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Susan CournoyerThis blog welcomes guest posts from SPM members on relevant topics. One of our Society’s newest members, Susan Cournoyer, is a tech industry analyst, and is familiar with the concept of systems that are well designed or weakly designed, e.g. with a “single point of failure” – a single item that, if it breaks, makes the whole system fail. 

When that “system” is patient feedback, the result can be that nobody in the whole system ever hears the patient’s voice – a complete failure of patient experience, rendering patient-centered care design impossible. Her story sounds all too familiar.

When no other feedback channels exist, the Patient Advocate becomes a single point of failure

“Have you reached out to Louise*,”  the hospital administrator asked me. “She’s our Patient Advocate.” The manager for women’s healthcare continued, “I know you called to tell us about your experiences, but we can’t listen to just anybody who calls in.”

I am slow to contact the Patient Advocate, partly because I notice that she appears to be among the least credentialed on the hospital staff. I see big titles for some executives, such as the Chief Quality Officer, with an MD and an MPH. Apparently, the Chief Quality Officer works with the medical staff. These must be the “somebodies” in this hospital. Louise, though, manages Patient Relations, and has been doing something along these lines for 25 years. A quick look at the org chart tells me that Louise does not rank as a decision-maker in the organization. Based on her LinkedIn page, Louise has no specific credentials. I guess that qualifies her to work with the average anybodies who walk in off the street for medical care here.

I admit that I have been trying to avoid the route of the patient advocate. I would rather provide feedback than deal with the bureaucracy to file an official complaint. However, this marks me as a naive “anybody” in the healthcare universe. I also have read that patient complaints usually end up with private meetings and non-disclosure agreements —  Matthew Syed covers this likelihood in detail in his new book: Black Box Thinking: Why Most People Never Learn from Their Mistakes — But Some Do. (Maybe Louise soothes dissatisfied patients while they navigate the bumpy path to non-disclosure agreements.)

As I have reached out to different contacts across this hospital, I notice that Louise seems to be the only contact for patient questions. In my field – high technology – when only one names comes up again and again, we have learned to ask whether this could be a single point of failure, or an accidental dead end.  I have learned that for medical practitioners in this hospital, the hospital has leaders for Quality at several levels of the organization. Maybe this gives practitioners some options when they have questions or concerns. But for patients, all roads lead to Louise.

Could it really be that one of the least credentialed staff in the organization – the Patient Advocate, in this case – has all the answers to patient care and satisfaction? I suspect that the opposite may be true; that the hospital does not seek and does not act on patient feedback. In terms of the evidence-base, it may be that the only evidence for patient satisfaction here is whether patients come back, or leave for good.

* “Louise” is not the advocate’s real name


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