Setting Expectations in a Complex Healthcare System

Over the past few weeks, I have written various posts on the experiences I have had with a few people whom I am working with as a Nurse Advocate. Each person came with unique issues related to their health. One patient has a suspected deep vein thrombosis, one was diagnosed with a reoccurrence of lung cancer, and the third person had a GI bleed that took months to identify and get under control.

My role was to support them by helping them navigate the complex healthcare system by breaking through barriers each faced. These included getting appointments in a reasonable time frame, researching specialists who had the expertise to diagnose and treat them (and who were in their managed care network), work through the complexities of authorizations, payment, and reimbursement issues that accompanied each visit. I also had to explain why they had to wait in a waiting room for 30 – 45 minutes or more when they were on time for their appointments.

Those of us who make up the healthcare system know, know each of these issues are common and viewed by most as ‘this is just how it is.’ I would have to say the most challenging part of my job as a nurse advocate was to help set expectations.

I did this by explaining the situation and letting them know that I cared. I would go to the best person who could address the problem and then explain the reasoning to the person. Most of the time, this pacified them but did not relieve the stress they felt

I worked to communicate professionally with various healthcare providers. This was not always easy, as most were not used to the person they were seeing having an advocate with them who asked questions that the average person did not ask. Many understood my role was to support the patient and help them as they worked with the person to design a plan of care to treat their condition. I found communication a constant struggle that was frustrating to me and was distressing to the person I was with.

In a system that is overloaded, stressed, and very complicated, setting expectations is not an easy job. Three things that I have learned over the past few weeks have helped me include:

• Building a good relationship with both the person I was working with and the various members of their healthcare team. I tried to show each that I cared and that I would work with them as best I could to address the challenges each faced.
• Employ two-way communication. I asked the person I was with, what they wanted, and then tried to communicate this to the staff and their physicians. I listened to the staff as to their challenges and how we could work around those issues.
• Be proactive when things go wrong. I addressed problems and tried to offer solutions calmly and professionally.

I tried to remember the people I was with wanted to be treated with respect and have those who saw them address their needs so they could return to their lives. It is not easy, but writing about it has helped me reflect on what I was doing with fresh eyes. I learn something new with each encounter, and that allowed me to understand things and how I could handle situations in a way that met the person’s expectations.

Thank you for reading this post. Feel free to leave a comment as to how you set your expectations as a patient and a member of the healthcare team. Doing so will allow each of us to learn new tactics.