Janice Gulsvig, Chief Operating Officer, Align

Are you keeping up with all of the buzz about patient activation and patient engagement? Whether you are perusing the 2014 Impact Legislation Proposed Rules, browsing the AARP website, or taking a course in patient management strategies, you are bound to have come across those two terms. But why should you even pay attention to them?

The answer is easy. First of all, in terms of the health status of yourself and those you care about, there is plenty of evidence to suggest that the more activated and engaged you are in your health and health decisions, the more likely it is that you will have better health outcomes.

Secondly, it’s probably safe to assume, because you are reading this blog, that you have a professional relationship with healthcare. If your role is to promote positive outcomes for the patients and residents you serve, as well as for your organization, then expanding your understanding of the principles of patient activation and patient engagement is a good idea.

In the spirit of promoting a better understanding of these two concepts, let’s look at them a bit more closely.

First of all, why do they matter in post-acute care?

I’m going to focus most of this discussion on short stay patients. I make this focus because without patient activation and engagement, you likely will not achieve the results you need with these types of patients. Why? Because it’s been clearly demonstrated that active involvement in healthcare decision making and in self-management drive:

  • Improved health outcomes
  • Increased satisfaction with the healthcare experience
  • Lower healthcare costs
  • Reduced risk for hospitalization, re-hospitalization, or ED visits
  • Better care coordination across the continuum

Does that list of outcomes ring a bell with you? Probably so. In all likelihood these goals have been a topic of discussion during recent strategy meetings – from compliance and risk management to quality improvement. Without the active involvement of an engaged patient, your organization will have a harder time achieving these goals.  

What is the difference between patient activation and patient engagement?

Patient activation is defined by Judith Hibbard, Ph.D., of Oregon University as, “the patients’ knowledge, skills, ability and willingness to manage his own heath and care.”  Hibbard describes four distinct activation levels with specific needs, goals, and approaches to move the patient towards self-directed management. Providers can help patients and residents move through these stages.

Patient engagement on the other hand is defined by the Center for Advancing Health from the healthcare consumer’s point of view as, “the actions we as consumers take to support our own health and to benefit from healthcare.”

These definitions beg these questions:

  1. What can you do to contribute to the ‘knowledge, skills, abilities, and willingness’ of patients and residents using post-acute services?

  2. How can you change your internal focus from patients as ‘passive recipients of care’ to practices that encourage the patient to be an ‘active participant in healthcare decision making and self-management’?

Let’s just get it out there – it won’t be easy and it won’t be quick.  Anything worthwhile rarely is. But it’s worth the time and attention to at least consider that changes might be necessary.

It’s probably safe to assume that you’ll have to look closely at multiple, if not all, internal practices that surround the way you approach patient care delivery. What do you do every day without ever really thinking about it? You take care of people that need your services. That’s how we were trained, and to a certain extent that’s how we’re wired.

But in this new reality we are being challenged to shift from that care delivery model to one in which our role is also coach, mentor, and teacher. With every touchpoint the focus should be on helping that patient ‘do for themselves’ and ‘think for themselves’ when it comes to their own health status and decisions. Obviously you still have to provide clinical care and quality services to all patients. But you also have to add into the mix an understanding that their outcomes will also be driven by their active involvement.

By now you’re probably wondering where in the world you will find the time to be able to add these concepts into an already jam packed day. And who is going to do it? That’s why I said it won’t be easy and it won’t be quick. But it is necessary. You can start by taking small steps:

  • Incorporate the principles you’re already doing – those of patient-centered or patient-directed care. Putting the patient in the driver’s seat automatically lets them know they are in charge. 
  • Identify patient–specific needs, barriers, strengths not just in terms of clinical assessment, but also in terms of patient expectations and goals. Have them define not only the goals, but what they think THEY need to do to achieve them. This clearly causes them to think about the role and the responsibility they carry for outcomes.
  • Evaluate knowledge gaps. But keep it reasonable. In the case of a short stay patient, you can’t possibly assume that you will fully activate or engage them in the course of a few days or weeks. So what is the key knowledge that will be critical to their post-transition success? Focus on that. Again, small steps.
  • Build teaching, coaching, and mentoring into routine tasks. For example, when taking a blood pressure, take the time to teach the patient to do it for themselves. And then have them do it. This simple teach-back strategy builds confidence that, once back home, they will know how to do this for themselves. If the patient has a specific diagnosis, for example CHF, take the time to educate the patient on the symptoms, what to watch for after discharge, and what the treatment plan is. Use professional, easy to read patient education materials to support learning. The important point is – make sure patient education isn’t something you do ‘if you have time’. It’s not optional! And simply handing the patient a folder full of materials likely won’t be enough. Patient education is important – but patient learning is critical. If they didn’t learn, you didn’t educate. Spend enough time to make sure learning occurred.
  • Assume nothing! When it comes to assessing readiness and confidence to self-manage after discharge, the only way to know for sure is to ask the patient and his/her support system if they’re ready. And if they say no, you then know you still have unfinished work to do before they leave. 
  • Don’t solve problems FOR them, work WITH them to solve their own problems. This simple approach contributes to their ability to begin to think through issues and to make decisions on their own behalf.
  • Always consider what other resources and services have a role in supporting the patient. Care coordination across providers is becoming increasingly critical. A lot can be accomplished in terms of post-discharge outcomes by simply communicating effectively with all involved.

Speaking of which, do you ever wonder how patients are doing after they leave? Well, wonder no more. Post-discharge follow up has value in multiple ways. It shows the patient and family that you care – and that you are there should they ever need services in the future. It contributes to the overall positive perception of your facility back out in the community. You might be able to point the person back to a healthcare provider based upon what they tell you. And you can measure post-discharge outcomes that you otherwise may not have available to you. This isn’t a nice to have – it’s a need to have in the evolving healthcare economy.

I could go on and on – but the basic take away is this: Look at what you are doing today. Decide how you can build the principles of patient activation and patient engagement into those practices. Make those principles part of the way you do your work – at which point it stops being more work to do.

Janice Gulsvig is the COO of Align. She has more than 35 years of experience in the field of senior healthcare, with extensive leadership spanning both for-profit and not-for-profit sectors.