Inventing Management Reforms to Promote Greater Advocacy by Health Professionals in Acute-Care Hospitals

A review of hospital management literature indicates minimal attention to the provision of advocacy, even though the codes of ethics of nursing, medicine, social work, and public health require their members to engage in advocacy, as do the accreditation standards of the Joint Commission.  Advocacy has mostly been relegated to literature of these various professions, even when data from a PCORI-funded research project suggests that management reforms are needed to encourage advocacy by health professionals.

This research project collected quantitative data about advocacy from 300 frontline workers (nurses, medical residents, and social workers) in eight acute-care hospitals in Los Angeles County, as well as qualitative data from 30 administrators and 30 patients.  This data has greatly expanded scientific knowledge about the extent these frontline professionals engage in advocacy at patient and policy levels with respect to problems widely experienced by hospitalized patients in seven core areas: ethical rights, quality care, preventive care, culturally responsive care, affordable care, mental health care, and community-based care.  This data has also provided information about psychological, sociological and organizational factors that predict whether frontline workers will engage in patient advocacy and policy advocacy.  This data will be used to identify possible management reforms that may increase the amount and quality of frontline professionals’ advocacy, including increasing tangible job supports for advocacy, providing training and incentives to identify and address patients’ unresolved problems, increasing organizational receptivity to advocacy along several dimensions, providing training to frontline professionals about how to provide advocacy, and restructuring hospitals’ culture so that it embraces advocacy. We will also identify possible barriers to advocacy among administrators by discussing qualitative data obtained from in-depth interviews.  We will discuss strategies for addressing these barriers so that administrators commit to management reforms that will enhance advocacy engagement by frontline professionals in their hospitals.