Engagement for good health outcomes!

 What is Patient Engagement?

“No blockbuster drug can make a difference if a patient doesn’t take it,”  noted Donald W. Kemper, Founder and CEO Healthwise.  To get the patient to “take the med”, the patient must believe that taking it is something they want to do.  Engagement moves the patient towards such action.

Patient engagement is helping patients take a more active role in self-managing their disease.  Providers can better engage patients by establishing a person-centered not patient-centered partnership, as this encompasses the whole person and their life — their body, mind, spirit, family, and full health community.  Person-centeredness is needed if we truly want to be able to set up a positive partnership with that person to improve their health.  Nurses play a central role in engaging patients by facilitating the provider-patient communications and emotional disclosure.  More definitively, engagement occurs when the provider or health coach spends time exploring what is most important to the person and allow them to choose their own course of action on whatever health concern they wish—through inquiry, personal discovery and accountability.

Why is it Important? 

Patient engagement is the key to improving quality, efficiency and health outcomes.  The absence of engagement is associated with preventable deaths —a shocking 40% of deaths are due to changeable lifestyle factors.  Half of all patients do not follow physician referrals, and most (75%) do not keep their follow-up appointments. 1  These factors are related to behaviors, and are maladaptive behaviors that can be unlearned and replaced by new healthy behaviors that will prolong life.  We know that changing behavior is hard, but entirely possible through focused attention by the patient that is supported and guided by a trained provider or health coach. 

Not long ago, when a patient refused treatment they were called “non-compliant”.  Within this paternalistic framework, physicians would tell patients what to do and were expected to adhere to that unilateral advice without having any opportunity to question or redirect.  They might have even felt uncomfortable questioning authority.  We now know that this can no longer be an excuse to not fully engage people in their care. When a provider demonstrates commitment to the patient and is caring and understanding, the result is an increase in their engagement in the relationship and their health goals .2  In fact, the way providers now interact with and motivate patients is touted as the new 21st century healthcare breakthrough.  A growing body of evidence clearly shows that providers who engage with their patients achieve significantly improved clinical outcomes. 3  Furthermore, health care organizations that emphasize patient engagement can improve productivity and patient satisfaction. 4 

Patient engagement is evolving from a perk to an necessary part of healthcare practices, academia, and government. Major health reform initiatives are zeroing in on patient and family engagement.  These include Accountable Care Organizations (ACOs), Patient-Centered Medical Home (PCMH), and CMS Stage 2 Meaningful Use of the EHR Incentive Programs, and. In 2014, Stage 2 Meaningful Use will require providers to allow for increased patient and family engagement, electronic transmission of medical summaries, e-prescribing and lab results, and rigorous health information exchange so they can receive incentive payment 5

How to get buy-in from your patient:

  • Make it easy to connect with their doctor: deploy an online patient portal that provides access to medical records, lab and other test results, appointment scheduling, registration, educational resources, and online bill payment.  Compliance with ICD-10 and Stage 2 Meaningful Use, and other mandates is essential.
  • Empower your patients:  provide an effective space for the client to develop new insights into their own health and to create a specific plan to reach their goals.  The client is responsible and held accountable for taking action on their plan.  A health coach can effectively motivate and support the patient’s health behavior change.  Coaching can elicit internal motivation and connect health goals to life purpose, increasing the chance the new behavior will be maintained.
  • Bridge care to technology:  A growing number of companies use cloud-based and patient monitoring technology to obtain complete and timely medical data.  For example, Philips uses salesforce.com to help improve patient engagement in its new cloud-based telehealth platform that focuses on medical device and data interoperability.  It compiles data gathered from electronic medical records, home-based monitoring equipment, and personal devices such as Apple’s HealthKit. The process compels both providers and patients to work together in using these data to design an dynamic personalized care plan that works best for them.  This has already seen success in Banner iCare of Arizona a pioneer accountable care organization (ACO).  As Marc Benioff, CEO of salesforce.com observes:

”We have entered a new transformative era for healthcare, and technology is enabling the industry to connect to, care for and engage with patients and each other in a profound new way…We are creating an open health platform and ecosystem to benefit everyone that cares about one of the most important issues of our time.” 6 Eric Wicklund


1 Anand K, Parekh, “Winning their trust”, N Engl J Med 2011: 364:e5June 16, 2011

2 Duke Integrative Medicine

3 James, J. “Patient Engagement.” February 2013. Health Affairs/Robert Wood Johnson Foundation. Available at: http://www.rwjf.org/en/research-publications/find-rwjf-research/2013/02/patient-engagement.html

4  http://www.athenahealth.com/knowledge-hub/patient-engagement/what-is-patient-engagement.php#sthash.cZwrhnWg.dpuf

5 http://www.cms.gov/eHealth/downloads/eHealthU_EPsGuideStage2EHR.pdf;   http://www.athenahealth.com/knowledge-hub/patient-engagement/what-is-patient-engagement.php#sthash.cZwrhnWg.dpuf 

6 Patient engagement: The unifying link in telehealth. August 20, 2014 | Eric Wicklund – Editor, mHealthNews; http://www.mhealthnews.com/news/patient-engagement-unifying-link-telehealth