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Enemies? No, But With an Important Distinction

A recent email exchange with an APHA member highlighted a point we don’t make often enough, and one you need to embrace so you can discuss it with potential clients. The problem is – she used it to leap to an errant conclusion, one that demands clarity.

In her email, she mentioned that she was considering joining a different professional organization, one that focuses on hospital advocacy, teaching hospital advocates how to do their jobs. She stated that the other organization

“has multiple affiliations with those purported enemies of true patient advocacy, patient relations departments.”

What? I was so taken aback! Enemies? How on earth would anyone construe that hospital patient relations personnel are enemies of private patient advocates?

Let me be clear. THEY ARE NOT. Not even close. Those words should never be in the same sentence.

But somehow she had drawn that conclusion, causing me to examine why she had done so. And while I can’t explain the leap she took, I did identify the genesis of her idea, confirmed by subsequent email exchanges, as follows:

The Allegiance Factor

The Allegiance Factor is the explanation for why a patient may not get the answers or satisfaction he or she needs from a hospital or insurance company patient advocate.

It’s the fact that since hospital or insurance company advocates derive their paychecks from one of those organizations, their allegiance must be to their employer. It’s a job expectation – their jobs are to help patients to the point where it can be helpful to that patient and the hospital or insurer but not impinge negatively on the interests of their employer.

That doesn’t make these advocates the enemy. That simply ties their hands behind their backs. If they go beyond a certain line to help a patient, they risk losing their jobs.

Private, independent advocates have no such constraints. Their allegiance is to the source of their paychecks, too – their patient-clients (or someone acting on that client’s behalf like an adult child, or parent, or even an employer.)? There is no profit-impinging line they can’t cross for their clients.

Here are some examples:

  • A hospital or insurance advocate can only serve the patient while the patient is in their domain (the hospital, or on the phone) while a private, independent advocate can be with the patient at any time she is needed – in or out of the hospital, on the phone or in person.
  • The insurance company’s goal is to profit by taking in more money in premiums than it pays out in coverages. If a patient is prescribed a treatment that is not covered by his insurance, and the insurance company is unwilling to spend the money, then the patient will not benefit from working with the insurer’s patient advocate. (Yes – I do know some insurance company advocates have gone to bat for patients in difficult situations – but that’s because they are good-hearted people and not because they are insurance company patient advocates.)
  • The hospital’s patient advocate / patient representative / patient relations / ombudsman’s job is to help patients get answers while keeping the hospital out of hot water. Now suppose an arrogant surgeon creates problems for the patient (as a mind-blowing example, I share the story of a surgeon who made major waves in the media in my own hometown) – the patient or family complains… But the hospital advocate’s hands are tied. Just like the linked example, he can only report the incident to the powers-that-be. There is nothing he can do to improve the lot of that patient because that surgeon produces millions of dollars in revenue a year.* There is no way he can make progress on the patient’s behalf when the hospital weighs one unhappy patient against that multi-million dollar revenue producing surgeon.On the other hand, a private advocate is able to take much more aggressive action, connecting with lawyers, or the state health department, finding another surgeon for subsequent treatment, and more.

So you tell me – who would you rather have on your side? An employed advocate who is rendered helpless in difficult situations? Or a private advocate who can help you to the fullest extent possible?

So how did the person who made that statement about enemies reach that conclusion?

It seems she decided that there is a contentious relationship between private advocates and hospital or insurance advocates based on the Allegiance Factor.

But our relationship should not be considered contentious at all. We are all trying to improve the experiences the patient is having.** In fact, when asked, I always tell patients that if appropriate, they should try to get help from the hospital or insurance advocate first. Then, if they don’t get what they need, or if their circumstances call for help beyond the scope of those organizations’ advocates, then that’s when a private advocate will be most helpful.

We advocates aren’t fighting each other. We’re so very far from enemies.

We’re all in this together.


Employed and private advocates have the same goals – to help the patients who need them.

Since we have the same goals, we should, instead, collaborate and coordinate our efforts on behalf of our patient-clients. That’s how to create the win-win-win.

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Share your experience or join the conversation!


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*In the linked example, the surgeon was fired after a year of slapping and insulting his patients, then was reinstated six months later. After all – he was a cash cow! An investigation showed that the hospital lost $4.3 million in revenue in just those six months.

** Please note that I have avoided the euphemism “patient experience” here. Patient Experience is the mantra now being used by hospital personnel – usually in marketing departments – for making it seem to patients as if their hospital stays were satisfactory. Most don’t address more important factors like patient safety, or discharge planning, or any of the truly difficult topics. (Although, yes – sometimes hospital food is better than it used to be!)

2 thoughts on “Enemies? No, But With an Important Distinction”

  1. So true! I have found myself explaining the concepts I learned 31 years ago when I first learned team building and negotiations skills and was given a copy of “Getting to Yes” by William Ury. Just a skinny little paperback but so helpful in removing the “butting heads” concept and focusing attention on common goals and outcomes, getting people off of their dug in positions. I have sent several people off to buy that book lately who have said it has been helpful in this field, in working with their families….you name it! Less conflict is better for our clients’ interests if we can get to where they need to be in my opinion! And for our future relationships too.

  2. Nicely written Trisha. Like Lee, I reflect on and utilize the concepts I learned in my graduate school class on negotiation in which we too used “Getting to Yes” by William Ury. The other resource I call upon every day are the Leadership Practices of my favorite researchers and authors on the topic; Kouzes and Posner and the Leadership Challenge. Their framework and The 5 Practices of Exemplary Leadership Model have guided me since graduate school and guide me every day in my work within Healthassist. Inspire a Shared Vision, Challenge the Process, Model the Way, Enable Others to Act, and Encourage the Heart are what we do for, and with, our clients creating an opportunity for the healthcare system to evolve and change to meet their needs.

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