Improving Healthcare Through Advocacy E-Book

Bruce S. Jansson

• Herausgeber: John Wiley & Sons
• Kategorie: Geisteswissenschaft
• Sprache: Englisch

Seitenzahl: 1079

Veröffentlichungsjahr: 2010

Beschreibung

Praise for Improving Healthcare Through Advocacy A Guide for the Health and Helping Professions "Bruce Jansson's thoughtful and innovative book will appeal to students in social work, nursing, and public health as well as those working in the health field of practice. The case examples are extraordinary, and Jansson provides the ideas, context, and theoretical base for readers to acquire the skills of advocacy in healthcare. This is by far the best advocacy book I have seen." --Gary Rosenberg, PhD Director, Division of Social Work and Behavioral Science Mount Sinai School of Medicine "Improving Healthcare Through Advocacy is a terrific description of opportunities for advocacy intervention and provides the skill sets necessary for effective advocacy. A needed book." --Laura Weil, LCSW Director, Health Advocacy Program Sarah Lawrence College "Improving Healthcare Through Advocacy is an invaluable resource for practitioners working in the healthcare field as well as for students. It very thoroughly covers healthcare advocacy issues, contains real-world case examples, and provides a clear, step-by-step framework for practicing advocacy." --Kimberly Campbell, ACSW, LCSW Lecturer, Department of Social Work Ball State University An important resource for all who strive for the best in healthcare treatment for their patients, themselves, and the nation Bestselling author and award-winning researcher Bruce S. Jansson uses an intervention framework to illustrate how everyone in the healthcare system can advocate effectively, not just for better healthcare delivery to individual clients but for the necessary policy change that will deliver long- term solutions to our nation's healthcare crisis as well. Improving Healthcare Through Advocacy provides professionals with: * Tools to move from traditional services to case advocacy and policy advocacy tasks * Over 100 case studies from the perspective of patients, healthcare providers, and others who relate the experiences they have encountered in the healthcare system and share the wisdom they have learned * Practical tips on how to provide effective advocacy and bring about positive and long-term change in this complex environment

Leseprobe

Table of Contents

Cover

Title

Copyright

Dedication

Preface

Chapter 1: Embedding Advocacy in the U.S. Health System

Seven Problems Commonly Encountered by HealthCare Consumers

Advocacy

Scenarios and Vignettes

Resurgence of Interest in Case and Policy Advocacy

Advocacy from Outside the Health System

Advocacy as an Underground Activity

Advocacy as an Ethical Imperative

A Philosophical Premise

An Outline of This Book

Online Materials Relevant to This Chapter

Chapter 2: How the U.S. Health System Contributes to Consumers' Seven Problems

The Poor Law Tradition

Emphasis on Technology

Entrepreneurialism

Insufficient Emphasis on Prevention

Lack of Diversity in Medical Personnel

Uneven Acceptance of a Biopsychosocial Framework

Medical Silos and Insular Care

From History to Case and Policy Advocacy

Online Materials Relevant to This Chapter

Chapter 3: An Advocacy Practice Framework

Brief Overview of Case-Advocacy Interventions

Eight Case-Advocacy Tasks

Task #1: Reading the Context

Task #2: Triage

Task #3: Allocating Case Advocacy Services

Task #4: Diagnosing Task

Task #5: The Strategizing Task

Task #6: Implementing Case-Advocacy Strategy

Task #7: Assessing Advocacy Interventions

Task #8: Progressing to Policy Advocacy

Case Advocacy for a Very Sick Child

Summary

Chapter 4: Case Advocacy Skills

Four Skills for Reading the Advocacy Context (Task #1)

Four Skills for Case-Advocacy Triage (Task #2)

Four Skills for Allocating Case-Advocacy Services (Task #3)

Four Skills for the Diagnosing Task (Task #4)

Four Skills for the Strategizing Task (Task #5)

Four Skills for the Implementing Task (Task # 6)

Four Skills for the Assessing Task (Task #7)

Four Skills for the Progression Task (Task #8)

Two Skills in More Detail

The Nature of Influence

Empowering Consumers

Empowerment (Continued)

Advocacy with Respect to Seven Consumer Problems

Chapter 5: Advocacy to Protect Consumers' Ethical Rights

Promoting Ethical Conduct in Healthcare

The Policy and Regulatory Thicket for Promoting Ethical Conduct

Obtaining Skills in Ethical Reasoning at the Case Level

Nineteen Scenarios Encountered by Case Advocates

Summary

Moving From Case-Advocacy Scenarios to Broader Policy Issues

Online Materials Relevant to this Chapter

Chapter 6: Advocacy to Improve Consumers' Quality of Care

A Definition of “Quality HealthCare”

General Criticisms of the Success of U.S. Healthcare in Addressing Physiological Illnesses

The Policy and Regulatory Thicket as It Pertains to Quality of Care

Fifteen Scenarios Encountered by Consumers with Respect to Quality of Care

Online Materials Relevant to This Chapter

Progressing from Case Advocacy to Policy Advocacy to Enhance Quality of Care

Chapter 7: Advocacy to Promote Culturally Competent Health Services

Conceptualizing Cultural Competency

What It Means to Be Culturally Competent: A Conceptual Framework

The Case for Providing Culturally Competent Services

The Policy and Regulatory Thicket

Ten Scenarios Pertaining to Culturally Incompetent Services

Policy Advocacy to Promote the Cultural Competency of the Health System

Moving from Case Advocacy Scenarios to Broader Policy Issues

Chapter 8: Using Advocacy to Promote Prevention in Health

Defining Prevention

Threats to Health

Prevention Goals and Strategies

Why U.S. Consumers Particularly Need Prevention

Barriers to Prevention

The Policy and Regulatory Thicket

Twelve Scenarios of Consumers Regarding Preventive Services

Moving from Case Advocacy to Policy Advocacy

Summary

Chapter 9: Using Advocacy to Help Consumers Finance Their Healthcare

Buck-Passing

Seniors' Angst

The Medical Wheel of Fortune

Some Effects of Poor Coverage on Health Outcomes

Ripple Effects of Health Costs and Coverage

The Policy and Regulatory Thicket Protecting Consumers with Respect to Health Coverage

Twenty Scenarios Encountered by Advocates

Moving from Case Advocacy to Policy Advocacy

Fifteen Scenarios Presented in This Book

Online Materials Relevant to This Chapter

Summary

Chapter 10: Advocacy for Healthcare Consumers Needing Mental Health Services

Why Many Consumers Turn to Health Settings for Help with Mental Conditions

Kinds of Mental Distress Often Experienced by Consumers

Who Attends to Consumers' Mental Health Needs?

Some Liabilities in the Policy and Regulatory Thicket

Assets in the Policy and Regulatory Thicket

The Policy and Regulatory Thicket: Laws, Regulations, and Staff That Facilitate Social and Mental Health Services

Twenty-Six Scenarios Encountered by Case Advocates

Moving From Case Advocacy to Policy Advocacy

Chapter 11: Advocacy to Help Consumers Receive Community-Based Care

Consumers' Health Ecosystems

A Compendium of Community-Based Health Services

Assets and Liabilities in the Policy and Regulatory Thicket

Fifteen Advocacy Scenarios for Consumers Needing Community-Based Care

Moving from Case Advocacy to Policy Advocacy

Online Materials Relevant to This Chapter

Summary

Chapter 12: A Framework for Policy Advocacy by Healthcare Professionals

The Importance of Policy Advocacy

A Policy Advocacy Framework

Surmounting Fatalism, Controversy, and Vested Interests

Policy Advocacy in Four Settings

Chapter 13: Using Policy Advocacy to Embed Advocacy in Healthcare Organizations

What Advocates Seek to Change in Health Organizations

Using Policy Advocacy to Embed Advocacy in Health Organizations

Summary

Chapter 14: Policy Advocacy in Community, Electoral, and Government Settings

Health Advocacy in Communities

Policy Advocacy in Electoral Settings

Policy Advocacy in Legislative and Regulatory Settings

Advocating for Regulatory Changes

Establishing a Policy Agenda in Specific Health Settings

Online Materials Relevant to This Chapter

Summary

References

Author Index

Subject Index

Wiley End User License Agreement

List of Tables

Chapter 3: An Advocacy Practice Framework

Table 3.1 Evaluating the Context

Chapter 5: Advocacy to Protect Consumers' Ethical Rights

Table 5.1 Ethical Reasoning Matrix

Chapter 7: Advocacy to Promote Culturally Competent Health Services

Table 7.1 The 4 Cs of Culture

Table 7.2 Racial Distribution in the U.S., 2000 to 2007

Table 7.3 Differences in Communication Styles: Asians and Caucasians

Table 7.4 Strategies to Address the Needs of Patients With Limited Health Literacy

Chapter 10: Advocacy for Healthcare Consumers Needing Mental Health Services

Table 10.1 Mental Health Interventions in Healthcare

Chapter 11: Advocacy to Help Consumers Receive Community-Based Care

Table 11.1 Community-Based Health Services at the Case Level

Chapter 12: A Framework for Policy Advocacy by Healthcare Professionals

Table 12.1 Using Policy Analysis to Develop Policy Proposals

Chapter 13: Using Policy Advocacy to Embed Advocacy in Healthcare Organizations

Table 13.1 Extent Nurses and Social Workers Reported They Were Aware of, Became Involved in, and Wanted Greater Participation in Ethical Deliberations

Table 13.2 Questions Probing Extent of Case Advocacy Regarding Consumers' Ethical Issues By % Choosing Specific Answers

Table 13.3 Social Workers and Nurses Involvement in Policy Advocacy to Create Policies and Practices to Enhance Involvement in Ethical Deliberations

List of Illustrations

Chapter 1: Embedding Advocacy in the U.S. Health System

Figure 1.1 Consumer Advocacy and Navigational (CAN) Model

Chapter 2: How the U.S. Health System Contributes to Consumers' Seven Problems

Figure 2.1 Systemic Causes of Consumers' Seven Problems

Chapter 3: An Advocacy Practice Framework

Figure 3.1 A Case Advocacy Framework

Chapter 4: Case Advocacy Skills

Figure 4.1 Direct Power Transactions

Figure 4.2 Exerting Influence Through Intermediaries

Chapter 7: Advocacy to Promote Culturally Competent Health Services

Figure 7.1 Process of Cultural Competency

Figure 7.2 “Bottom-Lines” from the Department of Health and Human Services LEP Guidance

Figure 7.3 Excerpt of “I Speak” Card developed by the U.S. Census Bureau

Figure 7.4 Guiding Principles for Organizational Cultural Competency

Chapter 8: Using Advocacy to Promote Prevention in Health

Figure 8.1 Linked At-Risk Populations

Figure 8.2 Benefits of Different Kinds of Prevention

Chapter 9: Using Advocacy to Help Consumers Finance Their Healthcare

Figure 9.1 Shares of Health Spending

Chapter 12: A Framework for Policy Advocacy by Healthcare Professionals

Figure 12.1 Five Systemic Factors That Require Policy Advocacy

Figure 12.2 Policy Advocacy Framework

Guide

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Table of Contents

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Improving Healthcare Through Advocacy

A Guide for the Health and Helping Professions

Bruce S. Jansson

Copyright © by John Wiley & Sons, Inc. All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey.

Published simultaneously in Canada.

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Library of Congress Cataloging-in-Publication Data:

Jansson, Bruce S.

Improving healthcare through advocacy: A guide for the health and helping professions/Bruce S. Jansson.

p.; cm.

Includes bibliographical references and index.

ISBN 978-0-470-50529-8 (paper: alk. paper); 978-1-118-04414-8 (ePub); 978-1-118-04415-5 (ePDF); 978-1-118-04416-2 (eMobi)

1. Patient advocacy–United States. I. Title. [DNLM: 1. Patient Advocacy–United States. 2. Patient Rights–United States. W85.4 J35a 2011]

R727.45.J36 2011

2010019082

610–dc22

To Lisa Gebo, who taught us how to be skilled

advocates as she battled breast cancer

Preface

The Goal

For the millions of people who navigate the American healthcare system, there are seven common problems they often encounter:

1.

They cannot finance their care.

2.

They receive care that does not meet widely accepted standards.

3.

They encounter violations of their ethical rights.

4.

They receive care that is not culturally competent.

5.

They fail to receive needed preventive services.

6.

They fail to receive appropriate care for their mental health.

7.

They do not receive care that links their healthcare to the communities where they live.

Despite these deficiencies, existing health literature and textbooks fail to discuss sufficiently how health professionals can become advocates for people with these problems—whether at the case or patient level, or at the policy level. Improving Healthcare Through Advocacy provides the first, detailed, hands-on, step-by step, case advocacy framework (see Chapters and), as well as a companion policy advocacy framework (see Chapter). Each of these frameworks identifies specific tasks of advocates as they provide advocacy interventions, whether at the case or policy levels. Each describes value-clarifying, analytic, influence-wielding, and interactional skills.

Case and policy advocates campaign on behalf of patients or health consumers—or empower them so they can be their own advocates—so that they receive the services, benefits, and rights that they are currently being denied. Advocacy is a highly skilled intervention that often requires the use of influence, assertiveness, and negotiation skills.

Chapters through utilize 118 specific scenarios to describe situations where health consumers often need case advocacy with respect to the seven problems identified previously. Some examples of these scenarios include: Scenario 5.1: Advocacy to Enhance Consumer's Informed Consent (in Chapter, which discusses health consumers' or patients' ethical rights), Scenario 6.1: Advocacy to Help Consumers Learn About Evidence-Based Care (in Chapter, which discusses health consumers' or patients' right to quality care), and Scenario 8.1: Advocacy to Help Consumers Identify PersonalAt-Risk Factors (in Chapter, which discusses preventive services).

The book also provides many vignettes authored by health professionals or patients themselves. These brief scenarios illustrate how professionals engage in advocacy and why patients or health consumers often need them.

The case and policy frameworks are embedded in their respective policy and regulatory contexts because advocates cannot protect the rights of consumers if they are not informed about the myriad laws and regulations that entitle health consumers and patients to specific rights, benefits, and services. These include HIPAA; Medicare, Medicaid, and S/CHIP, the Americans with Disabilities Act, and the Patient Protection and Affordable Care Act of 2010.

Advocacy is also discussed in its organizational context. Advocates often encounter resistance and negative repercussions from their advocacy. I discuss strategies for minimizing these repercussions. Time pressures also can often make advocacy difficult—this book seeks to identify ways healthcare workers can triage patients to determine who most needs advocacy. It includes discussion of how clinics and hospitals can discourage, as well as promote, use of advocacy—and provides strategies for how readers might team with other health professionals to create institutions that welcome and encourage advocacy.

Advocacy is on the upswing in the health services industry due to the prominence of consumerism and evidence-based practice. Some of the most prominent health systems and institutions that promote advocacy across the nation are identified.

Patients and health consumers often need policy advocacy because their care is hindered by defective policies and procedures in organizational, community, and government settings. I discuss how policy advocates can work to make their clinics and hospitals more receptive to advocacy. (Chapter provides exploratory data that suggest health professionals are more likely to engage in advocacy when it is supported by specific organizational mission, culture, and working arrangements.)

For Whom?

In theory, this book is intended for social workers, nurses, public health staff, and residents (who I sometimes call “frontline staff”) because they have more contact with health consumers and patients than many physicians. In practice, this book is intended for every health professional because all of them see patients and health consumers whose needs are not currently met by the health system.

Improving Healthcare Through Advocacy can be used in the classroom where its combination of policy, regulations, advocacy interventions, and specific scenarios provide ideal teaching tools. The book's advocacy frameworks and scenarios can be used for role plays and classroom simulations. Its 118 scenarios describe real-life situations confronted by many patients and health consumers who clearly need the help of an advocate. It can be used in continuing education settings because many health professionals must augment their education in order to learn how to provide advocacy interventions.

Consider this book, then, as a bottom-up approach for improving healthcare that complements and supplements top-down policies such as statutes, regulations, and evidence-based medicine. It makes the case that health professionals have an ethical imperative to provide advocacy—and it offers a hands-on methodology for providing it.

Added Value

Online materials accompany specific chapters in this book at clearly marked places. You may access these materials at www.wiley.com/go/jansson. Also, readers may wish to visit the web site that I am currently establishing for brief updates relevant to this book: http://www.janspan.org.

Acknowledgments

I am grateful to have received assistance from many people. Helpful comments on the manuscript were given to me by Gary Rosenberg, Ph.D., Director of the Division of Social Work & Behavioral Science at Mount Sinai Hospital in New York City; Laura Weil, M.A. Director of the Health Advocacy Program at Sarah Lawrence College; Kimberly Campbell, ACSW, LCSW, Department of Social Work, Ball State University; Iris C. Freeman, M.S.W, Public Policy Consultant with Advocacy Strategy, Minneapolis, MN and Associate Director of the Center for Elder Justice and Policy at the William Mitchell College of Law, St. Paul, MN; Cassandra J. Bowers, Ph.D., School of Social Work, Wayne State University; and Ann W. Banchoff, M.S.W., M.P.H., Program Director of the Office of Community Health of the School of Medicine of Stanford University.

I greatly benefited, as well, from feedback on early drafts from three health professionals: Julie Anne Miller, M.S.W., Director of the Department of Social Work at Huntington Hospital; Charles Mulley, RN, Care Coordinator at Huntington Hospital; and Carlos Sosa, MSW, Clinical Professor at the USC School of Social Worker and Department of Social Work at Huntington Hospital.

I was greatly assisted in researching this book by the late Jennifer Paek, M.S.W., who tragically died before this book came into print. I benefited from her considerable experience in hospital social work and her commitment to vulnerable populations. She collected some of this book's vignettes. She documented that existing health literature has often exhorted health professionals to engage in case and policy advocacy, but failed to provide them with a hands-on advocacy framework. She tracked down many citations.

Min Ah Kim, M.S.W., and a doctoral student at the University of Southern California School of Social Work, located many citations in this book, particularly in Chapters and, as well as helped to develop schematic figures. Erica Lizano, M.S.W, M.P.H, and a doctoral student at the University of Southern California School of Social Work, infused her knowledge of organizational behavior into Chapter, which she coauthored with me. Dr. Dennis Kao, Assistant Professor at the School of Social Work at the University of Houston, coauthored Chapter with me. His considerable experience in advocacy with persons from different racial and ethnic groups proved indispensable.

I am indebted to Professor Sarah-Jane Dodd at the School of Social Work at Hunter College for developing and analyzing exploratory data that I cite in Chapter that suggests that the hospital context powerfully influences the extent that social workers and nurses engage in advocacy. Professionals who work in settings that emphasize collaboration, team practice, and multidisciplinary training sessions are far more likely to engage in case and policy advocacy than other professionals.

I am obliged to many students in a graduate health-policy course at the School of Social Work of the University of Southern California, particularly the class of spring 2009, who gave me useful suggestions about this emerging book. Nadya Hernandez and Shunae Dyce contributed vignettes at the ends of Chapters and, respectively. Thanks to Gina Frierman-Hunt for her fact-checking and location of citations as this book neared completion.

This book is dedicated to the late Lisa Gebo who, at the end of Chapter, contributed a moving personal account of her use of advocacy to battle breast cancer.

Chapter 1Embedding Advocacy in the U.S. Health System

I discuss a bottom-up approach to reforming the American health system in this book, which is to be used in tandem with top-down approaches such as those enacted by the Patient Protection and Affordable Care Act of 2010 as amended by Congress. Health professionals and consumers ultimately decide who gets served and with what benefits and services, even if high-level policies shape these choices—and they must take the initiative to correct ill-advised healthcare choices and policies through the use of advocacy.

I argue in this book that health professionals and consumers often must engage in advocacy to increase the odds that consumers will receive quality services, as well as preventive services, protection of their ethical rights, access to services, culturally-competent services, attention to stress and mental-health issues, and linkages to community resources. I cite extensive research that documents that millions of Americans don't receive these services and benefits.

Advocacy has received insufficient attention in existing health literature, whether the literature of physicians, social workers, psychologists, public health staff, nurses, occupational therapists, or physical therapists. I argue that these professionals have an ethical duty to advocate for specific patients or consumers when they don't receive needed services and access to care—or to provide patients or consumers with the skills and knowledge to advocate for themselves.

I argue that case management and navigation services, while important, do not give sufficient attention to advocacy. They focus on coordinating care and helping patients and consumers navigate the health maze, but they do not usually provide advocacy.

Many health professionals and consumers won't engage in advocacy, however, if they don't learn how to provide it. It requires them to develop specific advocacy skills. This book provides the first framework that links advocacy for individual patients or consumers (case or patient advocacy) with advocacy for groups of patients or consumers (policy advocacy). It identifies specific skills needed by advocates in sufficient detail that they can develop a practice of advocacy in their work.