Core Competencies

4.01 Healthcare Systems: Advocacy

Introduction

Advocacy for children is fundamental to the practice of pediatric medicine. It is particularly significant for pediatric hospitalists who primarily care for children and their family/caregivers during acute illness when they are most vulnerable. Pediatric hospitalists have a unique opportunity to leverage the healthcare system to advocate at the individual, population, hospital, and community levels. Advocacy for children, an activity which takes many forms, embraces the desire to ensure children, particularly those from vulnerable populations, have their interests promoted, their rights safeguarded, and their voices heard on issues which affect them. Advocacy includes family centeredness and empowerment; it requires leadership skills to ensure care for children is promoted in varied healthcare settings.

Knowledge

Pediatric hospitalists should be able to:

  • Identify principles of advocacy for children and families/caregivers.
  • Define the role of the pediatric hospitalist as advocate within the community, the healthcare system, and an individual child’s medical home.
  • List strategic foci for advocacy, such as age, gender identity, sexual orientation, diagnosis, socioeconomic status, cultural or demographic group, access to healthcare, chronic healthcare needs, mental health concerns, and additional social determinants of health.
  • Discuss methods by which pediatric hospitalists can approach common advocacy issues affecting hospitalized children, such as securing pediatric-specific needs (medications, equipment, or pediatric subspecialty services) or obtaining approval for recommended post-discharge care.
  • Describe the unique challenges of advocating for the needs of children within an adult-oriented system.
  • Review the role of the pediatric hospitalist as advocate for the child in the context of child abuse, neglect, and other situations where the child’s needs may not be met by the family/caregivers.
  • Discuss how collaboration with social workers, law enforcement, school system members, and other non-clinicians is important for both individual patient and systems advocacy.
  • Distinguish different payment systems, types of healthcare expenditures, and means of financing healthcare (including government and private payors) that affect the delivery of care to children.
  • List local, regional, and/or national organizations involved in pediatric advocacy with which pediatric hospitalists collaborate.
  • Cite examples of opportunities to engage in advocacy for children at the individual, population health, hospital, community, and national levels.
  • Describe the legislative process by which advocacy issues are converted to policy and identify opportunities within this process for hospitalists to advocate directly with policymakers.

Skills

Pediatric hospitalists should be able to:

  • Utilize evidence-based methods to identify physical, social, emotional, and environmental factors that may negatively impact physical and mental health and well-being.
  • Demonstrate the ability to advocate for the needs of hospitalized children and the family/caregivers, attending to the acute condition, as well as preventive health concerns.
  • Utilize tools to access local, state, and national data on factors impacting the health of communities.
  • Assist in creating group- and hospital-wide policies that encourage social inclusion, equality, and justice for children.

Attitudes

Pediatric hospitalists should be able to:

  • Exemplify collaborative practice with members of hospital administration, the healthcare system, and community groups to advocate for the needs of children.
  • Advocate for the health and well-being of children in all encounters.
  • Recognize the potential disparities effecting healthcare in all encounters, reflect on their impact, and employ sensitivity in communications with patients, the family/caregivers, and healthcare providers.
  • Maintain awareness of political, cultural, and socioeconomic trends affecting the physical and mental health of children.

Systems Organization and Improvement

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

  • Ensure the principles of child advocacy are promoted for every hospitalized child and the family/caregivers.
  • Work with hospital administration to align advocacy efforts with the hospital system’s mission, vision, and values.
  • Work with educational leaders to incorporate advocacy topics into healthcare provider, hospital staff, and trainee curricula.
  • Lead, coordinate, or participate in developing effective partnerships between hospital administration and community partners to improve child welfare.
  • Lead, coordinate, support, or participate in efforts to defend and promote the welfare of children and the family/caregivers in media of different formats.

References

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