Chain Reaction, Part I
Two slides into the Health Care Organizations 101 webinar it hit me: for years MLP attorneys have talked with health care staff about a standard advocacy strategy called chain of command.
It works like this: mom complains to lawyer or paralegal about a letter she received from [fill-in the blank – social security, food stamps, housing, welfare, etc] agency. Legal team calls agency worker on mom’s behalf to “push” the system. After a couple of unreturned calls, lawyer calls supervisor to inquire about mom’s case and demand a solution. If supervisor fails to return call, lawyer will continue up the administrative chain of command pressing for explanations, answers, accommodations. This is frequently accompanied by email or letters documenting activities in a range of language from cooperative and unctuous to aggressive and threatening….
Chain-of-command gets results, and it is part of the toolkit for healthcare providers who want to help their patients get what they need in the complicated safety-net of the new millennium. It requires training and empowerment, because doctors don’t naturally buck the system [see Megan Sandel’s May 09 blog entry]. And they need help identifying what the rule is, and what to ask for. But armed with the right tools, there is no more credible advocate than a savvy physician.
Chain Reaction, Part II
Legal aid lawyers love chain-of-command. It is a strategy to help ensure that government agencies adhere to their policies and procedures. Chain-of-command can help nip huge problems – like a lost housing voucher – in the bud, thereby protecting clients from wretched bad luck, incompetence or vindictiveness at the hands of government bureaucrats.
Good administrative chain of command advocacy depends on understanding how bureaucracies operate, where the power centers lie, and how decisions get made and unmade. Some of the legal aid community’s most successful advocates never see the inside of a courtroom or hearing room. They are people who tend relationships in bureaucracies and devise strategies to support their clients using their knowledge of the administrative system.
So why does they prospect of navigating the bureaucratic byways of an academic children’s hospital cause even the most experienced, intrepid legal aid attorney heart palpitations? Is it because the lines of authority don’t carry the same clarity of an administrative agency? Or because we can’t fall back on our more “aggressive” strategies when all else fails and phone calls go unreturned?
Maybe it is something less tangible, and more organic. Lawyers are trained to prize the client relationship above all else. So chain-of-command advocacy with a client purpose is a different (more tolerable?) proposition than having coffee with the assistant general counsel for the hospital with the vague goal of building a relationship over the long-term.
Two slides into the Health Care Organizations 101 webinar it hit me: for years MLP attorneys have talked with health care staff about a standard advocacy strategy called chain of command.
It works like this: mom complains to lawyer or paralegal about a letter she received from [fill-in the blank – social security, food stamps, housing, welfare, etc] agency. Legal team calls agency worker on mom’s behalf to “push” the system. After a couple of unreturned calls, lawyer calls supervisor to inquire about mom’s case and demand a solution. If supervisor fails to return call, lawyer will continue up the administrative chain of command pressing for explanations, answers, accommodations. This is frequently accompanied by email or letters documenting activities in a range of language from cooperative and unctuous to aggressive and threatening….
Chain-of-command gets results, and it is part of the toolkit for healthcare providers who want to help their patients get what they need in the complicated safety-net of the new millennium. It requires training and empowerment, because doctors don’t naturally buck the system [see Megan Sandel’s May 09 blog entry]. And they need help identifying what the rule is, and what to ask for. But armed with the right tools, there is no more credible advocate than a savvy physician.
Chain Reaction, Part II
Legal aid lawyers love chain-of-command. It is a strategy to help ensure that government agencies adhere to their policies and procedures. Chain-of-command can help nip huge problems – like a lost housing voucher – in the bud, thereby protecting clients from wretched bad luck, incompetence or vindictiveness at the hands of government bureaucrats.
Good administrative chain of command advocacy depends on understanding how bureaucracies operate, where the power centers lie, and how decisions get made and unmade. Some of the legal aid community’s most successful advocates never see the inside of a courtroom or hearing room. They are people who tend relationships in bureaucracies and devise strategies to support their clients using their knowledge of the administrative system.
So why does they prospect of navigating the bureaucratic byways of an academic children’s hospital cause even the most experienced, intrepid legal aid attorney heart palpitations? Is it because the lines of authority don’t carry the same clarity of an administrative agency? Or because we can’t fall back on our more “aggressive” strategies when all else fails and phone calls go unreturned?
Maybe it is something less tangible, and more organic. Lawyers are trained to prize the client relationship above all else. So chain-of-command advocacy with a client purpose is a different (more tolerable?) proposition than having coffee with the assistant general counsel for the hospital with the vague goal of building a relationship over the long-term.
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