In their February Health Affairs article, Kristin Carman and colleagues provide us with an excellent framework for approaching patient engagement. The framework shows the progression of engagement activities as they move from simply consulting patients, to involving them in their care, to a full partnership with patients. In addition to showing this progression at the patient care level, the framework also shows how this same progression can play out at the organizational level and at the societal or policy-making level. The proposed framework provides organizations with a high-level road map for improving patient and family engagement on the ground. Providing this type of high-level road map will allow pioneering organizations, through their experiences and efforts, to fill in the details of the map.
Through my work, I have had the opportunity to observe how some organizations are creating policies and systems that move them toward greater patient engagement in care delivery. The changes that I see going on at the organizational level are similar to what happens when individual patients become more activated or engaged: first the individual gains an understanding of what their role is in the care process, and then they acquire the skills and knowledge to take on that role. For organizations, there is also the discovery of their role as organizational leaders recognize the impact that patient engagement can have for reaching their own organizational goals. Then there is a process of gaining the skills and knowledge for effectively partnering with patients and their families. As individuals and organizations gain skills and knowledge, they both become more confident in their ability to be successful in patient-engaged care.
Many organizations are breaking new ground in moving toward patient centered approaches. One example is the Fairview Health Services in Minnesota, who is attempting to systematically build into care protocols strategies that meet the patient “where they are.” They use the Patient Activation Measure (PAM) as part of patient care, and this information enables staff to tailor how they support patients. The goal of these protocols is to increase patient involvement and improve outcomes.
These protocols tell the care team, for a specific situation, what should be done. For example: if a patient with a low PAM score comes in for a primary care visit, that patient gets a specially trained medical assistant who helps the patient formulate his/her questions for the visit. After the visit the medical assistant reviews with the patient the next steps and follows up the next day with a phone call. Another protocol currently in development at Fairview is aimed at helping to prepare lower activated patients to participate in shared decision-making.
As an organization, Fairview is actively building in opportunities for patients to participate in their care and to fully partner in their care. Further, they are specifically making it easier for those patients who have been passive in the past to become more involved. So in addition to moving the organization along a continuum of greater involvement in patient engagement, they recognize that patients are also at different points along a similar continuum and are attempting to meet them where they are.
The changes that are taking place at the direct patient care level will likely translate into greater patient activation and improved outcomes. However, the direct care changes could not occur without the organization embracing this patient engagement direction and deciding to build its own internal capacity for carrying it out. As the framework for engagement suggests, changes at the direct care level need to be supported at the organizational and policy levels.
Thinking about the patient and family engagement from multiple levels is certainly a new thought, but an important one. All three levels of engagement – point of care, organizational, and societal—happen simultaneously. Efforts by organizations to create engagement policies and systems impact engagement at point of care, and build a larger population of activated citizens who are able to engage in larger social health policy decisions. This alignment of the different levels likely produces synergies that result in greater change and effectiveness than simply adding up the contributions that each level makes to increased patient engagement.