Eight Principles of Patient Engagement

Vital Signs: May 2013

Today, physicians not only have to change the way they interpret and use clinical data to improve overall patient care, but they also have to find ways to “engage” patients.

Patient portals, email, and patient education material are only a few of the many tools that are used to engage patients in their health care. Recent studies suggest that patient engagement can lead to better health outcomes, contribute to improvements in quality and patient safety, and help control health care costs. This area is considered so important that in 2008 the National Quality Forum declared patient and family engagement to be one of six national priorities to eradicate disparities, reduce harm, and remove waste from the health care system.

On March 1, the MMS hosted a program, “The Impact of Effective Communication on Patients, Colleagues, and Metrics,” which featured three expert speakers on the topic. Dr. Ronald M. Epstein, Dr. Helen Riess, and Dr. David L. Longworth addressed the key areas of patient engagement, care coordination, physician-to-patient communication, and physician-to-physician communication.

Dr. Longworth, who practices at the Cleveland Clinic, uses a “wellness widget,” an internal tool to create personalized patient assessments of multiple wellness domains with customized intervention and treatment recommendations. This is used as part of the pre-visit planning work flow and is overlaid on EHRs. Wellness domains covered in the widget include tobacco use, nutrition, exercise, sleep hygiene, and depression screening. Another tactic that may be used to improve patient engagement is the “4 Habits Model.” This model was utilized to train thousands of providers in the Kaiser Permanente system and combines evaluative and descriptive elements of physician communication. The Cleveland Clinic adopted it as a component of their patient engagement and patient experience strategies. The four habits are: invest in the beginning; elicit the patient’s perspective; demonstrate empathy; and invest in the end.

Dr. Epstein, professor of family medicine, psychiatry, oncology, and nursing at the University of Rochester Medical Center, talked about the importance of doctor-to-doctor communication. He stressed that poor communication may lead to errors and lapses in care. Furthermore, he explained that while EHRs should ideally facilitate the communication process, they often have the opposite effect. Dr. Epstein stressed that today’s challenges in communication are ever growing due to an increasing geographic isolation of clinicians, poorly defined roles and responsibilities, multiple communication media options that exist, and lack of reimbursement for communication. In order to address the many challenges that exist in today’s environment, Dr. Epstein suggested using the following eight principles in practice:

  1. Put patients first:Do the right thing and keep them informed.
  2. Know your colleague(s):Create respectful working partnerships.
  3. Consider the medium:Use face-to-face, page, or phone for sensitive or urgent issues.
  4. Say the important things first:Have specific reasons and goals for consultation and use clear, succinct recommendations.
  5. Be transparent — let them know what you’re thinking:Judgment, values, uncertainties, and “intangibles.”
  6. Actively consider other view- points.
  7. Don’t be afraid to disagree (respectfully).
  8. Be explicit about follow-up plans and roles.

For more information on patient engagement and to view the program online, visit www.massmed.org/pprc.

— Talia Goldsmith

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