Five Ways of Achieving Patient Engagement: Part 1: WITHOUT Technology

If one looks at communications revolving around healthcare these days, whether emanating from political, healthcare economics, clinical, or technology spaces, the term patient engagement is invariably found as one of the cornerstones of the conversation.  This is no more evident than in the digital health technology space. One would think that patient engagement is only possible by hitching a wagon to the technology horse.  I would like to explore the issue with two posts, the first devoted to non-technical considerations and the second examining best practices of technology utilization in this regard.

1.     Listen to the patient.  Patient-physician communication is the basis for much of what transpires during the tenure of the professional relationship.  Lack of good communication has been cited for medication nonadherence.  William Osler, the father of modern American medicine famously stated that the patient will tell you the diagnosis with the narration of the history. Given the fact that most office encounters today last 15-20 minutes and that patients have comorbidities requiring attention, it is no wonder why many times they are not heard.  The physician is looking at the computer screen clicking off checks. The system is no longer geared towards human interaction and this creates a recipe for poor care, even if unintended.  This is why direct care or concierge medicine is becoming popular.  Both physicians and patients are returning to communicating in this setting. Other solutions need to arise to promote communication. Providing patients with pre-visit guidance in order to organize their thoughts and concerns might help.

2.    Motivate your staff to be as patient-focused as you are. Office and hospital staff should reflect the provider’s patient-focused approach to care. Many times they are too task-oriented and forget there is a patient who is the reason behind those tasks.  If the staff takes on the mindset of a stakeholder in the patient’s care and not just performing a job, the result will be a happier patient. Patient satisfaction surveys (an important part o the future healthcare landscape) will reflect this aspect of the care.  Patient-centered professionalism should be the goal of all ancillary staff.

3.    Demonstrate to the patient that you are an advocate.  Going to bat in front of an insurer for a patient who really needs a specific drug or procedure is something I always felt good about. Spending time on such matters is something physicians years ago (dating myself) went into the field thinking they would have to do.   However onerous, it is what patients need docs to do in critical moments. And patients do very much appreciate this. It is what made me feel good going to sleep at night.

4.    Show them your personal side.  Social media is a great way for providers to show their personal side.  This is not to say that personal interactions with patients should take place one on one, but a way in which patients see the personal (and hopefully appropriate) side of their healthcare professional.  I believe Twitter is a better forum for this than ‘friending’ between a provider and patient on Facebook.

5.    individualized self-management.  Patients will partner with providers in their treatment plans with different levels of enthusiasm.  Some patients will require more support than others (motivational and material) and this should be discussed. Discussing patient engagement early on in the relationship is important.  It should also involve a caregiver who might be the one participating in the engagement on a larger scale. A provider who embraces co-management and is seen as both a partner and supporter of the patient will be appreciated.

The above might seem obvious to most people, but in today’s discussions surrounding patient engagement, the humanistic aspects of achieving this are lost in the vision of technology magically transforming how patients react to their medical conditions and to their healthcare providers.

About davidleescher

David Lee Scher, MD is Founder and Director at DLS HEALTHCARE CONSULTING, LLC, which specializes in advising digital health technology companies, their partners, investors, and clients. As a cardiac electrophysiologist and pioneer adopter of remote patient monitoring, he understood early on the challenges that the culture and landscape of healthcare present to the development and adoption of digital technologies. He is a well-respected thought leader in mobile and other digital health technologies. Scher lectures worldwide on relevant industry topics including the role of tech in Pharma, patient advocacy, standards for development and adoption, and impact on patients and healthcare systems from clinical, risk management, operational and marketing standpoints. He is a Clinical Associate Professor of Medicine at Penn State College of Medicine.
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8 Responses to Five Ways of Achieving Patient Engagement: Part 1: WITHOUT Technology

  1. David,

    It seems like all of these boil down to one simple thing: show the patient that you really do care. I would never argue against the idea that people who feel cared about are be more open to engage.

    But there seems to be a fundamental assumption common to all the patient engagement discussions I’ve seen or heard. An assumption that may very well be completely wrong. This assumption is that patients want to engage.

    Here is an alternate narrative (not one I’m saying is right, but one I’m proposing to reframe the topic in order to reveal different questions):

    Patients don’t want to engage. They don’t want care — even though on occasion they desperately need it. They don’t want care because it is a disruption to what is normal, and normal is what they do want. People don’t want to engage, they want normal.

    From this frame you might start to ask different questions that could lead to breakthrough thinking, like “how do you meaningfully engage someone who doesn’t want to engage?” Any solution to this question would also benefit those patients who do want to engage — meaning we can only gain by asking it.

    This necessarily changes the conversation from “what can we do?” to “what do patients want?”

    I wish I had answers, but for now I’ve only got questions.

    • I respectfully disagree, John. Survey after survey say they want to engage. One large study in PA showed that 80% of people surveyed stated that they are the ones most responsible for their own care.

    • Joe Crandall says:

      I could see your point about the lack of patient activation/engagement being at the center of the issue. Although I agree with David. Patients want to be engaged and involved. From first hand and second hand experience as a patient/caregiver, there is a lot of fear and timidness on the part of the patient. Patients are like visitors to a foreign country. They don’t know the language, customs and traditions so they shut down – especially when the natives are not initially friendly. When they spot a person willing to give them some empathy, time and understanding, they open up. Most of the time this is not the doctor or nurse.

      Back to the article, the point of any technology in healthcare should be to enable the staff to do their jobs better and to make better decisions. It is not a replacement for the human-to-human conversation. Machines can only supply data. The people receiving that data have to use their maturity in decision making to apply the data to drive an action.

  2. Pingback: Five Ways of Achieving Patient Engagement: Part 2: WITH Technology | The Digital Health Corner

  3. Jon Ivanhoe says:

    Dr Sher,
    I will jump into the fray, not because I can effectively argue against any of the non-technical considerations you so eloquently listed as means for improving patient engagement, which I do agree are important, but because the argument itself comes from the supply side. This is not to say patients don’t want better care or that innovation in patient engagement shouldn’t happen, but it is only half of the solution.

    In the majority of articles I have read about patient engagement, strategies are discussed from the perspective of what the practitioner, provider, hospital and health system can do to engage patients, often without including patients/consumers in the conversation. This is akin to advertisers/marketers creating messages that play on human emotions to drive a “want” into a “need” and create a market.

    A basic assumption we make is that good health, which can be defined in many ways, is a desirable outcome for all people. You have to be a heretic to challenge that premise. However, we observe that beyond being pre-disposed genetically, people exhibit behaviors that put “good health” at risk to various extremes and value health as an economic choice. I think the challenge for healthcare practitioners is not only to recognize that “engaged” patients are already valuing the benefits of the health information exchange and your considerations will make the relationship even stronger. But, I would suppose that there is a subset of patients, and most likely the ones that our society could benefit greatly from improved clinical outcomes, that recognize they are responsible for their care, but continue behaviors that are counter to being able to act. My concern is that this population may not want to be engaged; sees much less value modifying behavior to improve health outcomes and remain compliant and may not be receptive to non-technical or technical patient engagement strategies. Before we take a “build it and they will come” mindset into the patient engagement arena, consider that not all patients will respond homogeneously to supply side strategies and we should be open to tackling the issue of people’s motivation around health outcomes, compliance and non-engagement in ways that put the patient at the center of the discussion.

    • Thank you for the thoughtful comment, John. Certainly one cannot make the horse drink water just because the water is there or you tell it to drink. What is paramount is that people are educated enough about the issues to make informed choices. Right now they are not. An app like Fooducate not only gives you qualitative analysis about the food you buy from the barcode scan, but will offer healthy alternatives. THIS is what is needed. What will help also and what you allude to is building behavior aspects as integral parts into apps. I do believe that designing apps for the worst case scenario, the type of patient who is anti-change, will rise the health tide of all the other ‘ships’ in the market’s waters.

  4. Chris Rosati says:

    Doctor: All due respect, but the 80% stat is mis-leading. Typically those who participate in surveys are those who care.

    It seems that much of the conversation around patient engagement has a clinical approach. But we must understand we’re talking about ultimately changing patient behavior. That requires sustained engagement. Being a better listener for 10 minutes and finishing w the same old patient education sheet is only going to yield very minimal improvements.

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