Navigating Healthcare: The Importance of a Hospital Advocate

Working for the last decade in large hospitals, I get calls. Even though I am not a doctor or nurse, family and friends call when they get sick. All are experiencing some combination of being scared, stressed, and confused by how healthcare works in the United States. They generally ask for advice about how to navigate being a patient.

I always give them the same advice:

Make sure you have someone advocate for you while you are in the hospital.

I will share in this post why I absolutely hate having to give this advice and what can be done about it.

Why it is Important for Patients to Have a Hospital Advocate

Family and friends can serve as hospital advocates

Hospitals are busy places. They are designed to care for the sickest of the sick. A good rule of thumb is if you feel like you are not getting enough attention at a hospital, it means that your doctors do not consider you among the sickest patients in the hospital.

So that’s the good news.

With that said, it can also mean long wait times for simple tests, bumps in the operating room causing your surgery or procedure to be postponed, and limited face-time with your care team. Unfortunately, these delays are all patient dissatisfiers and the uncertainty involved can be stressful to anyone receiving care.

There are many reasons why hospitals operate this way, many of which are economic and operational, so I won’t get into that for this post. (Although if you want to know, just ask, I’d be happy to hear from you).

Because of these factors, navigating care at a hospital can be difficult. Furthermore, The patient in the hospital is usually in a compromised and vulnerable state. They are sick, medicated, in pain, anxious, bored, and sleep deprived, among other things.

That is why you need an advocate in the hospital.

The Best Hospital Advocates

The best advocate for a patient is generally a family member or a close friend. For more complex cases, there are for-hire patient advocates who are usually trained medical professionals.

Sometimes, there is an employee or volunteer affiliated with the hospital called a “Patient Advocate” or “Patient Representative.” These roles range in functions from risk (Dealing with the threat of legal action) to service recovery (Trying to fix a patient’s experience reactively) to ombudsman (Listening to patients and investigating issues to correct them for future patients).

Unfortunately, many hospitals cannot provide someone to advocate for your needs as a patient like a family member or friend can. The simple act of walking over to the nurse’s station, getting to know them, and asking questions about your loved one’s care can go a long way to helping to improve a patient’s care.

To check myself on this advice, I have asked former colleagues of mine what they think about it. Almost universally, doctors, nurses, and administrations I speak with agree with this advice.

The best thing you can do as a patient is to have someone with you to advocate for giving you care and attention while you are in a hospital.

The Downside to a Friend or Family Being a Hospital Advocate

Within the last 13 years, my father, mother, and sister have all been neurosurgery patients. Without exception, during any hospital stay, none of them were alone for any period of time. When my father had emergency surgery, my mother never left the hospital and vice versa. My mother stayed with my sister during the entirety of her multiple hospital stays as well.

At first, I thought they were crazy. But, having now worked in hospitals, it is clear to me that this had major benefits to each of them as patients. Furthermore, the nurses and physicians welcomed the help. My mother and father refilled water, brought up food, and helped to make sure the room was tidy. These responsibilities almost always fall to a nurse or another member of the care team.

In fact, during the COVID-19 pandemic, we frequently heard from doctors and nurses that patient experience was worse when family members were restricted from visiting.

However, this schedule was not without cost. Both of my parents are self-employed and had to miss work and reschedule other life events. They often slept upright in an uncomfortable chair. They didn’t shower. The stress they felt was palpable. While they appreciated the people on their care team, they didn’t trust the hospital to take care of them.

It shouldn’t have to be like this.

I often say that my life’s work as a leader in healthcare is to create an environment where I wouldn’t have to give this advice.

In this reality, family and friends can stay with a patient, of course, but could feel confident that their love one is in good hands. That they can go home and shower, sleep in a bed, and work knowing that the people at the hospital care about their loved one.

What Can be Done?

Fundamentally, patients need an advocate in the hospital due to a lack of trust.

Hospitals generally don’t do a great job building trust. Hospitals are almost always running late and timelines get missed. Doctors and nurses are overworked, rushed, and often burned out. It is difficult for doctors and nurses to empathize with patients because of the mundanity effect, which happens when something extraordinary (like caring for patients and saving lives) becomes routine.

From my point of view, the solution here is three-pronged:

  1. Fix the aspects of the hospital operation that make doctors and nurses jobs unnecessarily difficult or that take them away from patient care.
  2. Create and enforce behavioral expectations for how doctors and nurses treat patients and family members.
  3. Create ways for patients to see more of their doctors and nurses.

While this list is pretty easy to type out, actually making these changes could take decades. Most hospitals are still operating under business strategies and process improvement models from the 1980s. Remember, healthcare is highly regulated and complex. Making change doesn’t take weeks, months, or years. It usually takes decades.

The issues in healthcare are systemic and ingrained. There are many large stakeholders involved in the system today including large care providers, insurance companies, health plan administrators, etc. Large players like Amazon and Walmart are even trying to disrupt this behemoth of an industry, which has been notoriously hard to do.

Trying to change or cure the underlying diseases of healthcare has too long of a time horizon to make meaningful change for struggling patients and families today.

The Role of Technology

Luckily, technology can help with #3 – Create ways for patients to see more of their doctors and nurses.

This is why I made a career change recently.

I recently joined a company called WUWTA (pronounced “What-ah”) as their CEO. I first met WUWTA co-founder and Chairman of the Board, Jock Putney, when I was Chief Experience Officer at Robert Wood Johnson University Hospital.

On the WUWTA platform, physicians can guide patients through their healthcare journey personally from referral to discharge and follow up appointment. When I led Patient Experience, I spoke to patients every day. They desperately wanted more of their physician’s time and often were so excited when the physician spoke to them, they could not retain what the physician said!

WUWTA addresses this patient experience pain point simply. At each stage of the patient’s journey, the patient gets a video from their physician, explaining their next step in simple terms. The WUWTA platform enables doctors to hold a patients hand digitally and at scale.

Platforms like WUWTA are the necessary interim step to helping patients have a better experience without having to immediately address every systemic healthcare system disfunction.

After meeting with Jock, I felt so passionate that WUWTA represented a way forward to make healthcare better for patients, that I left RWJ to join the company.

What’s Next

We are far from my dream of a hospital system where having an advocate would not be necessary. Technology offers an important interim step to achieving this goal.

My belief is that it is a good thing that technology has enabled patients have access to more information. As the healthcare system continues to shift to be more consumer centric, patients will use that information to demand a better experience. That is when real change will happen faster. I am excited to be a part of it.

Key Takeaways

A hospital advocate is essential for patients navigating complex healthcare in the US, ensuring personalized attention and care in busy hospital settings. Technology platforms like WUWTA provide interim solutions by improving patient access to doctors, empowering them with information, and enhancing their healthcare experience.

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The connection between customer experience and leadership

Everybody wants to be a part of an organization known for having the best customer experience. Organizations in every industry market themselves as having “The #1 rated customer service” or “We’re known for our customer service,” but often fail to deliver on that brand promise.

In this post, I am going to explore why that is, starting with the relationship between achievement in customer experience and leadership.

Customer Experience and Leadership work together
Strong Leadership and Strong Customer Experience Go Hand-in-hand

Customer Experience as a Differentiator

I was recently listening to a speech by the famous billionaire investor Warren Buffett. In the speech he shared that any business that excels in customer service, can be a successful business.

In that speech, Buffett described the story of Jack Taylor, the founder of Enterprise Rent-A-Car. When Taylor got into the rental car business, there were two dominant companies in that market: Hertz and Avis. Taylor started Enterprise with 17 cars compared with Hertz and Avis having thousands, Enterprise was located in undesirable locations because the larger companies already had prime real-estate (think airports, for example), and the 17 cars he had were no different than the other companies.

Enterprise’s value proposition focused around customer experience and treating the customer better than any other rent-a-car company in America. For example, Enterprise is known for their slogan, “We’ll pick you up,” a commitment to free customer pickup when they need a rental car.

When Taylor passed away, Enterprise Rent-A-Car was worth more than all the other car rental companies put together, despite starting later and with many disadvantages in a commoditized industry.

The power of superior customer experience is real. It is a business imperative to get customer experience right and a business opportunity in industries known for poor customer experience.

What it takes to create a business that delivers incredible customer service

I have led the customer experience function for two large organizations. I know that most companies want their brand to be synonymous with excellence in customer service. However, most senior leaders of these companies do not understand what it takes to accomplish this goal.

A number of companies are known for excellence in customer experience. They include well known brands like the Ritz Carlton, Disney World, Chick Fil-A, Zappos, Starbucks, and Trader Joe’s.

While most companies say that they want to deliver the best customer experience, these companies above have actually done it. Their tactics are published in books, their leaders have explained what it took for them to do it, and their cases have even been studied in business schools.

These companies all follow the same framework to achieve their successes. They do the following:

Step 1: Define the universal behavioral expectations of the company in simple terms.

Example: At Disney World, they teach behavioral expectations aligned to 5 “Keys”: Safety, Courtesy, Inclusion, Show, and Efficiency.

Step 2: Create a campaign of engagement around these universal expectations.

Example: At the Ritz Carlton, the “Ladies and Gentlemen” read from their Credo Card that includes the Ritz Carlton service values on a daily basis during their lineup process.

Step 3: Educate all team members about the expectations.

Example: At Disney World, new hire orientation is called, “Traditions”. This immersive program is the first step of many training and education opportunities for Disney “Cast Members” to live the 5-Keys.

Step 4: Create reinforcing systems that show the employees and the customers the importance of the expectations.

Example: At Zappos, orientation for all positions includes time to answer calls at the call center. Also at Zappos, the company celebrates long customer service calls, where other companies establish Key Performance Indicators (KPI’s) to reduce the length of calls with individual customers.

Step 5: Empower team members to live the behavioral expectations in new and creative ways.

Example: At Ritz-Carlton, every “Lady and Gentleman” are empowered to spend up to $2,000 per day per guest to rescue a poor guest experience.

Despite the roadmap being relatively simple, it is difficult to execute. Many businesses struggle with customer experience, including basic customer service.

The Zappos approach to building a fantastic customer experience

Former Zappos CEO Tony Hsieh gave a 54-minute talk at Stanford University about Zappos’ culture. I would encourage you to watch the seminar in its entirety here:

In the seminar, Hsieh speaks to the discipline and focus a leader needs to run a high performing customer experience organization. Leadership at the highest level of these companies have a relentless focus on the needs of the customer. They prioritize customer experience over short term interests to build high performing cultures.

And, truly, that is the rub when it comes to building a high performing customer experience company. Most senior leaders want the result without understanding the work that excellence in customer experience entails.

Why leadership matters for customer experience

As you heard in the seminar, Tony Hsieh studied how great organizations create cultures that achieve results. A high performing customer experience organization cannot exist without leaders who understand how to build a culture that can execute on the five steps to create a high performing customer experience organization we discussed earlier.

Leaders like Jack Taylor and Tony Hsieh embodied the values they promoted. They were trusted because they would sacrifice short term gains for those values. Furthermore, they understood that the people closest to the work should love their jobs and feel equipped to create human connections with customers, while the leaders create the space for them to do that.

This may seem simple but it is not at all easy. Many leaders treat customer experience as an initiative to improve a KPI like net-promoter-score (NPS) or, in healthcare, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. They often try to achieve the targets through tactics likes scripting, pushing customers for survey scores, or through financially incentivizing their teams to achieve those scores.

These tactics represent traditional command, control, and manipulative leadership. At best, the results of initiatives like this are temporary. At worst, they become an outright joke.

When Customer Experience Goes Wrong

Here’s what I mean by outright joke: Call AT&T, or whoever your cell phone provider is. Mine is AT&T.

I had an issue with AT&T that took 18 months to resolve. It took 18 months, multiple phone calls, multiple customer service chats, and one desperate plea at an AT&T store, which got me to a number where an agent finally was empowered to resolve the issue. It was painful.

After the experience, I was certain that my number one goal was to become a customer of literally any other cell phone carrier.

But won’t you believe that after every interaction, I was asked to give them 5-stars in the survey after the call. As a Chief Experience Office (CXO), I was embarrassed for AT&T by that request.

Leadership matters. It sets the tone and direction of the organization. Leadership that prioritizes customer experience also prioritizes humanness.

Why customer experience matters so much to me personally

We share planet earth with more than 8 billion other people. Our world, especially the lens in our head, is a tiny spec in the universe.

My own thoughts and needs are a dichotomy. On one hand, they are all I have to keep me safe as I experience the world. On the other hand, in the grand scheme of the world, I realize that my thoughts and needs are insignificant. 1/8,000,000,000.

It’s a humbling thought.

I have found that the more I can be kind and helpful, the better I can use my spec in the universe to make the human experience easier for other specs in the universe. I do not want to live in a world where everyone is so focused on their own thoughts and needs that the rest of humanity is irrelevant for them. Imagine if we all lived in that world. It would be miserable for all of us.

Organizations, whether public or private, not-for-profit or for-profit, giant companies or small businesses, are fundamentally just organized groups of people. They have the power to make someone’s life a little easier or a little harder. Organizations that choose to prioritize customer experience are also prioritizing making other people’s lives a little bit better.

In my life, I have experienced how frustrating it can be to interact with people and businesses that make my life just a little easier. It makes a difference in my day.

Mission BBQ

There’s a local chain that started here in Maryland called Mission BBQ. I absolutely love this place. The food is great, and they are connected to the brotherhood and camaraderie of the military. The restaurant is not fancy, it’s just the people who work there are genuinely good people. They take care of me at Mission BBQ no matter which location I go to.

When I am having a day where I feel like I need life to get just a little easier, I go to Mission BBQ. It is a company that has become a haven of sorts for me.

Customer experience matters. To me, it’s really making a better human experience in a fast and crowded world. It can be done well, but it requires real leadership.


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Transformational leadership and Starbucks

Over the next few weeks, I am going to be writing a series on transformational leadership. In my next post, I will define the concept as well as an alternate style called transactional leadership. To kick off the series, I wanted to illustrate the hallmarks of transformational leadership through the story of one of my favorite transformational leaders: Howard Schultz, the founder of Starbucks.

Embed from Getty Images

Howard Schultz is a transformational leader because of the way he developed a vision and then made it into a reality in partnership with Starbucks’ other employees. His vision was for Starbucks to be a “third place” between home and work and that Americans would pay $3-5 for a cup of coffee. Schultz used his charismatic personality and values to develop a transformational work environment at Starbucks that built a coffee empire. He uses motivation, influence and referent power to overcome business obstacles and achieve shared success.

Evidence of Howard Schultz transformational leadership qualities are a key component of the Starbucks operation. In the most obvious example, Starbucks refers to all its employees as, “partners” and offers them stock options and health care benefits (for both full and part-time employees) . He writes, “From the beginning of my management of Starbucks, I wanted it to be the employer of choice, the company everybody wanted to work for.” Schultz realized that leadership was about the people at the front lines doing the work to bring his vision to reality. He focused on the employees and used his strong motivation and influence skills to achieve his vision.

Schultz has also demonstrated the ability to motivate his employees both in terms of direction and emotional intelligence. On the first day Starbucks was in business, Schultz went to address the other Starbucks partners. He had three points written down on a 5-by-7 note card that read, “1. Speak from my heart. 2. Put myself in their shoes and 3. Share the Big Dream with them.”

When the response to Schultz’s first speech was a combination of skepticism and guarded optimism, he recognized what he needed to do. Schultz knew he had to develop referent, expert and position power in addition to his legitimate power role as the CEO of Starbucks. He used the tactics of shared benefits, consultation and collaboration, emotional calibration and consistency to motivate his new employees. He writes, “The only way to win the confidence of Starbucks’ employees was to be honest with them, to share my plans and excitement with them and then follow through and keep my word, delivering exactly what I promised – if not more.”

Schultz focused on outcomes, satisfaction and trust to build employee commitment to Starbucks, which minimized turnover and retained employees who were aligned to the vision and brand for Starbucks. He writes, “A business plan is only a piece of paper, and even implemented properly [is not complete] unless the people are committed to it with the same heartfelt urgency as their leader.” When Starbucks lost its way, in Schultz’s eyes, he closed all Starbucks locations temporarily for mandatory training, including lessons on how to make the perfect espresso shots.

Schultz has impacted not only the Starbucks partners who have grown and thrived with the company, but also the patrons of Starbucks. In his book Onward: How Starbucks Fought for Its Life without Losing its Soul, Schultz describes the reactions of patrons when they learn that their neighborhood Starbucks was closing due to the suffering performance of the company, when, at one point, it was nearly at the brink of bankruptcy. They felt the loss on a deep emotional level because of what the store meant to the community. Schultz describes stories where people reacted emotionally to the announcement that the store they frequent was closing. One woman in Minnesota wrote, “I can’t believe that ‘my’ Starbucks is closing. You never know how important a place is until you are about to lose it.”

The impact of the Starbucks that Schultz created has also impacted me personally. In fact, I have written portions of this post from a Starbucks. It is incredible to me to witness what Schultz visioned coming to life in front of me. I was recently in one of the first Starbucks locations on the East Coast in Friendship Heights. The layout, the service, and the atmosphere was exactly how Schultz would have described it to a potential investor, partner or customer. There was a romance to the coffee service, and sitting there doing work at a table and drinking from my own personalized cup of coffee was surely a small but meaningful luxury. Knowing how much work it took Schultz to achieve that vision, including overcoming many skeptics and frequent trips to Italy, made the taste of my peppermint mocha even sweeter.

KEY TAKEAWAY: Transformational leaders pursue an important vision by empowering people to be a part of something larger than themselves. Leaders like Howard Schultz lead through respect and empowerment.


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The Power of Visualization

Last week in Baltimore, I participated in two continued-learning opportunities through the American College of HealthCare Executives (ACHE). I always look forward to learning opportunities like these—being in a classroom type setting, learning about what is new and what is coming in the field brings back fond memories of learning as a grad student.

In the first session, we used a tool that was familiar to me, called the Business Model Canvas. This canvas is one of a series of tools from Strategyzer. It is used to visually map out a business model, using a tool that focuses on delivering value to the customer (called the “Value Proposition”). This tool is useful for both new and existing businesses and can be utilized in strategic planning for any organization.


In addition to the Business Model Canvas, the seminar introduced a variety of other canvases, such as the Context Map Canvas, the SWOT (Strengths, Weaknesses, Opportunities, and Threats) visualization tool, and the Innovation matrix to name a few. Teams of people who had just met a few hours before were then tasked and able to work on the same page using the canvas frameworks.

It made me think about the power of visualization tools and how leaders can better utilize them. To be clear, I am not talking about PowerPoint presentations or those poster slides that Members of Congress use. I am referring to a tool that gives participants an opportunity to be an active part of crafting a narrative and creating something new.

I have noticed throughout my career that many executives under-utilize visualization tools, which is an opportunity lost. Visualization, done right, can build out a better framework for solving a problem, while simultaneously building understanding and trust. Without visualization, it is incredibly difficult to get multiple voices to properly understand and participate together in an activity.

For a while, I was hesitant to go up to the whiteboard and facilitate a discussion at work. I thought sometimes it was cliché to do so. But I was wrong. If you ever get the urge to go up and write something out, or draw something new, it will help the group as a whole facilitate their understanding. A leader’s ability to use visualization and facilitation to achieve team synergies is a must have.

I encourage you to never hesitate to use visual tools when leading a group. Check out the resources at Strategyzer to help you to determine how best to apply visualization beyond the Business Model Canvas. All it usually requires is a marker or two, a white board, sharpies and post-its. Happy visualizing!

KEY TAKEAWAY: Developing visuals help facilitate teamwork and team trust. Visualization and facilitation are must have skills for leaders looking to solve complex problems in a team environment.

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Book Review: Prescription for Excellence

You may have noticed that health care has been in the news a lot recently. Whether it is the Democratic Party presidential candidates talking about their plans, price transparency, or access to prescription drugs, it is fairly safe to say that the current system is not working for a group of people in our country.

There is so much to fix, including the experience of receiving care. Many patients experience customer service outside of health care and they expect that same level of care, treatment, ease, and convenience.

RxforExcellenceSeveral years ago, the University of California, Los Angeles (UCLA) health system decided to work on fixing the experience of care. Their results were astounding, going from the 30th percentile of U.S. hospitals to the 99th percentile. Dr. David Feinberg, the then CEO of the UCLA hospital system (he has since run the Geisinger Health System and now is the VP of Google Health), was committed to doing better as the UCLA system grew in Southern California.

Using the lessons from other retail leaders who are known for their customer experience, UCLA did some progressive things to enhance and enrich the hospital’s patient experience. The progress is summarized in Joseph Michelli’s book Prescription for Excellence: Leadership Lessons for Creating a World-Class Customer Experience From UCLA Health System.

I appreciate that Dr. Michelli, who has written on companies like Starbucks and the Ritz Carlton, used part of his introduction to the book to acknowledge why it was important for him to write about a health care organization. The demands are high, regulations abound, safety is paramount, and politics are rampant. Delivering excellence in that environment is a unique feat and one that keeps those of us who are part of the business aspect of health care both fired up and very busy.

What I enjoyed about Prescription for Excellence was learning about the leaders from the organization who invested in the patient experience system, called “CICARE” (pronounced See-I-Care). Leaders modeled the behaviors that they asked the staff to model as well, and they were constantly present, speaking to patients to learn more about their care.

What UCLA figured out is that, just like in another industry, the three main elements of hard-wiring a consistently excellent and customized patient experience are: alignment, empowerment, and engagement. CICARE was their system of alignment, they empowered the team to act on it by training them, and engaged them in the work, partly by emphasizing the importance of it.

The following quote in the book sums this idea up nicely, “Relationships-based caste is often about empowerment. Empowerment starts with leaders giving staff members the tools and the trust they need to provide extraordinary service. Those tools include structure service behaviors…When well-selected employees are given resources, trained, and empowered effectively, extraordinary service relationships developing, and customers are empowered to build skills that meet their needs.” (Michelli 64).

Developing systems and allowing people to innovate within those systems are keys to delivering service excellence whether in health care or any other industry.

KEY TAKEAWAY: Excellent service systems are created from aligned, empowered, and engaged team members.

Prescription for Excellence is available for purchase on Amazon for $30 (does not include Prime discount)