Team Advocacy A Mutaual Outcome Model

by Steve Mathew

Advocacy is a term heard frequently in health care, but what does it mean? The importance of advocating for the older adult is emphasized in literature, books, training seminars and workshops throughout the field of long term care; however, the term ‘advocacy’ is very broad and general. The challenge now is to develop guidelines for care providers, professionals and family members in order for them to become empowered as advocates. Through a team advocacy process, they can begin to achieve the ultimate goal of quality of life for the client.

Advocacy simply defined means speaking on behalf of someone else or helping another to voice their own needs. The client in long term care requires advocacy. This is not to imply that there is license to become overly paternalistic and treat the clients as children in need of protection. Instead this refers to the older adult who, for whatever reasons, has become vulnerable to their environment or circumstances.

In such a situation the individual requires an advocate or a “second voice” to ensure that their needs are met. Some of my early experience in advocacy came from collaborating with an attorney who specialized in advocacy for the elderly. Through that experience I learned about the guiding principles of advocacy:

A better approach to performance assessment is benchmarking for Best Practices. As this article will convey, Best Practices can be viewed as both a process or action and an outcome or result. It will be demonstrated that benchmarking for Best Practices involves a number of key steps to ensure that any comparisons are as relevant and useful as possible. The desired outcome of this significant effort is to establish a new way of doing something - a Best Practice - relating to some key clinical, administrative or governance process.

So, what is involved in establishing a Best Practice? As with any significant initiative that requires a major commitment of time, energy and resources from an organization, the first and foremost requirement is agreement on what processes should undergo in-depth assessment and comparison. No organization has the resources to assess more than a handful of processes at any one time. Therefore, the ones chosen must have the potential for the greatest impact on improving organizational performance. Just as important, given the significant and sustained commitment that is required to achieve the full potential of a Best Practices exercise, understanding of and commitment to the process on the part of senior leadership is a prerequisite for success.

It is only once these two requirements have been fulfilled that the organization should proceed to the next steps in a Best Practices process.

For advocacy to be successful, the two groups that most directly impact on the client must work as a team, the family and the organization. The family must learn to be assertive, not aggressive. There is a big difference! Assertiveness gets results, aggression creates animosity. Family needs to be informed, obtaining as much information, support and resources as they can find. The long term care facility is responsible for providing access to resources: information on local Alzheimer’s societies, support groups, seminars, books and videos. Family must want to become involved, and conversely, staff must solicit their involvement on admission and on an ongoing basis. Now as team advocates, staff and family constantly monitor the client’s needs. Family and staff must be encouraged to give continual feedback about the client’s status. This is proactive, addressing issues before they develop into problems.

For the organization, assigning a staff member to a designated client as their Client Advocate aids the process of advocacy. This individual should be a client-centered leader who knows the client well and can assume the role of a facilitator. When a need is identified, the Client Advocate assembles the multidisciplinary team to assess and discuss the needs of the client.

The care conference becomes the ideal forum for this to take place. The players on the team are chosen relative to the need(s) of the client. For example, if the need pertains to physical care issues, then the physician or nurse may play a key role. If the need is psychological, perhaps a counselor or psychiatrist needs to be drawn into the process. Social, cultural and spiritual needs can be met by a variety of individuals ranging from family, recreation staff and volunteers from the community. The specific Client Advocate is always part of this care conference. A summary of the process of advocacy is as follows:

Following the assessment and discussion, the team decides on a plan of action. Once the plan is executed, it is then monitored and followed up and the outcome evaluated. All members of the team have an equal say, with the Client Advocate taking initiative and leadership to ensure that the plan is executed, the process is in place and the principles of advocacy are adhered to.

For team advocacy to occur and become effective, family and staff need to take the initiative to be proactive right from admission. Lines of communication need to be kept open by the organization, and family must be willing to learn their role. Follow up must be consistent and most importantly, the client must be the decision-maker whenever possible. In the event where the client is incapable, then the question must be asked and discussed by all: “If the client were able to voice their needs, what would they want?” As advocates that is a call to action.

As organizations move towards achieving client centered care, the need for a team advocacy process involving the family becomes crucial. When individuals make advocacy their goal, care practices and organizational dynamics can only be further enhanced. The challenge for organizations in creating a team advocacy model is to empower their staff as advocates, and to encourage family participation. The challenge for the families is to get involved and make their voices count. The outcome for the client is quality of life.