Defining Patient Engagement

The mad scramble to figure out how to 'engage' patients in their healthcare has begun!

Prompted by federal stimulus money for health information technology development and usage, the rising number of patients and caregivers using the internet to question both their care and the health care system, unsustainable costs of patients with preventable chronic disease, and new quality measures that grade medical facilities on their 'patient-centeredness'; everyone from PR firms to hospital boards are trying to figure out how to engage patients.

What does it mean to engage?
According to the Merriam Webster online edition, E-N-G-A-G-E has several different meanings. The 1st of which is 'to offer (as one's word) as security for a debt or cause' ' I guess this is how consumer directed health care came to mean patients pay a greater share of the cost of their health care. The 6th meaning is 'to enter into contest or battle with' ' this must be what many doctors envision will happen if they allow patients equal footing in health care decision-making. It is the 5th meaning 'to hold the attention of : engross b : to induce to participate' that most intend when they talk about engaging patients in their health, although this too frequently devolves into, listen to all the health information and medical treatment prescriptions we give you and comply.

What does meaningful engagement look like?
Properly done, patient engagement in action looks like shared responsibility between patients (and their families if applicable), health care practitioners (the entire team: surgeons, physicians, nurses), and healthcare administrators (providers of the infrastructures and the payment models) to co-develop pathways to optimal individual, community and population health. Patient engagement brought to life means involving patients and caregivers in every step of the process, providing training or financial support if necessary to their participation. Patient engagement is not satisfied by a survey or an annual meeting of an advisory board. Going back to the definition above ' patient engagement must 'hold the attention of patients' give us something useful to do? Let us provide solutions to medical error rates, give input on facility design (not just the paint color, but the placement of the outlets in the rooms so I can stay attached to my infusion pump and still get to the bathroom), develop research questions, define what outcomes we find valuable to measure, train staff to be culturally competent ' that would hold my attention. As for 'induce to participate', beyond making the connection of action to our own health and well-being, many patients are willing to devote significant time and effort to making the system better for their children, grandchildren, and for future patients.

My question to hospitals and others pushing back on the idea of meaningful patient engagement is this: Why would you reject the help of thousands of individuals positioned in various ways to help you be more successful?

CFAH's work is focused on promoting people's engagement in their health and health care'here are two resources on this topic:

CFAH's Engagement Behavior Framework defines engagement as "actions individuals must take to obtain the greatest benefit from the health care services available to them."'  The EBF realistically describes what each of us must do to benefit from the health care available to us. It offers information, guidance and support that all patients can use to be knowledgeable and willing to act on their own behalf.

In addition, CFAH's Snapshot of People's Engagement in Their Health Care report found that most of us do not actively and consistently perform many of the actions directly linked to benefiting from the health care available to us.'  Roughly one-third of people perform them inconsistently or tentatively and another third do not perform them at all.