The case conference involved the entire clinical care team at the hospital. The doctors, nurses, social workers and dieticians were present.

The doctors reported first. The nurses seemed to be excluded. The hierarchy of influence limited the discussion.

Our job as advocates was to deepen the analysis of both the problem and possible solutions.

Our team at RCM Health Consultancy Inc. (RCM) led by Raymond Rupert, patient advocate, was fulfilling the role of the advocate in representing the rights of our client ( the patient) to access timely and quality care in order to achieve the best outcome possible.

We began to understand that the hospital team did not have a plan. Their actions were entirely reactive. There was chaos. They were traumatizing the patient. They were confusing the family. They were not advancing the care.

When we started to ask questions about their actions, it was clear that these questions were not welcome.

But our job as advocates is to ask questions, to go deeper in terms of the analysis of the root cause(s), to bring new ideas to the table, to introduce positive strategies used in other hospitals and universities.

That was unfortunately not welcome. In fact, our work as advocates was seen to be disruptive.

But we realized that to advance the quality of care in this case, it was necessary for us to be disruptive when in fact we were deepening the analysis of this case with the objective of achieving the best outcome posssible for the patient.

So we have settled into our role as being perceived to be disruptors of a fragmented process of care that needs to change in order to protect the rights of the patient to be the best outcome possible.

Raymond Rupert, patient advocate and healthcare consultant.