A patient advocate may be present for healthcare appointments and alert the healthcare provider about patient compliance issues. He or she may separately assist the healthcare provider and support staff with potential issues and communication challenges. The patient advocate is also responsible for maintaining communication with the patient and healthcare provider to ensure that patients understand the procedures. By reducing fear and increasing patient compliance, this can result in higher successful treatments. Generally, a patient advocacy contract that includes a release of medical information must be placed with each healthcare facility (Ad Hoc Committee on Advocacy, 1969).
Some institutions may require a power of attorney for healthcare for a patient advocate to exchange confidential information. The patient advocate may provide medical literature and research services to the patient, family, or healthcare provider. The patient advocate may also assist with family communication on issues arising from illnesses and injuries . This may include further referral for care and support for both patients and families.
The patient advocate has a responsibility for awareness of compliance, appropriateness, and coordination of care for the patient, such as oversight for potentially conflicting treatment modalities and medications. The patient advocate can ensure that questions about the appropriateness of treatment are promptly discussed with the patient’s care provider, and that all treatments and concerns are promptly entered into the patient’s healthcare record. The patient advocate is also responsible for reviewing the patient’s healthcare record for correctness and for explaining it to the patient. Another responsibility of the patient advocate is to create and maintain an electronic log for the patient that is available on disk to healthcare providers i This log may be of great benefit in subsequent urgent situations. The patient advocate can also assist in resolving disputes between patients and their healthcare provider, as well as engaging in communications on behalf of the patient in case of employment issues by approaching the employer to achieve a mutually beneficial solution for the employer and the individual employee.
Where applicable compliance standards are not met, the patient advocate may conduct liaison with corporate oversight, government agencies, or legal professionals to further negotiate such issues on behalf of the patient and family. It is the duty of a patient advocate to maintain patient privacy according to local and national laws, treating all patient and family information as privileged and protected. This includes ensuring that healthcare providers’ communications are treated as highly confidential and privileged, whether or not those communications are specific to the patient, and that permissions to disclose information are negotiated carefully. It is also the duty of the patient advocate to follow any referrals for medical, financial, legal, administrative or other personnel to assure that the patient is always kept safe and well informed, never abandoned or misled during the process (Carlton, 1984)
When developing a SWOT analysis for the Patient Advocate Organization, three primary purposes emerged: 1. Inspire continued trust and confidence in the nursing profession among patients, their families, and the American people; 2. Leverage nurses, the single largest health care workforce, together with patients, partners in their care, in accelerating performance improvement; and 3. Stimulate reform through shared perspectives, knowledge, and values among nurses and patients, their families, and consumer stakeholders. A SWOT analysis focuses on internal strengths and weaknesses and external opportunities and threats. In this instance, these concepts have been applied to a proposed alliance that serves these three proposed purposes. Typically, SWOT analyses are presented in tabular formats and entries are listed in one of four quadrants in the table (i.e., strengths, weaknesses, opportunities, threats). The SWOT analysis is presented in Table
Purpose 1. Inspire continued trust and confidence.
a. Existing nurse workforce is the largest segment of the healthcare workforce b. Living up to nursing’s promise to represent the patient voice c. Expanding consumer recognized success (e.g., number of hospitals, evidence-based link to quality/safety). d. Expanding and maturing evidence-based that establishes nursing-quality-value linkages. e. Operating consumer advocacy groups is a well-known skill for several of the major groups with which we could partner f. Convener organizations have a proven track record in working together (e.g., areas of education, competency development, leadership)
Purpose 2. Accelerate performance improvement
a. Expanding and maturing evidence-based that establishes nursing-quality-value linkages b. Partnering to expand and accelerate current and future measurement sets (examples follow): b.1. Experience with, and advancement of, measure development and data collection (i.e. NDNQI, AWHONN EDGETM Database, etc) b. 2. Existing national, regional, and state nursing performance measures databases (e.g., NDNQI, CalNOC, Maine and Massachusetts) b.3 Existing national quality measurement and reporting infrastructure (e.g., Compare websites) Purpose
3. Stimulate reform
a. Existing nurse leaders with strong organizational skills and credible backgrounds b. Threats by existing nursing and nurse faculty shortages are widely recognized by policy makers and health care stakeholders. c. Patients and nurses, each individually, make strong advocates; together, their combined effectiveness will likely be transformative d. Reviewing the evidence suggests that nurses make effective policy advocates
Purpose 1. Inspire continued trust and confidence.
a. Existing, numerous professional nursing organizations and specialty groups result in fragmentation and diffusion of the expertise and resources among nursing as a whole. May be confusing/distracting to consumer groups who join an alliance b. Creating a new “fancy” alliance may not change nursing’s image from that of a profession that “takes orders.” We may remain unable to gain access to high levels of policy making and policy makers c. Funding source for sustained support is unknown
d. Participation would be voluntary (e.g., What incentive would organizations have to provide technical time and support for NPQA?) Purpose 2. Accelerate performance improvement a. Representation of VANOD, CalNOC, MilNOD is lacking in the convener group gathering under the planning grant b. Lacking sufficient nursing-sensitive outcome measures and resulting data to address all patients in all settings across an episode of care limits how comprehensively nursing care quality can be portrayed and might limit partnerships with certain consumer groups c. Developing standard language may be necessary prior to creating additional standard measures (e.g., birth date or date of birth) d. Adding/changing billing codes (e.g., G-codes, E-codes) to document nursing care is not in the realm of influence for nurses or consumers but together we may have more success.
Purpose 3. Stimulate reform
a. Nursing is not typically a ‘target’ of federal policies because of employee-employer relationship (rather than direct contractors with payers for services) b. Existing consumer and nursing organizations approach policy makers with multiple requests: lack of unity c. Nursing inclusion within existing alliances may be viewed as duplicative
Purpose 1. Inspire continued trust and confidence
a. Build upon nursing social capital with consumers as the most trusted among health care professions b. Identify (empirically, anecdotally) and enhance the value-added of nursing with consumer participation and support c. Improve consumer understanding about the quality of nursing care d. Improve nursing’s knowledge of consumers’ experience of professional nursing Purpose 2. Accelerate performance improvement
a. Continue quid pro quo to various alliances (i.e. HQA, KCA, QASC) providing entry into these policy discussions b. Dedicates significant, shared resources to improving quality, safety and value c. NPQA could serve as a neutral reporting entity to achieve economies of scale and scope by moving performance measurement reporting from various nursing organizations to a central source. d. NPQA sets agenda for measure adoption and collection
Purpose 3. Stimulate reform
a. Disseminate practice-based questions/issues to policy makers and thought leaders to guide funding of research or studies b. Recognize evidence that suggests that nurses, APRNs and consumer groups have opportunities to strengthen their policy voice c. Vision for proactive, toward thinking policy agenda that can push (e.g. What so we want decision makers know about nursing performance?), pull(e.g. What do decision makers already know about nursing performance ?) and/or Partner (e.g. What do decision makers want/need to know about nursing performance ?)
Purpose 1. Inspire continued trust and confidence
a. Consumer partners may overwhelm nursing. Nursing may be subordinate to consumer leadership. b. Potential to be barraged or criticized by special patient advocacy groups and specialty nursing groups who are not included in membership c. Partnership adds complexity to operational aspects of an alliance such as leadership, governance, membership dues, etc
Purpose 2. Accelerate performance improvement
a. Current national practice specialty organizations (AORN, AANA, ONS, AWOHNN, AACN, ACNM) have limited resources and will have to decide where to invest (e.g., choices will need to be made that could result in weakening NPQA) b. Data may portray low quality nursing performance with subsequent unintended consequences for nursing c. Established boards of both large nursing organizations and consumer organizations may refuse to support or may change support as leadership and resources fluctuate d. Alliances with whom nursing has a quid pro quo relationships have not universally welcomed nursing participation and have rationed our involvement (e.g., don’t recognize different nursing groups) e. Consumer group(s) may not recognize a need to measure nurse performance in the same manner in which nurses do. Conflict may result (e.g. consumers may think, “Did the nurse carry out the order?”)
Purpose 3. Stimulate reform
a. Absence and inattention to nursing issues/strengths in health care reform proposals b. Presence of a strong medical lobby and physician advocacy groups linked with consumers c. Established alliance landscape and inconsistent/ ‘unwelcoming’ nature among existing alliances to nursing d. Lack of awareness by policymakers of the necessity to engage nursing to realize dramatic and sustainable improvements in quality and safety
Before implementing this process in South Florida, it is necessary to conduct the market research to check whether this process has market relevance to this area. In other words, it is important to find out whether customers want to use patient advocacy and then analyze if it is available for implementing it in this area via the drives of value. Basically, there are three interdependent drivers of value, including population health, patient experience and total cost per capital, to promote the development of patient advocacy. The data published by U.S. census government shows that the population in Florida is experiencing a huge change during recently year, no matter the change is characteristic by age or race. First, as illustrated in Figure 2, we can see that from 1960 to 2040, the actual and projected census population will rapidly grow from around 50,000 to over 25,000,000 in Florida. There are two main factors causing this phenomenon. On the one hand, there are the baby boomers. This accounts for the natural population increase. While births exceeded deaths during each of the two decades, less than half a million persons were added to Florida’s population each decade due to the natural increase.
On average, 118 more Floridians were born than died each day during the decade of the nineties (Census Report, 2000). On the other hand, individuals’ life expectancy is rapidly extended. As populations of modern societies have begun to age, the older age cohorts have become disproportionately represented. Figure 3 show that the age group over 65 and up holds the largest percentage during 2010 to 2030. For example, in the area of Southeast Florida, its population of 6.2 million, is larger than 34 of the 50 states in 2008. About one in every three (31.2%) South Florida resident was born in the state of Florida. Meantime, in South Florida, the elderly are projected to reach almost one million (20.7% of the total) in 2030, up from 14.4% in 2010 (Ogburn, 2010). Compared to the Treasure Coast, the change is becoming more obviously as it is shown in Figure 4. The data described above figures out that even though the population growth slowed down in recent days, South Florida continues to grow at a speed that is faster than the nation as a whole, with higher rates in the northern region.
Apparently, the change population characteristic provides a huge market for the patient advocacy. A demographic trend often overlooked in discussions of healthcare is the changing structure of American families and households. There has been a decline in the proportion of the population that is married and a proportionate increase in the size of the single, divorced, and widowed population. The average household size has declined, and there has been a large increase in the proportion of the population that lives alone. Therefore, more and more households are involved in the health industry to some extent. This means that Floridians’ expectations for acquiring healthcare knowledge and learning about diseases is increasing. This will help them know how to make decisions when they face the healthcare problem and know whether the plan recommended by physicians and nurses are available to them. Secondly, as illustrated in Figure 5, it can be shown that the race/ethnic composition of Southeast Florida was made up of 37% Hispanic or Latino.
In 2000, the non-Hispanic White population represented 47% of the regional total, down from 57% in 1990. In other words, the non-Hispanic White population of Southeast Florida ceased to be the majority sometime in the 1990s, due mostly to the growth of the Hispanic population in Miami-Dade Country (Ogburn, 2010). Hence, it is very important to take the Spanish language into account when patient advocacy is established. Thirty-three percent of the South Florida population is over age 65, so for those elderly who do not know how to speak English, patient advocacy could help them understand what the medical staff tell them about their diseases or how to take those pills. It also helps to reduce the potential abuse error when patient advocacy staffs teach those patients via their own language.
Thirdly, as acute illness has declined as the pervasive type of disorder, chronic conditions have emerged as the dominant type of health problem in developed countries. Chronic conditions generally do not contribute directly to mortality, but are often cited as underlying causes of death. They are more likely to interfere with the quality of life, since they often result in some form of disability. Chronic diseases always result in more cost and more time for recovery. Some maybe even cannot be treated. Thus, patients find themselves confused about the advantages and disadvantages of the treatment. Patient advocacy members listen to confused patients and help them collaborate with physicians and insurance companies. Patient advocacy will offer medical assistance, insurance assistance, home health assistance, elder and geriatric assistance and legal assistance. Those types of assistance will help patients with chronic illnesses to understand their healthcare conditions in detail.
The Four Ps
The four marketing Ps (product, price, place and promotion) are important in developing the entire marketing process for every company or organization. In other words, the heart of a marketing strategy is the development of a response to the marketplace. For every business, all they need to do first is to identify the customers’ needs, and then determine the price customers are willing to pay. Then, they need to identify what place is most convenient for customers to purchase the product or access the service and, finally, they need to promote the product to customers to let them know it is available (Berkowitz, 2011). Hence, when conducting the Four Ps analysis, there are some questions we need to figure out. Those questions are shown on Figure 6.1 (“4Ps Marketing,” n.d.):
The important thing to remember when offering the service of patient advocacy to customers is that they have a choice. For example, for health care providers, they can rely on the customer service center in their own organization to deal with patients’ complains; for patients, they might turn to their doctors or friends who have those treatment experience for help when they need. Therefore, patient advocacy organizations should considerable emphasis on developing a list of help service which customers really want. For example, in South Florida, as we also mentioned earlier in this paper, a large proportion of people speak Spanish as their first language, so Spanish speaking can become a selling point and add into the service list in this area; especially in a situation of establishing commutation between a Hispanic or Latino patient and an English-speaking physician. What is more, for those existing services, the organization should also pay attention to the product life cycle as well.
For example, with the implementation of Obama Care, the American healthcare system has become a complex system, and it has become increasingly difficult for patients to understand and adapt, so patients’ fears and frustrations have continued to grow since they may get confused by the new policies and become worried about how to get their reimbursements after the treatment. In other words, customers’ requirements change over time. What is important and useful today may be discarded tomorrow. Therefore, marketing should continuously monitor the external environment and other factors to modify the services in order to meet the customer’s need.
Price focuses on what customers are willing to pay for a service (Berkowitz, 2011). And the customer’s perception of value is an important determinant of the price charged. Customers draw their own mental picture of what a service is worth. So the pricing decision is a major aspect of marketing strategy. In the healthcare industry, the issue of price is less likely to be a concern since pricing was based on predetermined reimbursement formulas. However, in order to sustain and develop and organization, whether public, non-profit organization, private, or for-profit, patient advocacy organizations still need to pay attention on how they establish the price.
1. The Types of Services and Complexity of Service.
As customers’ needs are varied, there are perhaps dozens of services health advocates can provide, ranging from explaining treatment options to reviewing hospital bills, from uncovering clinical trials appropriate to customer’s need, to getting their insurance company to pay a claim they think should be covered. Each service should cost differently according to the time it takes to accomplish it.
2. The Background and Expertise of the Employee
Just as would be true in any service business, the more credentials an advocate has achieved, the more it will cost. Further, some advocates have developed specific niches to their work that becomes a benefit to customers, who may be worth a higher salary. So obviously, a higher price should be made for these employees in order to sustain the organization.
3. Geographic Location.
Just as there are variations in cost for almost anything we buy based on where we live, the same is true for health advocacy services. As shown in Figure A7 (“Miami Household,” 2011), in Florida, take Miami as an example, households with income under 15,000 reached 25% in 2010, which was twice as many household of the entire United States. Considering the low-income rate in this area, the price should not be too high when providing services. However, the danger of using low price as a marketing tool is that the customer may feel that quality is being compromised. It is important when deciding on price to be fully aware of the brand and its integrity. A further consequence of price reduction is that competitors match prices resulting in no extra demand. This means the profit margin has been reduced without increasing sales.
All businesses must decide how many other organizations are needed to distribute their product or service, so does the patient advocacy organization (Berkowitz, 2011). In fact, the purpose of getting any intermediary organizations involved is to provide service to customers in a more accessible way. Therefore, not only big general hospital, but also small primary care clinic should be considered when providing services. Besides, “place’ in the marketing mix, is not just about the physical location or distribution points for services. Especially in the healthcare industry, it encompasses the management of a range of processes involved in bringing patient advocacy to the end consumer.
Promotion is more than just advertising (O’Malley, 2001). The promotions aspect of the marketing mix covers all types of marketing communications such as advertising, personal selling, publicity, and sales promotion. However, advertising is an important part of promotion. Generally, advertising is conducted on TV, radio, cinema, online, poster sites and via the printed press (e.g., newspapers, magazines). Different advertising channels can be used to maximize the effectiveness of advertising. For example, TV advertising makes people aware of a help service and press advertising provides more detail. This may be supported by in clinic or hospital recommendation to get people to try the service. It is imperative that the messages communicated support each other and do not confuse customers. A thorough understanding of what the brand represents is the key to a consistent message. The purpose of most marketing communications is to move the target audience to some type of action.
This may include purchasing the service, visiting or calling the organization, and recommending the choice to a friend or purchasing another service that he or she may also need. The key objectives of advertising are to make people aware of the service offered by the organization, which they cannot get from anywhere else, and to feel positive about it and remember it. Therefore, when promoting, messages should gain the customers’ attention and keep their interest. The next stage is to get them to want what is offered. Showing the benefits that they will obtain by taking action is usually sufficient. The right messages must be targeted at the right audience, using the right media. Take South Florida as an example, 33% of the population in this area is over age 65, so it is important to find an advertising channel to reaches this group of people. In this case, Internet advertising may not be such a good idea while newspaper and television may bring more customers to the organization instead.
After analyzing the market in South Florida, we can easily reach the conclusion that there are great needs to have patient advocacy in South Florida. In fact, patient advocacy is an emerging practice, and it deserves more recognition when developing healthcare business. Whether you are in private practice, serve as a hospital patient advocate or are developing an advocacy program in a managed care company, having a clear marketing plan of patient advocacy in your business region is a key factor to successfully grow your practice in the future.
Agency for Healthcare Research and Quality. Healthcare costs and financing. Research Activities. 2011. Accessed at heep://www.ahrq.gov/research/jun11/0611RA11.htm. Ad Hoc Committee on Advocacy. (1969). The social worker as advocate: Champion of social victims. Social Work, April, 16–20. Berkowitz, E. N. (2011). Essentials of Health Care Marketing. 3rd Edition. Jones & Bartlett Learning, LLC. Carlton, T. O. (1984). Clinical social work in health settings. New York: Springer Publishing Company. Florida Population: Census Summary 1990 and 2000.
Make a difference as a patient advocate. Retrieved from: http://allhealthcare.monster.com/benefits/articles/3210-make-a-difference-as-a-patient-advocate?page=2 Miami Household Income Statistics (2011). CLR
Search.Retrieved from: http://www.clrsearch.com/Miami-Demographics/FL/Household-Income Ogburn R. F., 2010. Demographics and population growth in southeast Florida. South Florida Regional Planning Council. Retrieved from http://www.sfrpc.com/region/demographics.htm
O’Malley, J. F. (2001). Healthcare marketing, sales, and service: An executive companion. Chicago: Health Administration Press, p. 101 4Ps Marketing Mix Example (n.d.). SmartDraw. Retrieved from http://www.smartdraw.com/examples/view/4ps+marketing+mix/