Friday, October 11, 2013

Patient Advocacy: Improving the Hospital Experience for a Patient

It’s possible to become a patient-advocate without alienating hospital staff. You can help your patient without getting in the way of important tests, or hampering treatments

Doctors are not super humans and they cannot cure all their patients. However, sometimes they are so focussed on the technical aspects of the medical care they provide, that they forget that a pat on the shoulder and a reassuring smile can make a world of a difference to the patient.
As a patient-advocate, you can help doctors and nurses deliver humane, compassionate and empathetic care to their patients. You have the resources at your disposal. You have the medical knowledge and you know how the system works. You know where to go for a second opinion; and you know which hospital has the latest technology and which doctor has specialised expertise. You know whom to contact in case of an emergency, what forms to fill out; and what formalities to complete. You can tap into your skills to ensure that patients are treated with love and care by the medical staff.
It’s possible to become an advocate without upsetting hospital staff. There’s no need to rock the boat and put your patient’s life in danger. Being an advocate is all about being informed, present, persistent, and caring. It is not about being loud, arrogant, adversarial, or obnoxious. It’s a delicate balancing act, rendered with humility and helpfulness, where everybody has to learn to be a team player.
Your ultimate goal must be to establish a relationship of trust. For as long as you are in the hospital, try not to throw your weight around, or come across as uncouth; don’t over react over minor issues or pull strings to fix small problems. Change the way you approach a nurse or ward boy for help. Use words like “Help,” “Excuse me,” “May I,” “Thank you” and “Sorry” as often as you can, before asking for a bedpan, a glass of water, a change of sheets, an extra pillow etc.
You thank people who serve you at restaurants, so why not do it in the hospital too? If you are polite to nurses and ward boys, they will respond in kind. Have faith in the system. Believe that everyone wants to be helpful. Saying a sincere “Thank you” will make hospital staff feel good about their job and they will be more polite in the future.
When a doctor visits, listen carefully before you start bombarding him with questions. Be prepared with your list of doubts. Don’t waste his time by beating about the bush – this just irritates a busy doctor. Surgeons will always have one foot out of the door, so prioritise your questions and get to the point quickly.
Some staff members may still regard you as a nuisance. A few may appreciate your efforts and others may feel threatened. Don’t put them on the defensive. Don’t let the negatives of a situation vitiate the hospital environment. On the other hand, don’t get cowed down by the hospital staff either. You are not there to win a popularity contest - you are there to save a life. Not everybody has the skill or ability of being able to connect with others quickly and easily, but a good patient-advocate has mastered this art.
Because patients can’t fight for their rights any better than defendants can argue their own cases, or citizens can file their tax returns without the help of a CA, patients need the help of a patient advocate to make their hospital stay comfortable. In fact, progressive hospitals are investing in employing professional patient-advocates, whose job it is to make the hospital more hospitable. Patient advocates help to pamper patients, so that they go home fully recovered, and full of praise for the hospital and the medical staff.
Most doctors and nurses are professional and efficient in the discharge of their duties. But you still need someone who will put the patient first when she is in hospital - and no one can do this job better than a patient-advocate. An advocate provides personalised care to the patient. Every patient is entitled to the highest quality care - the kind a VIP gets when he enters a hospital. Patient-advocates can help to resolve complaints; gather feedback about hospital services; and implement suggestions to improve care and enhance patient satisfaction.
These professionals should not be viewed as competitors to the medical team, but as partners who can fill the gap in services, and assist patients in negotiating the complex healthcare system. The real value of a patient-advocate lies in her ability to represent the patient - and every patient is special and unique. She can assist the doctor in understanding the patient’s experience and her personal preferences, so that the doctor can customise the solution he offers to the patient. A patient advocate helps the medical team to deliver friendly efficient and effective service, tailored to the patient’s needs, by being a partner, teammate and personal coach. To illustrate, let me give you an example:
A 37-year-old patient with a serious lung infection had to be shifted to a ventilator and was put in a medically induced coma in the ICU. On the third day, he suddenly became alert and couldn’t figure out where he was. His arms were restrained and he could not spot any of his family members around him. He had had a tracheotomy done two days ago to assist him in breathing so he couldn’t even speak. When he came around, he naturally panicked and gestured wildly to the nurse attendant in the ICU.
Thankfully, she was a good nurse and she recognised that the patient was conscious and anxious. She rushed to the patient’s side, took his hand in hers and in a soft, crooning voice addressed him by name, while trying to assure him that everything was alright and that the doctors were making sure that his lungs were functioning normally. Then she offered to inform his family that he was awake. While doing all this, the nurse took care not to let go of the patient’s hand, made direct eye contact and spoke in a very warm, soft tone. The patient quickly calmed down - and was full of praises for the loving care he received.
Another incident that a five-year-old’s father once narrated to me was when he was taking his toddler to a hospital for treatment of a profusely bleeding wound on the scalp. He was frantically looking for a wheelchair for his son in the parking lot, and although it was not his job, the parking attendant on duty rushed to fetch a stretcher for the little boy, who was placed safely in good hands in a few minutes. The parking attendant saw the father’s distress and responded to it with urgency. To this day, this father has not forgotten that act of kindness. The moral of the story is that everybody working in a hospital, from the sweeper to the surgeon, has a moral obligation to be a patient advocate. An example must be set by the senior management team, who should take daily rounds, and visit each patient personally, so they can resolve complaints before they snowball. The message will then percolate down all the way to the ward boy - because staff members imitate what their bosses do - not what they say.
All hospital staff members must learn to read a situation from the patients’ point of view. Surrounded by a battery of specialists — cardiologists, endocrinologists, orthopaedists, neurologists, and more, patients are scared, confused, and vulnerable. Specialists are often too busy to give their patients the full attention they deserve. That’s when the others around them can step in to fill the void. If and when the opportunity presents itself, the supporting battalion of nurses, paramedics, ward boys, hospital administrators, and clerks must serve as patient advocates. It costs them nothing, but can deliver rich returns - both from the sense of personal satisfaction such acts of kindness generate; as well as the resulting enhancement of the hospital’s reputation. At the bare minimum, this would bring a smile to a harried patient’s face - and a patient who goes home with happy memories of her hospital stay will become a brand-ambassador for the hospital.
While all the hospital staff (barring a few rotten apples) mean well and want the patient to get well and go home as early as possible, sometimes they are spread too thin. After performing ten surgeries in a day, a doctor can be expected to feel a little tired. A nurse may be feeling low, because she has just done a double shift, or the billing clerk may be cranky because he got ticked off by his boss – and in those circumstances, they are not able to give tender loving care to the patient - after all, they are human too. This is where a personal full time patient-advocate can shine - and help patients get the care they want and need.
Playing the role of a patient-advocate

Even if you cannot afford a full time patient advocate, there’s a lot you can do personally to advocate for your patient. Once you arrive at the hospital and have provided staff with the information needed to admit or treat your loved one, you should:
                Find out who the “attending physician” is. This is the person who will coordinate and oversee your loved one’s care, work with consulting physicians and specialists, and have responsibility for your patient’s treatment plan.
                Get the phone numbers for the attending physician and make sure that he knows how to contact you directly regarding your loved one’s care.
                Keep a list of questions ready to ask your attending physician. You never know when the doctor will show up by your patient’s bedside. A typical visit won’t last more than 10 minutes. If, for some reason you won’t be in the room when the doctor visits, leave your list with the nurse.
                Introduce yourself to the nursing staff. They will be providing the bulk of the hands-on care to your loved one. They should be able to answer most of your questions on medication, treatments or procedures. If they can’t, they will direct you to another clinician who can. Nurses typically work on 12-hour shifts (i.e. from 6 a.m. to 6 p.m.) so find out when the shift change is and try to wait until the nurse on duty has the information she needs to answer your questions.

                Get to know the hospital’s discharge planner or case manager. It is their job to help with discharging your loved one and ensuring that you have all the information you need before leaving the hospital. She can provide you information about local resources, referrals to other medical professionals, when to follow up, etc.

The above is an extract from Dr.Aniruddha Malpani's book : Patient Advocacy - Giving Voice to Patients
The book launch will take place on Saturday, 16 November 2013 at Hall of Harmony, Nehru Center, Worl, Mumbai - 400018 during the 4th Annual Putting Patients First Conference.

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