Demystifying patient engagement: strategies for a participatory health system
Paying lip service to the concept of patient engagement is much easier than the reality of actually ensuring healthcare consumers are equal partners in their care. Equipping patients with the information and tools they need often requires fundamental rethinking of workflow, outreach and technology strategies.
In their HIMSS17 presentation, "The 'P' is for Participation, Partnering and emPowerment," Jan Oldenburg, principal at Participatory Health Consulting, and Mary Griskewicz, director of strategic sales at HIMSS will offer a talk – aimed at physicians, nurses and the C-suite – that seeks to demystify the process of an effective patient engagement strategy.
They'll offer tips on creating a truly participatory healthcare system that involves patients and clinicians, judiciously deploying digital tools to help ensure patients are reached where and how they're most likely to respond.
Such systems do exist, here and there, at provider networks across the U.S. The goal of this session is to show what they're doing well – and the pitfalls they sidestep – as they work to build participation across process, policy, IT systems – and, importantly, attitudes on both sides of the doctor-patient equation.
Healthcare IT News asked Oldenburg, editor of the HIMSS books Participatory Healthcare: A Person-Centered Approach to Healthcare Transformation and Engage! Transforming Healthcare Through Digital Patient Engagement for some perspective on the state of patient empowerment, and some strategies for doing it better.
Q. You've been working on patient engagement for a long time. How are are we doing nationwide (compared to, say, a few years ago) with empowering patients in their care? What are some continuing sticking points?
A. It is becoming mainstream to provide patients with access to their health data electronically and to accept that they will take a role in their own health – thanks in large measure to meaningful use rules and the widespread adoption of EHRs with patient portals. But simply making a patient portal available is a long distance away from building a delivery system that really focuses on empowering patients with the skills and knowledge to become partners in their own care – and until we shift the culture, beliefs, and systems that make it difficult for patients to fully participate in decision-making around their own care, we won't fully make this transition. I think we are much better than we used to be at understanding that patient engagement is a problem that requires both a high tech and high touch approach (to borrow from John Naisbitt). It requires us both to provide digital access to data and to support patients with in-person support and touchpoints – until we figure them both out, we won't really maximize the potential for helping patients change their lives.
Q. What are the successful providers doing right? What are some mistakes to avoid?
A. Successful providers understand that this change is far less about implementing a new system and far more about implementing a new culture. Success means moving away from the paternalism of "the doctor is always right" to a culture that embraces patients who ask questions and who come in with research. Successful institutions understand that everyone has a role in engaging patients: the scheduling clerks can mention that patients might be able to schedule appointments faster through the portal; the phlebotomists can mention that results are available faster through the portal than waiting for the postcard to arrive in the mail; the nurse who rooms the patient might mention that a summary of the doctor's orders will be available on the portal afterwards, etc. When the portal becomes embedded in the everyday operations of a clinic and everyone feels a part of its success – that's when it is most likely to be successful. Conversely, when everyone assumes that "Frank" or "Sally" is responsible for the portal's success or failure – that's when it is most likely to fail.
Q. How should technology fit into the equation? A starring role, or a supporting player? What sorts of tools work best?
A. Technology needs to fit the problem to be solved – and fit the individual with the problem. We fail when we try to apply the same solution to different problems, like the person with a hammer to whom every problem looks like a nail. In healthcare, we have often assumed that everyone responds to technology in the same ways. Further, we have also assumed that all severe diabetics or congestive heart failure patients will have the same reasons to change their behaviors. Technology will work best when it can help us match individuals to the solution that best fits their lifestyle and motivation. For some people, that will put technology in the starring role, for others, technology will be invisible. The key for technology to be effective is that it will match the person with information and tools that are most effective for that person's needs, processing style, and readiness to change.
Q. What about people and process – the "attitudinal and cultural barriers to participatory healthcare," as you put it. What are some keys to overcoming those?
A. This is such a hard question to answer, because people protect their current domains of expertise and power out of the fear that sharing them will reduce their authority, respect, and power. Making it safe to change is about showing people that sharing power and knowledge doesn't diminish them but enlarges them; that they have power in a whole different way. It also takes leadership, to model new forms of behavior that is participatory and egalitarian. It takes training, to help patients understand that it's safe to speak up and ask for what they need, that questioning is not just acceptable, but the best way to get optimal care.
Q. Do you believe most patients – especially those who might need to be paying close attention to their chronic conditions – want to be engaged, in your view? What are some keys to reaching those who would most benefit from engagement?
A. I'd like to suggest that the idea that "we" the healthcare system can "engage patients" starts us thinking in the wrong direction because it implies that engagement is something we can "do to" people. Engagement is always a choice that people make for themselves. We can create conditions that make them more or less likely to engage with us; we can be more or less engaging as individuals, as systems; we can create technology with features that are more or less engaging – but the choice of whether or not to engage is always the person's, not ours. This is one reason I have started to talk about "personal health engagement" rather than "patient engagement" because I think maintaining the focus on individual autonomy, choice, and intrinsic motivation is important.
At the same time, I think that most people want to be healthier. When you look at the list of things that people choose for New Year's resolutions, for example, the vast majority focus on health and lifestyle factors. Yes, people fall off the wagon, but most of the time it's because they don't know how to make or sustain changes, not because they don't want to make them. We in the healthcare system have done a pretty bad job of providing them with the tools they need to make the changes they want to make.
"The 'P' is for Participation, Partnering and emPowerment," takes place February 20, 2017, at HIMSS17, from 3-4 p.m in Hall F3 of the Orange County Convention Center in Orlando.
This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.