In the late 1960s, healthcare institutions began to appoint patient representatives, also called patient advocates or ombudsmen, to counter complaints about unsatisfactory and impersonal delivery of care. Patient representatives are now employed in over half the hospitals in the United States as well as in nursing homes, clinics, health maintenance organizations, and other health provider organizations. At The Mount Sinai Hospital in New York City, the Patient Representative Department was established in 1966 to provide greater access to the institution for community residents, to help solve patients' problems and complaints, and to serve as a quality assessment and improvement tool. It functions as both a proactive and reactive force, addressing patients' concerns, investigating sources of dissatisfaction, recommending corrective action when policies and procedures are not responsive to patient needs, and striving to create a patient-friendly environment.