In order to achieve patient-centered healthcare, we must activate and engage patients. Patient engagement is a critical component of safe patient-centered services. Engaged patients are better able to make informed decisions about their care options. A growing body of evidence indicates that patients who are more actively involved in their healthcare experience have better health outcomes at a lower cost. Patient engagement is one strategy that helps us to achieve the "Triple Aim" of improved outcomes, better patient care, and lower costs. In addition, resources may be allocated more effectively if they are aligned with a patient's priorities, which is critical for the sustainability of health systems.
Patient activation refers to a patient’s knowledge, skills, ability, and willingness to manage their own healthcare, while patient engagement is a broader concept that combines patient activation with interventions designed to activate patients and promote positive behaviors.
EXAMPLEConsider a call to action in the form of an email or text that asks a patient to schedule a colonoscopy and view a video explaining the procedure. This is a form of outreach that will normally activate and engage approximately 30% of patients to schedule the colonoscopy and follow through with the procedure. It lowers healthcare costs because it relies on automation, thereby reducing resources needed for outreach, as well as potentially identifying a disease in its early stages.
What does patient engagement mean to different stakeholders in different health settings? The terms used to describe patient engagement are used differently in the literature, and they can be interpreted differently by patients, providers, and administrative leaders.
The following are quotes and reflections from a focus group of key stakeholders:
“It generally has a lot to do with the knowledge that doctors have about various conditions and how they convey them to patients on a very basic frontline level… it’s a lot of personal skills, a lot of one-on-one, making sure the family understands what’s going on, the patient understands what’s going on and why and what the methods are.” -Patient
“It means the involving patients and families in all different levels and in all different ways in our health system so that we can learn from their experiences and so that we can work with them and they can work with us.” -Provider
The involvement of [patients] at an integrated level in terms of planning and operationalizing all aspects of an organization. And not just giving lip service to setting up an advisory group, but actually integrating them into interviewing staff, being part of your strategic planning sessions, all of those kinds of things” -Administrative Leader
Adapted from: Gallivan, J., Kovacs Burns, K., Bellows, M., & Eigenseher, C. (2012). The Many Faces of Patient Engagement. Journal of Participatory Medicine, part 4.
Patient engagement can also be conflated with patient experience. While the two concepts are closely related, they focus on different aspects of care. Patient experience centers on improving the patient’s perception of a single episode of care, such as an office visit or hospital stay. Patient engagement includes patient experience but focuses more broadly on empowering and equipping patients to become active participants in their care—within the health system and at home.
The IOM Crossing the Quality Chasm report defines four levels of care and sets forth criteria that define quality at each level—experience, clinical microsystem, organization, and environment. Collaboration and active participation by patients and families in care and decision making are relevant to all four levels of the transformational change in healthcare envisaged by the IOM. These levels of engagement are incorporated into a Multidimensional Framework for Patient and Family Engagement, shown in the image below. This was developed by Kristin Carman of the American Institutes for Research, along with her colleagues, and it conceptualizes patient engagement taking place at three main levels.