Recognizing Advocacy Needs and Actions in Hospital Care: Patient and Administrator Insights

Background. In the current healthcare system, unresolved problems related to a patient’s hospital care can result in higher costs, less satisfaction, and poorer health outcomes. Advocacy—taking action to help patients express their views, represent their interests, participate in decision-making, or obtain services they need—can support the right of each patient to receive the best healthcare possible. When advocacy is not effective, problems commonly reported by hospitalized patients may remain unresolved and negatively impact outcomes; patients may not receive (1) protection for their ethical rights, (2) quality care based on acceptable guidelines, (3) culturally competent services, (4) preventive services, (5) funding for care, (6) attention to their mental health needs, or (7) access to services in their community.

Little research attention has addressed advocacy needs or advocacy actions related to hospital care. This study’s broad purpose was to examine how often hospital patients and administrators were aware of advocacy needs, engaged in advocacy actions to resolve issues, and the organizational efforts to address problems.

Methods. Participants included a convenience sample of 30 hospital administrators and 30 patients drawn from 8 acute care hospital settings in Los Angeles as part of a larger PCORI study collecting advocacy data from nurses, medical residents, and social workers. Detailed personal and professional information and qualitative narratives collected from structured audio-recorded in-depth interviews were coded and analyzed using a grounded theory approach; these data, along with quantitative data collected on participants were entered into Dedoose software that allowed for mixed methods data analysis to examine narrative differences based on demographic variables, administrator work roles and patient reason for hospitalization and current health status. 

Results. Findings offer rich insights on the nature of advocacy in hospital care, patient identified advocacy needs and actions, and administrative efforts to comprehensively address patient problems in a changing healthcare system. The results suggest that differences in the conceptualization and definition of the term advocacy may result in an underestimation of the amount of advocacy awareness and engagement reported by participants, showing substantial narrative evidence reflecting activities aimed to address patient care and needs. “Quality”, “ethical rights” and “cultural competency” were most often viewed as essential to guiding care in other problematic areas; “mental health” issues were almost always viewed as separate but important to the emotional aspects of patient care. 

Conclusion. Findings provide a baseline of valuable information and insight on advocacy from patients and administrators in acute hospital settings. Evidence suggests that advocacy support offered by patients, family members or professionals can serve to enhance patient care, helping to resolve common problems encountered during a hospital stay. Increasing opportunities to empower the public to act as self-advocates or to assist other patients should be considered as essential for the health literacy for all persons.