Thursday, July 21, 2016

Finding the Missing Puzzle Piece... 3 Things to Know to Improve Patient Engagement and Outcomes

Today in health care there is such a focus on increasing patient engagement, which is primarily driven by costs.  Cost that are either saved or created by patient behaviors an outcomes.  It has been interesting to watch the various interventions that have been tested in patient environments to try and achieve changing patient behaviors.  Even myself and some others came up with a model a few years back aimed at reducing readmission to the hospital by utilizing a community-based approach similar to when I was a hospice nurse.  Obviously it wasn't viewed as the answer to every one's problems, or I wouldn't be sitting here this morning writing this blog.  I probably would, but at least I'd be doing it sitting on some sandy exotic beach somewhere in the world. :)

Seriously though, even I missed the boat with everything we were trying to accomplish.  Over the past three years I've had the opportunity to own my own business, work in leadership roles, and most recently function as a hospital care manager for the past year.  These different roles have exposed me to working with people in a variety of capacities, and have helped me reevaluate what I thought I knew about health care after 25 years.  What I believe is currently happening in health care that is alienating patients and frustrating people boils down to one issue.  A missing puzzle piece that can help us finally complete our masterpiece.  We have forgotten somewhere along the way that health care and medicine is about treating the human condition.

Each day I walk the halls of a hospital and interact with numerous physicians, other staff, patients, and their families.  Every group is playing a unique role in completing the puzzle that we're trying to build.  The one thing we all have in common, that somehow is being lost in the shuffle is that we all share the same humanity.  We are all people that experience e emotions and feelings, and respond to our environment based on those interactions.  What I've realized in the four walls of that hospital is that we're not dealing with diseases and illnesses, we are dealing with broken people whose bodies have become the physical manifestation of their brokenness.  I'm not trying to be a simpleton or deny my background as a clinician, but trying to shed light on why we might be missing the mark and be continuing to look for that lost puzzle piece.

3 steps we can implement to improve the patient experience and outcomes.

Know the person
All of us are part of some sort of relationship in our life.  How do you cultivate that relationship in the beginning?  We get to know the person.  Isn't that that goal of dating or the basis of building relationships.  We want to know about each.  What makes that other person tick, but why?  Think about the question for a moment as it relates to your own relationships.  We want to improve our interaction with each other.  We want to have a better relationship with our family and our friend because it enriches our lives, and creates joy and happiness.  Why should the interaction with patients be any different.  Aren't we trying to accomplish the same outcome, a better relationship that increases our satisfaction.
How do we accomplish this?  The same way we do in our own personal lives.  We get to know each other, so we can understand how best to communicate and meet each others needs.  What are the tools we use to accomplish this goal?, personality tests, first dates where we ask "what's your favorite color?".  If it works in all those aspects of our lives why can't we use the same approach in medicine?  Aren't we trying to each the same outcome, just with different players?
Therefore, I think to start finding the missing puzzle piece is we need to know what it looks like.  One way we can accomplish that is a method of having patients take a personality test that informs us about their core values, and communication style.  Wouldn't this help us first understand them, and also help us know how we can create a successful interaction.  One tool I came across recently that I thought was very interesting was at - "Huey Me allows you to first assess yourself and then through family and friends, explore why each of us are unique and motivated by specific feelings (motivations) that explain why we do, say and react the way we do to almost everything in life!".  
Know the learner -
The next component of improving patient engagement is understanding how to share information.  Not communicate, but information that we want a patient to retain.  How many of you are good students and how many of your are bad students?  Did the way you were presented information have any impact on how you were able to retain the information as a student?  Do you like to listen to books on tape, or do you prefer to read a book, or do you like to watch a video?  These all represent the very different types of media that enhance learning.  Knowing how someone absorbs information increases the chance of them retaining what we want them to learn  Along with this intervention we have to know their literacy level, so we can present information to their unique level of learning.  Therefore, I believe to improve a patients experience and outcomes we must understand both their learning style and level.
In the book, Understanding Student Learning, Entwhistle and Ramsden (2015) examine the extent to which these learning methods reflected the teaching, assessment and individual personalities of the students involved. The book contains interviews with students, experiments and statistical analyses of survey data in order to identify successes and difficulties in student learning and the culmination of these techniques is a clearer insight into the process of student learning.  Their work proves that helping people learn requires a unique approach that identifies both an individual's preferences for receiving information, and their understanding.  If we are to gain ground in helping patients with compliance, we will need to personalize the patient education experience to better serve our patients in improving their health while achieving our outcomes.

Know the reason -  
Finally, we have to again focus on what I said previously in this post.  Much of what is motivating discussions today in health care has a fiscal foundation.  Either it's about making money or losing money.  Those motives impact the way an organization does business, treats their staff, and ultimately treats their customer. Therefore, if organizations are led by internal motivations, we also need to understand that so are the patients we serve.  Why do they do or don't do things in relation to managing their health?  If we persist in providing a cookie cutter medicine approach, then we should expect to get same results that include not meeting patient's satisfaction with their care while missing the mark on our outcomes.  The only way I see to achieve a change from this direction we're going is to improve patient engagement by knowing the reason behind patient actions.

When your doctor gives you a pill isn't that action based on both his or her schooling, and also clinical studies that have proven using that type of pill is effective in treating your illness?  The answer is a resounding yes whether it's a pill, procedure, or referral to another provider.  There is a reason or evidence for the basis of every clinical action or decision.  If we believe in this approach in supporting patient safety, then why wouldn't we use the same approach in working with patients to achieve better compliance and improve quality of life?

One company that has been successful in this type of approach has been Insignia Health that has licensed the use of the Patient Activation Measure from the inventor Dr. Judith Hibbard who designed the tool from more than a decade of her clinical work.  This tool utilizes 13 statements that are presented to patients, and use their responses to stratify their level of "activation" or their own knowledge, confidence, and ability to manage their own health.  They also have a coaching application that coincides with the survey that allows you to tailor teaching to both the specific disease and their motivation level.  The levels are split into 4 categories of Activation from Level 1 (disengaged and overwhelmed), Level 2 (Becoming aware, but struggling), Level 3 (Taking action), and Level 4 (Maintaining behaviors and establishing new personal goals).  What is impressive about this tool is that it's supported by hundreds of peer reviewed journals, and has been successfully used in huge populations to achieve outcomes and positively change lives.  Now isn't that what it is truly about?
If we are looking to make a difference in the lives of the people we serve, then we need to first remember they are people.  All of us live in the same world, and have the ability to draw on the same type of emotions and perspective to impact our lives.  When we as a health care system understand that we need to Know the person, Know the learner, and Know the reason, then we will be able to develop a means to radically change the face of health care for both patients and the organizations that serve their needs.  Just my two cents.  Take care.

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Thanks for visiting. I would love to hear your thoughts. Take care, Dave.