Bruce S. Jansson

Improving Healthcare Through Advocacy: A Guide for the Health and Helping Professions

Praise for Improving Healthcare Through Advocacy: A Guide for the Health and Helping Professions (Wiley & Sons, January, 2011)

“Bruce Jansson’s thoughtful and innovative book will appeal to students in social work, nursing, and public health, as well as those working in the health field of practice. The case examples are extraordinary, and Jansson provides the ideas, context, and theoretical base for readers to acquire the skills of advocacy in health care. This is by far the best advocacy book I have seen.”
—Gary Rosenberg, PhD
Director, Division of Social Work and Behavioral Science
Mount Sinai School of Medicine

Improving Healthcare Through Advocacy is a terrific description of opportunities for advocacy intervention and provides the skill sets necessary for effective advocacy. A needed book.”
—Laura Weil, LCSW
Director, Health Advocacy Program
Sarah Lawrence College

Improving Healthcare Through Advocacy is an invaluable resource for practitioners working in the health care field as well as for students. It very thoroughly covers health care advocacy issues, contains real-world case examples, and provides a clear, step-by-step framework for practicing advocacy.”
—Kimberly Campell, ACSW, LCSW
Department of Social Work
Ball State University

I discuss in the first chapter why patients and consumers often need case- and policy advocacy by referring to extensive research that demonstrates that they often experience seven problems: their rights are often violated, they often do not receive evidence-based care, they often are not given culturally competent care, they often do not receive preventive services, they often cannot afford their care, they often possess mental distress not addressed by the health system, and they often do not receive community-based care. I document that existing health literature fails to provide a detailed case-advocacy framework that is linked, as well, to policy advocacy that addresses systemic shortcomings in the American health system.

I document that case- and policy advocacy are skilled interventions. They often occur in institutions that do not encourage them. Yet health practitioners have an ethical duty, I contend, to provide advocacy if specific consumers, or groups of them, will suffer harm if they do not receive advocacy.

I discuss in the second chapter why the American health system, as well as the culture and demography of the larger society, often spawns the seven problems that consumers often confront.

Curiously, existing health literature has failed to provide health professionals with tools to engage in case- and policy advocacy. This book provides two practice frameworks. A case-advocacy framework in Chapter 3 informs health professionals how to read the context, triage patients to determine which of them need case advocacy, allocate case-advocacy services in light of the time and skills of staff, diagnose why the needs of specific patients are not currently met, develop and implement case-advocacy strategy, and assess specific case-advocacy interventions. A policy-advocacy framework informs health professionals how to change policies, budget, regulations, and procedures in health institutions, communities, governments, and legislatures in Chapter 12.

Four skills needed to engage in case advocacy are discussed in Chapter 4, including ethical reasoning skills, influence-using skills, analytic skills, and interactional skills such as negotiating, communicating, and organizing ones. These skills are also discussed in Chapter 12 as they apply to policy advocacy.

I devote chapters 5 through 11 respectively to case advocacy with respect to each of the seven problems that American patients or consumers frequently experience. I discuss existing regulations, policies, and protocols that provide the context that health professionals and patients or consumers confront. I identify specific scenarios in each of these chapters where patients or consumers often need case advocacy--or a total of 118 scenarios in Chapters 5 through 11. I include many vignettes contributed by social workers, nurses, and patients in these chapters that illustrate case advocacy. I ask readers even in these chapters to consider policy advocacy that might be needed to change dysfunctional systemic factors that create the need for case advocacy in the first place.

I introduce the policy advocacy framework in Chapter 12 by discussing its eight tasks, as well as the four skills needed to implement them.

I use this policy advocacy framework in Chapter 13 to examine how health professionals can use it to help specific clinics and hospitals build a culture that supports case- and policy advocacy by their staff. I identify an array of health plans in the United State that encourage case- and policy advocacy such as the Geisinger Health Plan, the Cleveland Clinic, and hospitals under the Plaintree system. I provide exploratory data that suggests that health professionals' use of advocacy is strongly influenced by the organizational context and culture, including use of multi-professional teams, a culture that rewards critical questions about health services within it, and a willingness of physicians to listen to ideas of others. I suggest that health professionals should engage in policy advocacy to create systems of care that promote case- and policy advocacy.

I discuss policy advocacy in community, government, and legislative settings in Chapter 14.

Throughout this book, I often discuss how health professionals empower their patients to advocate for themselves by giving them information and by encouraging them to ask questions about their care.

Selected Works

This book provides the first detailed framework for health advocacy by members of the health and helping professions at both case (or patient) and policy levels
A pioneering book on the practice of policy and policy advocacy for professionals and Americans.
This book provides a critical analysis of the evolution of the American welfare state from colonial times to the present, as well as discussing strategies for reforming it.

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