Patient Advocacy Look Behind the Veil Mar 7, 2018 -
J. A. McNamara
There is oftentimes a rush to the high moral ground of advocacy in the health service (indeed in the public service generally) in which it is seen as being of advantage to be identified as an advocate for patients or for service development. This is both laudable and understandable but does raise questions such as motivation, substance and effect. Do those individuals and organisations who purport to be advocates, truly see advocacy through the eyes of patients or do they opportunistically see advocacy as a means to the pursuit of another end?
This is an important question and it merits reflection because the capacity to advocate for patient services is indeed a privilege and the capacity to actually do something in support of such services is even more so, whether that is at an individual or corporate level.
So important is the issue of advocacy for example that it merited the inclusion of a provision in the consultant common contract that inter alia contract holders “may advocate on behalf of patients / services users or persons awaiting access to service.” In fact everybody working in the health service has a right and an obligation to advocate for patients and for service improvement and this privilege is not one that is confined to any particular profession or group. In my view the suggestions that our portering, therapy or administrative staff for example make on a daily basis to improve the quality of services for patients are exceptionally important in contributing to our continuous quality improvement programme.
All too often is advocacy “for patients” is used (or abused) to promote personal or group agendae. The question must be asked as to how often potential conflicts in respect of motives are challenged in public discourse? Not very often I’m afraid. All too often there is an inclination to accept public commentary that passes for advocacy in an unquestioning way and we need to be continuously vigilant that those who purport to be advocating for patients are challenged to ensure that this is in fact the case and that such advocacy is not a proxy for the pursuit of other objectives.
At a corporate level there is an onus on executive, nursing and clinical leadership to be leaders in the promotion of advocacy for patients and service developments. The determination of priorities and the allocation of resources on the basis of decisions made, raise issues as to how serious and committed hospital leadership is to the prioritisation of improvements in service by advocating for such improvements among the very many other demands for resource allocation. I believe that the substantial developments that have taken place in the infrastructure and service profile of Cork University Hospital and in many other hospitals over the past two decades bear testament to our advocacy for service improvements for our community.
It is one thing to know what is required to improve service delivery and it is another matter altogether to know how to exercise the leverage required to obtain the funding and resources required to implement desired improvements in service. In this regard, it is worth noting the observations of leading management academic Professor Henry Mintzberg who talks about the “Professional Bureaucracy” and notes that one of the necessary skills for executive leaders is the ability to know how the system works and to be able to exercise judgement in navigating ones’ way through the bureaucracy. Far from being characterised as bureaucratic impediments to improvements in service provision because of budgetary concerns, (as is often the case) executive leadership have the expertise and the system knowledge to advocate for investment and in my experience do so very effectively.
Executive leadership (management) is often criticised for insensitivity in responding to the need for change and the promotion of investment. The fact is that executive leadership advocate for patients and service developments “with clean hands” that is without being compromised by factors such as maximisation of financial benefit or the accretion of power for narrow sectional interests. Their job requires taking a wide holistic view of the needs of the hospital. Furthermore as “Accountable Officers” executive leaders carry responsibility for the performance of hospitals and as such bear a responsibility for advocacy for patients and the community while simultaneously being responsible for expending public money judiciously.
It is really important that we work individually and collectively to create a culture in which advocacy, by every member of staff of every profession, is promoted, nurtured and cherished. It is also important that we acknowledge that no one profession has a monopoly on advocacy for patients and that we “go behind the veil” to confirm the bona fides of those in public commentary who purport to be advocating for patients to stress test, that there are no other motivational factors at play and that their advocacy is genuine. In doing so, we should be mindful that advocacy for patients by those who stand to gain no personal or professional advantage is particularly praiseworthy.
Chief Executive Officer