The Importance of Patient Engagement: Better Health, Better Outcomes

Patient engagement improves health outcomes. It does, however, require the patient to participate, to care or to “be engaged.” We’re not talking about marriage here. Rather, this is about the individual actions patients must take to gain the greatest benefit from their healthcare services.

When it works, it works well. Patient engagement can be a solid cornerstone, especially in primary care, says Neil Patel, IORA Health’s senior vice president and medical director for the Northeast and Atlanta.

“I can work all day long and feel like I did a good job that day, but if patients aren’t engaged in making plans together, and in sharing with me what I need to know, it can result in a patient who’s not going to improve,” he says. “This is how people end up going in and out of the hospital.”

Communication is more than ‘How are you?’

Patient engagement is rooted in real relationships, Patel says, and it impacts everything he and his team do, from top to bottom and back up, even as the players also maintain an unwavering focus on culture.

“Our physical space, with walls, chairs, even plumbing, is designed to make folks comfortable,” says Patel. “The kinds of people we hire are really good at drawing people into relationships—physicians, other practitioners, front desk staff, health coaches and more. They make hundreds of independent decisions every day and in a manner consistent with our priorities and our common set of values.”

Employees are encouraged to foster patients’ self-confidence, he adds. Staffers attend monthly  meetings at which they’re “reminded how important empathy is. We want them to ‘flex their empathy muscle.’ Doing so allows them to improve even more over time and get better at their jobs.”

Because patients are “outside healthcare” in their lives, Patel lauds the role of IORA’s health coaches, who most often come from outside the industry, but from within the community. “They have that magical quality that makes people want to share with them.”

During a visit, patients are initially greeted by the health coach, who may take vital signs, he says. “They help draw the connection between stated goals and where the patient is, and what they need today. We think of them in a positive way, as they set the stage, kind of like an opening act for a comedian.”

By the time the physician or nurse practitioner enters the room, the patient feels more comfortable in the environment. “They can feel the transparency there and the same when they go online and read their medical notes. Half of my [medical] jargon doesn’t do anyone any good, so I use different words. I show them the screen right up there as we discuss their plans, and they can see what I’m typing. Later, they can even quickly send a text to their health coach—or look up lab results. Why shouldn’t they be a part of all that?”

Discussions can take place around circular tables, “big enough to welcome a spouse, daughter-in-law or caregiver,” he says. Home visits include laptops, where information is shown to patients and others, with the healthcare professional assuming a welcoming body position that encourages engagement.

It’s all in the details, but they add up, Patel says. “Prioritize engagement and see what changes.”

Healthcare is not a machine

Because there’s no “set definition” of patient engagement, the term—and how to utilize it—is open to interpretation.

“There are ways of talking about patient engagement as a separate activity or procedure that’s different from the process of caring,” says Victor M. Montori, M.D., professor of medicine and director of the Knowledge and Evaluation Research Unit at Mayo Clinic. He’s one of the most cited researchers in the world in the field of clinical medicine and co-founder of the nonprofit The Patient Revolution.

“I’ve found it problematic that we think of healthcare as an industry achievement, a machine by which clinicians—anybody with privileges at the bedside of a patient, like nurse, doctor, pharmacist, therapist—approaches the patient,” he says. “This belies that they are interchangeable, that it doesn’t matter who shows up. I do not like the notion of clinicians as interchangeable beasts, because patients don’t see it that way.”

Echoing Patel’s emphasis on relationships, Montori says that patients with ongoing chronic conditions do require real relationships with clinicians in order to improve. “They don’t want to have to repeat themselves to tell the darkest stories to multiple people. There should be some continuity.”

Once clinicians demonstrate true interest in the patient, “a magical thing happens,” says Montori. “Most begin to care for and about the clinician. It is a transactional model. A business model is not always a caring model.”

Counting engagement brownie points

Montori addresses what he calls a common misconception. “We think of engagement as a tool to optimize industrial performance of healthcare, like ‘If you do well with engagement, you get extra brownie points when you go to the payor.’ When you develop and build relationships of care, those things take care of themselves.”

Engagement is sometimes easier when a patient is really sick. “They have skin in the game and are deeply interested in getting better,” says Montori. “With those not feeling sick, but with risk factors, and who need to be convinced that they need care—perhaps to lose weight or manage bone density—it’s harder for them to feel like a ‘patient.'”

The system itself may limit the ability to engage, he says. “Time with patients is interrupted by checklists, contract requirements, screening questionnaires or feeding the EMR’s documentation requirements.” The patient can end up getting short-changed on time.

Clinicians also then begin to fail to appreciate the patient. “They try to cope with recognition that they are a cog in the wheel of a machine, and begin to look for meaning elsewhere,” he says.

Engagement occurs when patients and clinicians have tools to make better decisions together, he says. “Let’s start a movement that helps us turn away from industrial healthcare, to provide careful and kind care for all,” Montori says.

Understanding is key

Health communication and engagement expert Geri Lynn Baumblatt of Articulations Consulting says achieving better engagement starts with knowing a few basics about the patient population. She says, “we’re not always giving people what they need in a really complex health system.”

Poverty, economics and the environment dictate a lot of what patients have access to and understand, and can hinder how they plan to improve their health. “Sometimes they just don’t know what questions to ask, or they’re scared or embarrassed to do it,” she says. “We massively underestimate what they understand, when they may not be able to search how to find what is appropriate for them. We don’t give people basic education about conditions, medications, insurance and other things.”

Clinicians should also think about helping patients use logic to know why they’re doing something, so they don’t just blindly follow instructions. “Participation is so important, especially when you tell them to do something really hard like stopping smoking,” she says.

A failure to communicate

Make sure to really listen, Baumblatt says. “Maybe a patient has side effects from medication, and calls the doctor to share that. The doctor says ‘here’s good data around the medication, so keep taking it.’

“The patient is then labeled non-adherent, when they called but were ‘blown off,’ and don’t understand,” she adds. “It’s also difficult to trust a doctor they see only a couple of times a year.”

In the clinical setting, shared decision-making that creates engagement involves thinking through all the options and weighing pros and cons, Baumblatt says. Encouraging patients to set goals that are important to overall quality of life can help propel engagement.

“Help them understand the impact this has on their life,” she says. “Tell them, ‘This is your health and you want to feel better to be able to play with your grandkids and go for walks with your partner.’ Then they can start to think, ‘I want to do these things so I feel better.'”

There is light at the end of the tunnel, when patients move forward in real collaboration with their healthcare provider.