April 13, 2004 Feature

Advocacy Brings Positive Outcomes

Getting What You and Your Patients Need

Does this describe the place you work? Your administrator has never denied a request you have made, even if it has a large budgetary impact. All the physicians understand the importance of what you do and make appropriate referrals. The nursing assistants follow all of the swallowing precautions you have listed for your patients, even on the night shift. Your department has as many staff members as you need.

If this describes your work setting, read no further-you probably have little need for self-advocacy techniques! The rest of us, however, face daily challenges to get what is needed for our patients, and for ourselves.

When you make the decision to do something about a problem instead of just complaining about it, you embark on self-advocacy. Self-advocacy is any action you take (e.g., letter, phone call, discussion) that would have an impact on any personal or professional issue. Self-advocacy doesn't have to be done alone. You can partner with other people-colleagues, other employees in the same company, even consumers of your services.

Self-advocacy can occur informally or in a more formal, structured way. For example, informal advocacy with a physician often occurs when you see the physician in the hall or the nursing station. Perhaps the physician typically admits patients and orders "thick liquids and chin down" but doesn't order a dysphagia evaluation. With physicians, you might share studies that show that chin down is not a technique that should be applied universally to all patients with dysphagia.

Self-advocacy may take place in a formal meeting. Perhaps you have requested a meeting with the facility administrator to discuss the need for another speech-language pathologist in the department. To reduce the risk of being caught off-guard in the meeting, think about the administrator's perspective. Can you predict what some of her concerns/ interests might be (e.g. trying to run the facility with reduced reimbursement; critical staff shortage in other areas; pressure from her boss to cut costs)? This will help you articulate your interests. Fisher & Ury (1991) in Getting to Yes: Negotiating Agreement Without Giving In, suggest that talking about interests rather than positions is more successful. For example, if you go into the meeting with the position that you must have another full-time employee in your department, and the administrator's position is that there is a freeze on hiring, there is not much room to negotiate. Instead of that approach, if you elaborate your interests (e.g. reducing missed visits, reducing length of time from referral to evaluation) and the administrator lists hers, your may find that you share many common interests. This discussion of interests may lead to a creative-and mutually acceptable-solution.

The most successful advocacy efforts utilize data to support your interests. Many different types of data are available to clinicians. You might have data from your department (e.g., what percent of instrumental studies result in the patient returning to a PO diet). National benchmark data against which to compare your data, such as those supplied by ASHA NOMS, is even more powerful. Perhaps the administrator of your facility views speech-language pathology only as an expense and does not see any cost benefit to your services. NOMS data can document how many patients who received swallowing treatment are able to discontinue tube feeding. The amount of money saved on tube feeding and nursing care related to the tube feeding can be compared to the cost of the speech-language pathology services rendered, demonstrating a clear cost savings.

Self-advocacy for yourself and your patients doesn't always result in the solution you hoped for. But without advocacy, it's unlikely you'll ever solve the problem. Take the first step. Make up your mind to move forward toward getting what you need.

Nancy B. Swigert, is a speech-language pathologist and owner of Swigert & Associates, Inc. in Lexington, KY. Contact her by e-mail at nswigert@aol.com.

cite as: Swigert, N. B. (2004, April 13). Advocacy Brings Positive Outcomes : Getting What You and Your Patients Need. The ASHA Leader.

Active Listening Strategies

In meetings, use active listening strategies. Sometimes the way a question or statement is framed can help facilitate a discussion while avoiding confrontation. Here are some to consider:

  • Please correct me if I'm wrong, but…
  • I appreciate what you have done, and hope you'll consider….
  • Can I ask a few questions to see if my facts are right?
  • Let me see if I understand what you are saying.
  • Let me show you where I have trouble following your reasoning.
  • Is there any reason we couldn't ….?

And finally, when faced with a question you simply don't know how to answer, you can try, "Let me get back to you." Then, agree on a specific date by which you will get the answer to the question.



  

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