When no other feedback channels exist, the Patient Advocate becomes a single point of failure

Susan CournoyerThis blog welcomes guest posts from SPM members on relevant topics. One of our Society’s newest members, Susan Cournoyer, is a tech industry analyst, and is familiar with the concept of systems that are well designed or weakly designed, e.g. with a “single point of failure” – a single item that, if it breaks, makes the whole system fail. 

When that “system” is patient feedback, the result can be that nobody in the whole system ever hears the patient’s voice – a complete failure of patient experience, rendering patient-centered care design impossible. Her story sounds all too familiar.

When no other feedback channels exist, the Patient Advocate becomes a single point of failure

“Have you reached out to Louise*,”  the hospital administrator asked me. “She’s our Patient Advocate.” The manager for women’s healthcare continued, “I know you called to tell us about your experiences, but we can’t listen to just anybody who calls in.”

I am slow to contact the Patient Advocate, partly because I notice that she appears to be among the least credentialed on the hospital staff. I see big titles for some executives, such as the Chief Quality Officer, with an MD and an MPH. Apparently, the Chief Quality Officer works with the medical staff. These must be the “somebodies” in this hospital. Louise, though, manages Patient Relations, and has been doing something along these lines for 25 years. A quick look at the org chart tells me that Louise does not rank as a decision-maker in the organization. Based on her LinkedIn page, Louise has no specific credentials. I guess that qualifies her to work with the average anybodies who walk in off the street for medical care here.

I admit that I have been trying to avoid the route of the patient advocate. I would rather provide feedback than deal with the bureaucracy to file an official complaint. However, this marks me as a naive “anybody” in the healthcare universe. I also have read that patient complaints usually end up with private meetings and non-disclosure agreements —  Matthew Syed covers this likelihood in detail in his new book: Black Box Thinking: Why Most People Never Learn from Their Mistakes — But Some Do. (Maybe Louise soothes dissatisfied patients while they navigate the bumpy path to non-disclosure agreements.)

As I have reached out to different contacts across this hospital, I notice that Louise seems to be the only contact for patient questions. In my field – high technology – when only one names comes up again and again, we have learned to ask whether this could be a single point of failure, or an accidental dead end.  I have learned that for medical practitioners in this hospital, the hospital has leaders for Quality at several levels of the organization. Maybe this gives practitioners some options when they have questions or concerns. But for patients, all roads lead to Louise.

Could it really be that one of the least credentialed staff in the organization – the Patient Advocate, in this case – has all the answers to patient care and satisfaction? I suspect that the opposite may be true; that the hospital does not seek and does not act on patient feedback. In terms of the evidence-base, it may be that the only evidence for patient satisfaction here is whether patients come back, or leave for good.

* “Louise” is not the advocate’s real name


Posted in: general | hc's problem list | reforming hc




3 Responses to “When no other feedback channels exist, the Patient Advocate becomes a single point of failure”

  1. Jeff says:

    I love when people outside healthcare, like ‘dime a dozen’ tech industry analysts, weigh in on the inner workings of other industries, particularly my industry. I am certain your ‘analysis’ of my role comes from the deep research you have done – speaking to and studying how those of us with no credentials handle patient complaints, rather than off the cuff comments.

    Speaking for the ‘anybodies’ who are patient advocates, we want you to know that our hospital systems have robust policies and procedures, some governed by federal law, on dealing with patient complaints. Most complaints are disseminated to those with big titles who aid in the investigation and resolution of complaints, and together, we – the non-credentialed, respond to the patient, federal government and patient’s attorneys.

    The private meetings you talk about, and I you must have been in some to know they exist, actually take place in safety and quality committees, RCA’s, ethics councils, etc., where we learn from evidence, how to do better for the patient.

    Although you did not mention it, I am sure your research informed you that the federal government, Medicaid and Medicare, mandate surveys be sent out and customer satisfaction data collected and analyzed. This data is posted on websites for all who can Google to see, not exactly privates meetings. In my hospital, there is no ‘single point’ of failure as complaints are sent to everyone involved and every employee is responsible for patient satisfaction. Your research may have missed that as well. Louise has been in her role for 25 years because she knows the system better than anyone else and has earned the respect of all the CEO’s, CNO’s, CMO, CFO’s, attorneys, managers and fellow nobodies.

    As for me, I can call, meet and text with any big titled person in our organization at any time to discuss patient complaints. I think you should re-evaluate your research.

    • Hi Jeff! Boy, what in hockeysticks pushed YOUR buttons today?

      Problem 1 with your comment: She’s speaking AS A PATIENT, not as a tech industry analyst. Do you have a problem with that?

      Problem 2: You seem to be denying that her experience happened. Or, no?

      Problem 3: You seem to have assumed she said ALL patient advocate situations are like yours. Right? Would you please reread what she actually said, when you’ve had a chance to cool down and get your buttons un-pushed?

      I’m truly interested in your thoughts when you’re able to respond to what she actually said, not a bunch of things she didn’t say.

  2. Ileana Balcu says:

    I shared the blog post on an online group of patient advocates at Beryl Institute. Below is an answer I got from one of the group’s members – shared with permission:
    “I think this is a major problem, though presented a bit too starkly in the example. Often there are multiple people in the “patient advocate” or “patient experience” or PFCC office. Often some of them have some organizational status and some degrees. Often they may sit on some organizational leadership team(s) and be afforded some at least lip service status and influence in the organization. (and some of those “oftens” are not all that often). Yet, nonetheless, it is commonly the case that they only have some real influence if the CEO/COO adopts policies and practices that make that happen (which isn’t all that often). In my experience the best antidote is for an organization to have patients and/or family members as respected members of most all organizational committees (ideally including the board) and/or there is a culture where no major decision is made without someone saying, “we should check and make sure what the patients think about this.” Getting to that point seems to work best if there is a CEO who is a believer (good data helps there) and there is lots of patience and persistence.”

    David Andrews
    Patient Advisor
    Georgia Regents Medical Center

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