GUIDANCE THROUGH THE DEEP WATERS OF TODAY’S HEALTHCARE


Click here to read PDF version: NAHAC Standards & Best Practices


NAHAC Standards & Best Practices

A.   Statement of Intent

NAHAC offers these Standards & Best Practices for the field of healthcare advocacy. NAHAC considers this a living document that will evolve over time. It constitutes the foundational statement of Standards & Best Practices for our organization. If NAHAC makes fundamental revisions to this document, its members will be notified of the changes.

B.  FORWARD

B-1      NAHAC is the nation’s largest nonprofit organization dedicated to the development of healthcare advocacy as a profession. The objective of the organization is to benefit and protect consumers. NAHAC is an organization of Professional Healthcare Advocates and lay members who share the goal of promoting safe, effective, holistic and compassionate healthcare services. NAHAC represents professionals working with individual consumers and family caregivers who need assistance navigating through complex healthcare situations. Titles of these professionals may include: healthcare advocate, patient advocate, patient navigator, and case manager. A professional Healthcare Advocate may work in diverse settings. For example, an advocate may work independently, or in a medical setting, in healthcare or other companies, or on behalf of communities or disease-specific populations.

B-2      The NAHAC Mission:

  • We are the professional organization for Healthcare Advocates dedicated to:  Assisting and empowering consumers to navigate the healthcare system effectively
  • Advancing the field of healthcare advocacy; and
  • Influencing public policy toward patient-centered care.

B-3      Why is there need for a document on Standards & Best Practices? NAHAC Standards & Best Practices is intended to be an extension and elaboration of the NAHAC Code of Ethics to ensure the protection of consumers/clients for whom its Healthcare Advocates work.

Adherence to NAHAC’s Code of Ethics is a condition of membership in NAHAC. NAHAC establishes these practices recognizing that similar work is being done by the Patient Advocate Credentialing Steering Committee, formed in 2013 and comprised of national leaders in Healthcare Advocacy. The mission of the committee is to establish a national credential for those who advocate for patients.

Ethical questions and concerns of the public regarding a Healthcare Advocate’s behavior may be referred to the NAHAC Board of Directors for evaluation.

NAHAC recognizes that its Code of Ethics and Standards & Best Practices will evolve as healthcare delivery changes over time.

NAHAC members and other interested parties should access the NAHAC website periodically for the most current version of all relevant documents. Its website is: www.nahac.com

B-4      Principles in Developing NAHAC's Standards & Best Practices: Healthcare Advocates who are professional members of NAHAC share a common commitment to professional practice based on (a) ethical professional conduct; (b) Standards & Best Practices; and (c) appropriate training and experience.

This Standards & Best Practices document serves as guiding principles that support the NAHAC Code of Ethics surrounding this particular field of advocacy. It attempts to articulate the knowledge, skills, responsibilities, patient protections, and limitations of advocate practice that a consumer should reasonably expect to be met by all NAHAC advocates. Further, this document acknowledges and recognizes that subspecialties in advocacy may reasonably require additional knowledge, skills, experience, training and/or licensing.

Healthcare Advocates work in a variety of settings including private practice, hospitals, government, legislative, community, insurance, and employee assistance programs and other organizations.

NAHAC recognizes that its work exists in an evolving interdisciplinary field that is currently formalizing best practice, credentialing, and licensing appropriate to the unique skills, roles, and responsibilities of this field.

C.  DEFINITIONS

C-1      Advocacy: The totality of services provided to consumer/clients by a Healthcare Advocate. A Healthcare Advocate is a person providing services to consumers/clients. Consumer/clients will be referred to as clients throughout this document.

The services Healthcare Advocates provide to clients include but are not limited to (1) helping to clarify the client’s personal values and preferences regarding their healthcare; (2) assisting clients or consumer groups at all levels in the healthcare system to make informed choices regarding available options and resources for their healthcare; and (3) maximizing client abilities to select among alternative treatment options by providing relevant healthcare information and (4) obtaining the highest quality healthcare available while fully utilizing health insurance and/or available resources.

Healthcare Advocacy supports or promotes the interest of the client. A Healthcare Advocate provides direct service to the client and/or family to promote access to optimal healthcare services within or beyond his/her local communities. The settings and roles of the Healthcare Advocate may vary.

Examples of Advocacy Sub-specialties: cancer; clinical trials; end of life care; legal; disability; financial issues.

Examples of special populations: pediatrics; senior care

Advocates can hold titles such as: Healthcare Advocate; Patient Advocate; Patient Healthcare Advocate; Health Advocate; Private Healthcare Advocate; Advocate; Care Manager, Geriatric Care Manager; Professional Health Advocate; Disability Advocate; Legal Advocate, Medical Navigator, Care Coordinator.

C-2      Definition of Code of Ethics as it relates to Healthcare Advocates: The demand for services of Healthcare Advocates within the community has been driven largely by several factors. These factors include: (1) the wide availability and dissemination of healthcare information in the public media over the past decade; (2) recent, dramatic changes in healthcare regulations, payment systems and treatment options; and (3) and growing public dissatisfaction with healthcare experiences.

The NAHAC Code of Ethics guides its professional members in ethical behavior, standards and values. The Code of Ethics is the foundation of the organizations commitment to the profession of healthcare advocacy. These standards and values articulate that:

  • Our primary purpose is to improve our clients’ well-being by making it as easy as possible to use the healthcare system for the best possible outcomes in accordance with the client’s wishes.
  • Healthcare Advocates assume the responsibility to assist clients to make informed choices regarding some or all aspects of his/her healthcare.
  • Healthcare Advocates act as liaisons between our clients and the people or organizations involved in his/her care.

C-3      Definition of Standards: Standards are defined as the minimal requirements to meet the best outcomes outlined in the Standards & Best Practices document.

C-4     Definition of Best Practices: Best Practices are defined as evidence-based recommendations to ensure successful outcomes.

The Standards & Best Practices document articulates responsibilities, protections, limitations of practices, as well as knowledge and skills that clients should reasonably expect to be met by any Healthcare Advocate. Healthcare Advocates with subspecialties or who work with special populations may require more specifically defined Best Practices as well as additional skills, experience, training and/or licensing.


Compliance with Ethical Principles and Best Practices:

The foundation of Healthcare Advocates’ professional responsibility to their clients is their compliance with Ethical Principles and Best Practices. Best Practices explain “how” to convert these principles into practice. Our Standards articulate the knowledge, skills, responsibilities, patient protections and limitations of advocate practices for all Healthcare Advocates.

D.  ETHICAL PRINCIPLES OUTLINED

Ethical Principle 1:    Advocacy

Ethical Principle: The Healthcare Advocate works on behalf of the client with the intention of supporting optimal health outcomes.

Objective: To establish a professional helping relationship with the client focused on a definition and assessment of the client’s healthcare needs, and providing information and guidance about navigating the healthcare system.

Best Practice: The Healthcare Advocate works for the client's wishes and needs.

Best Practice Standard: For each client, the Healthcare Advocate will:

  • Assess physical, emotional, social, spiritual, financial and environmental needs as they impact the client’s health and well-being.
  • Assess client’s living situation in terms of current or potential options.
  • Assess client’s interaction with significant others.
  • Share the assessment with the client.
  • Develop a plan of care based on the assessment.
  • Share the plan and come to agreement on the plan with the client.
  • Communicate with healthcare providers, significant others and additional resources to the extent appropriate to maintain or improve the consumer’s health and well-being.

Ethical Principle 2:    Transparency and Honest Disclosure

Ethical Principle: The Healthcare Advocate is committed to integrity and total transparency in the conduct of their practice.

Objective: To aid the client in fully understanding the role of the Healthcare Advocate

Best Practice: Transparency

Best Practice Standard: The Healthcare Advocate will:

  • Disclose to the client complete information about the Healthcare Advocate’s fees, training, education, experience, and credentials, as well as areas of possible conflicts of interest.
  • Develop with the client clear expectations related to scope of practice to allow for strong working relationships between the Healthcare Advocates and their clients.
  • Provide their CV/resume and references upon request.
  • Provide a fee schedule and written agreement to the client.
  • Whenever possible the Healthcare Advocate will refrain from referring clients to products or care services that will financially benefit the Healthcare Advocate. In the event that a referral to a service or product could financially benefit the Healthcare Advocate, the Healthcare Advocate must inform the client in writing of the potential financial benefit from the referral.

Ethical Principle 3:    Protect Confidentiality and Privacy

Ethical Principle: The Healthcare Advocate is committed to maintaining the client's right to privacy.

Objective: To respect the client’s right to privacy and protect client’s personal and protected health information.

Best Practice: Confidentiality

Best Practice Standard: The Healthcare Advocate will:

  • Abide by all relevant laws and regulations relating to confidentiality of personal health information (PHI) and personal identifiable information (PII).
  • Respect and protect consumer medical records, communications and identity of their consumer.
  • Examples of this may include but are not limited to the following:
  • Ensures that computer storage is password protected
  • Encrypts emails with protected personal and health information
  • Avoids using protected health information when using non-encrypted email

Ethical Principle 4:    Fostering Autonomy

Ethical Principle: The Healthcare Advocates will (1) respect and empower client’s rights to exercise informed decisions with regard to their healthcare; and (2) ensure that client’s wishes are the guiding force behind decisions on health care, even if they differ from family.

Objective: To empower the client to exercise meaningful, informed consent regarding healthcare decisions.

Best Practice: Empowerment

Best Practice Standard: The Healthcare Advocate will:

  • Treat each client with respect and compassion.
  • Respect the dignity and freedom of clients to make their own decisions grounded in the cultural, spiritual, and ethical context of that individual.
  • Promote informed decision-making related to each client’s healthcare including end of life decisions.
  • Assess client’s understanding of current health related circumstances and provide them with information to facilitate informed decision-making.
  • Assist clients with understanding their care and treatment options, including potential risks, benefits, and available alternatives.
  • When the client has a legally designated surrogate, the Healthcare Advocate will convey relevant medical history, statutory patients’ rights and possible care options, as well as any personal conversations in which the client may have expressed certain wishes to help aid in making informed decisions.
  • Encourage clients to complete necessary documentation as appropriate: e.g., Durable Power of Attorney for Healthcare; Durable Power of Attorney for Financial Affairs; Advanced Directives, Physician’s Orders for Life Sustaining Treatment.

Ethical Principle 5:    Provision of Competent Services

Ethical Principle: Healthcare Advocates will practice at all times within their area of competency and seek to enhance their professional expertise.

Objective: To ensure clients have received credible information in order to make truly informed decisions.

Best Practice: Competence

Best Practice Standard: The Healthcare Advocate will:

  • Inform clients of their specific areas of proficiency, and only advise clients within that area where they have demonstrated expertise. If a client needs assistance in an area in which the Healthcare Advocate does not have sufficient knowledge or training, the Healthcare Advocate will refer the client to someone who is equipped to provide those services.
  • Provide references to the client upon request.
  • Develop and maintain an adequate referral system to assist clients who need services the Healthcare Advocate is unable to provide.
  • Commit to continuing education in order to keep knowledge and skills current.

Ethical Principle 6:    Maintenance of Professional Boundaries

Ethical Principle: The Healthcare Advocate will at all times work within professional boundaries and will refrain from any behavior that violates or appears to violate those boundaries.

Objective: To clarify the scope and limits of the Healthcare Advocate’s role with the intent to avoid inappropriate interactions or conflicts of interest.

Best Practice: Professionalism and Role Boundaries

Best Practice Standard: The Healthcare Advocate:

  • Is prepared for each client engagement.
  • Is honest and ethical in all business practices.
  • Regularly assesses the client relationship in order to develop, recognize and maintain professional boundaries.
  • Maintains professional boundaries with the client, and remove themself from situations in which those boundaries are or appear to be at risk.
  • Provides the client with referrals to other Healthcare Advocates in situations where removal from the working relationship with the client is necessary.
  • Expresses respect for clients and other professionals with whom the Healthcare Advocate works.
  • Shares with the client the projected length and scope of the relationship keeping in mind criteria for appropriate termination of the relationship.

Ethical Principle 7:    Avoidance of Discriminatory Practices

Ethical Principle: The Healthcare Advocate promotes autonomy and dignity of individuals and acts to prevent discriminatory healthcare practices.

Objective: To avoid discriminatory practices while providing culturally sensitive advocacy services.

Best Practice: Cultural Awareness and Discrimination Avoidance

Best Practice Standard: The Healthcare Advocate will:

  • Accept and assist clients regardless of age, race, spirituality, ethnicity, sexual orientation or economic status. When the Advocate-Client working relationship requires assistance the Healthcare Advocate will seek guidance from or refer to another experienced Healthcare Advocate.
  • Develop terms-of-service / service agreement that is free of any evidence of discrimination.
  • Disclose to terms of service to clients.
  • Provide resources and referrals to the client based on the client’s healthcare needs and wishes.
  • When unfamiliar with a client’s culture, Healthcare Advocates will conduct appropriate research in order to adapt their practice as much as is feasible to meet the needs of the client in providing healthcare advocacy services.
  • Treat each client with respect and dignity, and promote access to appropriate healthcare and treatment.

Ethical Principle 8:    Continued Learning

Ethical Principle: The Healthcare Advocate is committed to continued learning to hone professional skills and maintain knowledge of current conditions and standards in a rapidly changing healthcare environment.

Objective: To attain and maintain the highest level of competence and service involving Healthcare Advocacy.

Best Practice: Professional Development

Best Practice Standard: The Healthcare Advocate will:

  • Participate in continued professional education.
  • Obtain continuing education credits as dictated by the respective professional license and regulatory/credentialing bodies.
  • Continue to develop skills and maintain competence in the respective specific area of expertise.
  • Share information and resources for the benefit of the NAHAC membership and the public.
  • Consult with colleagues regarding challenging client situations as an opportunity to learn.
  • Participate in the professional development of other Healthcare Advocates by mentoring or participating in professional education programs.

E.   REFERENCES

AMERICAN NURSES’ ASSOCIATION

http://www.nursingworld.org/

http://www.nursingworld.org/nursingstandards

"National Council on Interpreting in Health Care Develops National Standards
for Interpreters." Ethics and Standards of Practice. N.p., n.d. Web. 14 Jan.
2014.

"Welcome Visitors!" NAPGCM RSS. N.p., n.d. Web. 14 Jan. 2014.

REHABILITATION COUNSELORS

http://www.crccertification.com/pages/crc_ccrc_code_of_ethics/10.php

NATIONAL ASSOCIATION OF SOCIAL WORKERS

http://www.socialworkers.org/

http://www.socialworkers.org/nasw/annualreport2003/mission.asp

http://www.socialworkers.org/nasw/VisionSpeech0809.pdf

http://www.socialworkers.org/practice/standards/naswhealthcarestandards.pdf

SOCIETY FOR HEALTHCARE CONSUMER ADVOCACY

http://www.shca-aha.org/

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