect when you come in a hospital and how to be an informed consumer.

Does the representative often play a role in improving communication?
Yes, I would say facilitating communication is probably our major role. Most of the services we provide wouldn't be needed if things were communicated correctly in the first place. If something is misunderstood, we can help patients ask the right questions, or we can get the information ourselves and then translate it so that the patient can understand.

A lot of miscommunication is about what is being done for the patient. The patient will say, "I've been here, but nothing's being done for me." In fact, a lot of what has been done occurs behind the scenes, but they don't know what tests are being done or the future plan of care. In these situations, we have put a plan in place to make sure that this information is communicated to the patients.

Do representatives spend a lot of time educating family members as well as patients?
Yes, in fact, I would say, 50 percent of the requests we get are from family members.

Do conflicts of interest arise because the representatives are working for the hospital?
What I tell patients is that although I'm employed by the hospital, my sole responsibility is to represent your best interests, and the goal of the hospital is the best outcome of care for you. Our being aware of your issues and trying to resolve them helps improve care.

How are problems with a doctor usually resolved?
It depends on the level of severity of the problem. Oftentimes, just a phone call to the office manager or the physician will resolve the issue. Or we'll have the physician call and speak to the patient or the family member about the concerns, or speak to them in person. And sometimes we arrange a meeting between the patient and the physician and act as a facilitator.

Then there are times when you've tried everything and the patient says, "I don't want this doctor back in my room, I want a new physician." We walk them through the process of how they find a new physician, and how they have to keep that physician until they get someone else to accept their care. Because the physicians are licensed independently by the state, patients can also complain to the state licensing board.

What are some common mistakes that patients make when trying to communicate with their healthcare providers?
I think there are a lot of questions that they want to ask and then when the physician comes in, he'll say, "This is what we're going to do." It's so much to take in that they forget to ask all the questions they had for the physician, or they can't always remember what the physician told them.

We always recommend that the patient write down their questions so when the physician comes, he or she can address all those issues. And as the nursing staff comes in, they can look at those questions and maybe answer some of them for the patient.

What are some key questions patients should ask?
They should always ask the physician what the plan of care is. They should ask if they will they be in the hospital a while. Will they be moving to a skilled nursing facility, will they need a rehab hospital or will they need care at home? Will they need special equipment? What kind of medications are they going to have to be on once they're discharged? What type of pain can be expected? And it is also OK to ask the physician about treatment alternatives.

How would you say that representatives improve the care of patients in hospitals?
By promoting positive communication and positive behaviors, we can help enhance the level of care provided. There have been studies done that found that a satisfied patient actually has better medical outcomes. They follow through with their treatment plans, so they stay healthier. I would say that helping to promote that positive communication and their satisfaction in the hospital really does enhance the level of care.

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