Should management teams double as patient advocates?

The last thing that the manager of billing or medical records might expect to do is to make rounds on patients. But at Brockton (MA) Hospital, that’s exactly what they do one Saturday or Sunday every quarter. All of the institution’s clinical and nonclinical managers act as patient advocates on weekends when the full-time advocate is off duty.

The program reflects CEO Norman Goodman’s passion for showing patients that the hospital is in business to serve them. (See "Managers’ weekend rounds win approval," p. 102.)

While the program rounds out the patient advocacy function at Brockton, it could not exist without support from the top, cautions Carol Martin, the hospital’s QI coordinator and director of Cardiopulmonary/Rehabil-itation Services. After all, she notes, "management staff typically work 60-hour weeks, and we asked even more of them." Perhaps even more momentous than the time commitment was the plunge into unfamiliar territory.

Some of the administrators, particularly from the support functions, hesitated to volunteer for patient visits. To mitigate their concerns, Martin provided orientation to address all facets of patient contact. In addition to the universal precautions such as hand washing to maintain infection control, "we did not minimize or underestimate nonclinical people’s fears of illness. We took into account that we were taking people out of their comfort zones."

Trainees were encouraged to ask questions and express their doubts about what to say to patients and how to handle emotional situations. "After all, a finance specialist didn’t go into health care for patient contact," Martin says. "We recognized that nonclinicians would have the same type of fears as clinicians have when they become managers and face budgets and finance reports and trend measurements for the first time."

The first hurdle was the worst. At this point, most of the participants are eager to share their experiences with colleagues.

Martin suggests that managers’ rounds might be worth considering under the following conditions:

• If your facility has no patient advocacy program, it would be helpful to initiate managers’ rounds during the week. "Our industry needs to make patients the No. 1 focus of our existence," she insists. "How better to do that than start from the top?"

• If a patient advocacy service is not in place on weekends, managers’ rounds might fill the gap. Martin explains, "With short lengths of stay, some patients come in on the weekends and they’re discharged before the patient advocate can come to see them. If they leave with unresolved issues, the bad feelings might fester and you’ll never be able to take care of them. We are a 24-hour industry. So we have to stop thinking Monday through Friday because a lot can happen on weekends."