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Advocacy – Advocacy 101 1
Advocacy 101A Core Leadership Attribute Seminar on Advocacy
Created By:Nicholas J. Jouriles, MD, FACEP
Past-President, American College of Emergency Physicians Professor and Chair, Department of Emergency Medicine
NEOUCOM Akron General Medical Center, Akron, OH
Tenet Editor:Lee Shockley, MD, MBA, FACEP
Medical Director, Denver Health Medical Center, Denver, COProfessor of Emergency Medicine, University of Colorado SOM
Advocacy – Advocacy 101 2
Outline
• Background– Why Advocate
– Define Advocacy
• The Components of Advocacy
• A Starter’s Guide to Advocacy
• Keys to Success
Advocacy – Advocacy 101 3
Background- Why Advocate?
• To help your patients
• To help your specialty
• To help the House of Medicine
Advocacy – Advocacy 101 4
Background- An Example Case
• 52 year old male with chest pain that is worse with exertion and better with rest– PMH: HTN, borderline cholesterol– Exam: unremarkable– EKG nonspecific, troponin negative
E G
Advocacy – Advocacy 101 5
Background- An Example Case
• Now what?
E G
Advocacy – Advocacy 101 6
Background- An Example Case
• PCP declines admit and declines to be available for follow up visit
• Now what?
E G
Advocacy – Advocacy 101 7
Background- An Example Case
• Who gets the patient admitted quicker?– Doc A - worked on the fund raiser and
bylaws committee alongside PCP, their children go to the same school, Doc A knows about PCP’s hobbies and interests
– Doc B – anonymous voice
E G
Advocacy – Advocacy 101 8
Background- An Example Case
Congratulations!You are a patient advocate!
E G
Advocacy – Advocacy 101 9
Background- Dictionary Definition
Advocacy– The act or process of supporting a cause
or proposal
DEFINITION
Advocacy – Advocacy 101 10
Background- Dictionary Definition
Advocate– One that supports or promotes the
interests of another
DEFINITION
Advocacy – Advocacy 101 11
Background- Practical Definition
Doing what you can, and using your influence, to help your patients
DEFINITION
Advocacy – Advocacy 101 12
Background- Practical Definition
Doing what you can, and using your influence, to help your specialty*
*Which also helps your patients
DEFINITION
Advocacy – Advocacy 101 13
The Components of Advocacy
1. Opportunities
2. Expertise & Influence
3. Knowledge of the System
4. Available Resources
Advocacy – Advocacy 101 14
The Components of Advocacy - Opportunities
• Crisis/Disasters
• Prominent People
• Entertainment
• Society Issues/Debates
Advocacy – Advocacy 101 15
The Components of Advocacy - Opportunities
• Crisis/Disasters– The Silver Lining
– 9/11
– Tornados and hurricanes
– Flooding
Advocacy – Advocacy 101 16
The Components of Advocacy - Opportunities
• Prominent People– Illness– Notorious behavior– Causes
Advocacy – Advocacy 101 17
The Components of Advocacy - Opportunities
• Entertainment– Songs– Movies– TV shows
Advocacy – Advocacy 101 18
The Components of Advocacy - Opportunities
• Society Issues/Debates– Immunizations– Helmet & Traffic Laws– Gun Laws– Public Health Screening– Stem Cell Research
Advocacy – Advocacy 101 19
The Components of Advocacy - Expertise & Influence
• Your training• Your expertise• Your time• Your money• Society’s goodwill about physicians
[and especially nurses]
Advocacy – Advocacy 101 20
The Components of Advocacy - Knowledge of the System
Congress
CMS
Regulation Reimbursement EMTALA Regulation
TJC
Advocacy – Advocacy 101 21
The Components of Advocacy - Knowledge of the System
Medicine• Single problem• Emphasize facts• Aim for perfection
Politics• Many issues• Doing the most
good for the most constituents
• Emphasize relationships
• Looking for a balance
Advocacy – Advocacy 101 22
The Components of Advocacy - Knowledge of the System
• Driving forces in politics– Re-election
• Public opinion (votes)• Campaigning (money)
– Influence• One district Representative• Two state Senators
Advocacy – Advocacy 101 23
The Components of Advocacy - Knowledge of the System
• Political Preservation– Money
• Individuals• Corporations• PAC’s
– Votes• Every voter counts• They want to make you happy• Mobilize others
Advocacy – Advocacy 101 24
The Components of Advocacy - Knowledge of the System
• Money & Re-election– Volunteering: time is money
– Even small donations count• Maximum per person per federal election
cycle in $2000 per individual, $5000 per PAC
– They remember contributors!
Advocacy – Advocacy 101 25
The Components of Advocacy - Knowledge of the System
Money Talks, Everything Else Walks!
Advocacy – Advocacy 101 26
The Components of Advocacy - Knowledge of the System
• PAC Contributions (average/yr)
– Pharmaceutical company leaders - $4000
– Wall Street leaders - $2500
– Trial lawyers - $1000
– PHYSICIANS - $7AMA Report, 2009
Reporter: “Why do you rob banks?”
Sutton: “Because that’s where the money is.”
Advocacy – Advocacy 101 27
Willie Sutton’s Law
Negotiating – Persuasion and Influence 27
Advocacy – Advocacy 101 28
Willie Sutton’s Law
• Applies to Congress as easily as to differential diagnosis
• We all go for where the money is
Advocacy – Advocacy 101 29
The Components of Advocacy - Knowledge of the System
• Votes & Re-election
– You must vote
– Encourage others to vote
– Help your official gather votes
Advocacy – Advocacy 101 30
The Components of Advocacy - Knowledge of the System
• Votes & Re-election– Media
– Others that share your interest• Other health care providers
• Neighbors, family and friends
• Anyone from the district
Advocacy – Advocacy 101 31
The Components of Advocacy - Available Resources
• You– Education & experience
– Knowledge of the system
– Time and money
• Media
• Decision-makers
Advocacy – Advocacy 101 32
The Components of Advocacy - Available Resources
• Media
– Influence public opinion
– Influence votes
– Influence decision-makers
Advocacy – Advocacy 101 33
The Components of Advocacy - Available Resources
• Old fashioned– Friendly reporters– Press releases– Letter to the editor– Op-Ed pieces– Advertisements
• Relevant• Internet [YouTube, blogs, Twitter, etc…]
Advocacy – Advocacy 101 34
The Components of Advocacy - Available Resources
• Decision-makers– Know them
• Your elected officials• Organizational leaders
– Know what influences them• Reason• Anecdotes• Support
Advocacy – Advocacy 101 35
A Starter’s Guide to Advocacy
Advocacy – Advocacy 101 36
A Starter’s Guide to Advocacy
• Decide what outcome you want• Identify the decision-maker• Plan your message• Schedule an appointment• Deliver your message• Follow up• Be Persistent
Advocacy – Advocacy 101 37
• Decide what you want
• Know what they want
A Starter’s Guide to Advocacy - Outcomes
Advocacy – Advocacy 101 38
A Starter’s Guide to Advocacy - Decision-Makers
• Find the person in charge– Elected official– Authorized designee
Advocacy – Advocacy 101 39
A Starter’s Guide to Advocacy - Plan Your Message
• Remember the desired outcomes
• Have the needed facts
• Know a good story
• Make it a “win-win”
Advocacy – Advocacy 101 40
A Starter’s Guide to Advocacy - Plan Your Message
• Have the needed facts– The garner credibility– Everyone has them
• Available on the internet– Know them well
Advocacy – Advocacy 101 41
A Starter’s Guide to Advocacy - Plan Your Message
• Tell a story– Put a human face on the facts– Show how the facts relate to the district
or a constituent– A good story will always win
Advocacy – Advocacy 101 42
A Starter’s Guide to Advocacy - Plan Your Message
• Be succinct– Know your allotted time– One minute by phone– One page by letter or email
• Keep it simple• Make it personal• Emphasize how the patients, public, or
voters will benefit• Be nice
Advocacy – Advocacy 101 43
A Starter’s Guide to Advocacy - Schedule an Appointment
• Simple written communication is often not enough
• Even in the electronic age, face-to-face meetings work best
Advocacy – Advocacy 101 44
A Starter’s Guide to Advocacy - Deliver the Message
• Don’t miss your time & opportunity – You may never get a second chance
• Dress and act appropriately for the situation
• Be prepared and bring all your back up material with you
Advocacy – Advocacy 101 45
A Starter’s Guide to Advocacy - Deliver the Message
• If it is an elected official,– Begin with “I live at [address] which is in
your district and I would like to discuss …”
– They want to please their constituents – i.e. their voters
Advocacy – Advocacy 101 46
A Starter’s Guide to Advocacy - Following up
• Send a thank you message
• Do what you promise
• Remind them of what they promised
Advocacy – Advocacy 101 47
A Starter’s Guide to Advocacy - Be Persistent
• Not everything occurs the first time• Reassess what worked and what did
not• Make adjustments• Keep at it – perseverance matters
Advocacy – Advocacy 101 48
Keys to Success
• Go there early and often– Build a relationship over time
• Be very specific in your request– Stick to core principles
• Be patient and persistent– With your official– With the entire process
Advocacy – Advocacy 101 49
Keys to Success
• Remember your influence– You are a constituent [voter]– You should be a donor – You share stories from the district– You help in the campaign– You’ve been to the office /
communicated often
Advocacy – Advocacy 101 50
Keys to Success - You Can Do This
• What you do is important– You save lives– You interact with many constituents– You personify the American dream,
taking care of the poor, the weak, the huddled masses…
• What you do is admired– Everyone wants you in their time of need
Advocacy – Advocacy 101 51
Keys to Success - You Should Do This
• You are doing what is right for your patients
• You are doing your duty in a democracy
• You are helping to make EM a better place
Advocacy – Advocacy 101 52
The Bottom Line
• There are 300+ million Americans with 300+ million opinions
• You may be the smartest in the room, but being the most helpful and persistent will make you the most persuasive
• Help the decision-maker to help you
Advocacy – Advocacy 101 53
Suggested Readings
• NR Schlicher. EMRA Emergency Medicine Advocacy Handbook. EMRA, 2009
• C Kush. The One Hour Activist. Josey – Bass, 2004• C Kush. Grassroots Games. American Society of
Association Executives, 2002• N Tolbert. Transforming Media & Presentation
Skills. www.TheCommunicationCenter.com• C Kush. www.SoapBoxConsulting.com
Advocacy – Advocacy 101 54
National Residency Leadership CurriculumQuestions?
????
Advocacy – Advocacy 101 55
National Residency Leadership CurriculumSpecial Thanks!
Funded By:An American College of Emergency Physicians Chapter Grant
Endorsed By:American College of Emergency Physicians
Emergency Medicine Council of Residency DirectorsEmergency Medicine Resident’s Association
Society for Academic Emergency Medicine
Advocacy – Advocacy 101 56
National Residency Leadership CurriculumSpecial Thanks!
Senior Editors:Stephen Wolf, MD, FACEP
Andrew French, MDMatthew Mendenhall, MD, MPH
Tenet Editors:Britney Anderson, MD
Barbara Blok, MD, FACEPJeffrey Druck, MD, FACEP
Maria Moreira, MDLee Shockley, MD, MBA, FACEP
Administrative Editor:Barbara Burgess
Advocacy – Advocacy 101 57
National Residency Leadership CurriculumThank You!
For More Information Please Visit:www.DenverEM.org www.CoACEP.com
