By Coverys Risk Management

When we explore the topic of patient engagement, we often focus on what practitioners can do to involve patients in the healthcare process. But true patient engagement requires deliberate actions, decisions, and attitude shifts for patients as well. The Center for Advancing Health (CFAH) has defined patient engagement as "actions individuals must take to obtain the greatest benefit from the health care services available to them." (Emphasis added.) Health researchers Judith H. Hibbard and Jessica Greene take the definition a step further by addressing an additional component of the process known as "patient activation.” They explain that patient activation refers to patients’ willingness and ability to take steps to manage their health and care. This involvement can only happen when the patient understands their role in the care process and has the knowledge, skills, and confidence to adequately participate in their own healthcare.

Yet even under a philosophy that the best healthcare requires active participation from the patient, the burden of ensuring good health outcomes and avoiding risk still falls heavily on healthcare providers. New payment models, such as accountable care organizations (ACOs) and patient–centered medical homes (PCMHs), shift performance risk even more significantly to providers by requiring them to achieve specific quality or cost goals. Hospitals and health systems are accountable for patient outcomes over a longer continuum of care (e.g., the Medicare Hospital Readmissions Reduction Program). As healthcare becomes more complex, finding ways to meaningfully engage patients and their family members in the process is increasingly important.

Challenges to Patient Engagement

Complexity of Healthcare: Patients and families are faced with more responsibility for symptom management, medications, wound care, rehabilitation, and mobility ― tasks that have typically been performed by professionals during longer hospital stays. Many patients and family members are unprepared or unwilling to take on what is now required of them. In a national sample, researchers found that 12 percent of respondents thought they could remain passive recipients of care, and 29 percent felt they did not have basic facts or were not able to understand their treatment recommendations.

Attitudes: In her article about doctor-patient relationships and patient engagement, CFAH writer Valerie DeBenedette suggests, “Physicians set the tone for making the patient aware that they have some control over their health. … If the doctor conveys an all-knowing ‘I make the decisions’ attitude, the patient will revert to a passive role.” Patient attitude can be problematic as well. A recent study of patient perceptions revealed a widespread belief that more expensive care is always better and that patients have a general lack of understanding of the healthcare costs borne by their insurers and by society as a whole.

The competing priorities of organizations, insufficient clinician training, time constraints, ambiguity surrounding the definition of engagement, the large number of diverse strategies that can be employed, and lack of electronic patient tracking throughout the decision-making process have been cited (by the American Hospital Association and others) as additional barriers to patient engagement.

Patients and their family members, says Hibbard and collaborators, "possess expert knowledge about the patient’s status that may be unavailable elsewhere … [they] are essential partners in managing chronic illnesses and adhering to recommended therapies." Additionally, healthcare is complex, and the process can be frightening. Even when patients receive detailed, thorough information, they can be overwhelmed or lack confidence in their own choices. Patients need guidance and support throughout the continuum of care.
Risk Management Strategies to Improve Patient Engagement
  • Patient-Provider Relationship: Foster welcoming, respectful, inclusive relationships among providers, patients, and family members. In an environment in which the average patient encounter lasts 15 minutes or less, it is even more important to maintain a high quality of communications.
  • Health Literacy: Encourage clinicians to assume that all patients are at risk of not understanding information relevant to maintaining and improving their health. Accordingly, use plain language and simple fonts. Focus on actions to be taken. Supplement text with straightforward illustrations or diagrams. Limit the messages you are trying to convey. 
  • Start Where the Patient Is: Encourage them to take realistic steps to become more actively engaged; for example: suggest they log into the patient portal to view lab results or submit a question to the doctor, or introduce them to face-to-face or online support groups where they can learn more about their medical condition. Create opportunities for the patient to experience success and build on strengths. Listen, problem-solve, and collaborate with your patient.
  • Shared Decision-Making: Informed participation in decision-making and care helps patients establish trust in their clinicians and helps clinicians engage and communicate better with their patients. Patients are more satisfied with their healthcare because they understand the risks and benefits of their treatment options and decisions. They also feel that their needs and preferences are understood. Use decision aids and patient teach-back to verify understanding.
  • Decision Aids: Encourage development and use of decision aids, like diagrams and videos, that make it clear which healthcare decision needs to be made. Be sure to give patients and their family members informational materials and literature about treatment options and outcomes that will help them clarify their personal values and preferences.
  • eHealth: Encourage expanded engagement by providing access to easy-to-use patient portals. Be sure to also offer training on their proper use. The Journal of General Internal Medicine has reported that a study of ethnically diverse, low-income patients revealed that 60 percent of patients used email; 71 percent were interested in communicating electronically with their providers; 19 percent reported that they currently use email informally to communicate with providers. Patients are interested in and capable of communicating with you in more meaningful ways that will improve outcomes and reduce risk.
  • Peer Support: Patients can be overwhelmed when they are facing health challenges, particularly when they are diagnosed with a life-altering illness. They need information and support, and when it comes from "someone who has been there," it can be especially helpful. Be knowledgeable about local and online support groups specific to the patient’s condition.
When it comes to optimal health outcomes and minimized risks to patient safety, we simply can’t overstate the importance of patient engagement and shared decision-making.

No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances.