Beyond “Patient Satisfaction”: Promoting True Patient Engagement
By Mary Ann Smeltzer, MS, RN-BC, director of clinical informatics
“Patient engagement” is one of those catchy phrases that healthcare organizations like to put into their mission statements. It sounds good–no one wants “unengaged” patients. But what is it really, and why do organizations need it, and–most importantly–how do they get it?
True patient engagement means two things. First, your patients care about their own health and take active steps to protect it. Second, they turn to you to help them, every time. While there are many members of the healthcare team who share responsibility for moving patients toward taking responsibility for their health and steps to improve it, nurses spend a great deal more time with patients in hospital and other care venues than physicians or other healthcare professionals. We are tasked with carrying out physician orders and assuring that patients are taught about their condition and the steps they must take once they leave our care to avoid readmission to hospital and achieve their highest possible level of health. We listen, empathize and watch to be sure that they can perform the skills they will need to perform for themselves when they go home such as testing their blood sugar, administering their own insulin injections, performing wound care or taking care of their newborn on their own. We do all these things while trying our best to meet or exceed patients’ expectations and positively influence them and their families and other support persons regarding their perception of both our organization and healthcare in general.
In the coming era of value-based care, your organization will be responsible for keeping patients healthy. This means becoming a partner in their quest for optimal health and long-term wellness. Many, if not most, organizations struggle to achieve this level of trust and loyalty, but every person who interacts with the patient and his family/support persons will influence this level of trust and loyalty.
Beyond Patient Satisfaction
A common first step in evaluating patient engagement is to measure patient satisfaction. It’s easy to find out whether patients are satisfied with their care by having them fill out a survey form. As a former Director in various hospitals I had access to both reports on how we did on surveys administered by outside agencies after our patients were discharged and the letters and comment cards sent to the hospital that patients completed regarding their stays. In making daily patient rounds on my units, I informally learned a lot about how satisfied patients were with their care and how confident they were that they’d be able to manage at home. It wasn’t unusual for seemingly small actions by my nursing staff to be cited as making a big impression on how patients viewed their stay. Sometimes they called out a particular staff member as a transformative agent in their road to recovery and sometimes they spoke about the care they received as a whole team effort. Generally, when you review your surveys you’ll find out whether your patients thought the nurse responded quickly enough to their call, whether your food is decent, whether your front-office staff is friendly and efficient. All these things are useful to know. Maybe you’ll make some changes in areas where you fall short. But even patients who rate you five out of five won’t necessarily come back the next time they need care—if another physician’s office is closer to their house or has an earlier appointment available, they may forego your services. They may be influenced by the billboards they see as they drive about town or the ads on TV or in the paper to try out the hospital advertising superior care instead of coming back to yours. Patient engagement has to include patient satisfaction, but it doesn’t stop there.
What about patient portals, the technological face of patient engagement? It’s relatively easy to get patients to sign up by incorporating this process into their office visit or hospital registration. Nurses are often the ones who tell patients about the portal and how to use it as they prepare the patient for discharge or when the patient is about to leave the office after their first time visit.
But do they ever log in to make their appointments, look up their immunizations or e-mail their physicians? Providers who can get more than 20 percent of their patients to do any of those things are doing really well, according to KLAS Research The Centers for Medicare and Medicaid Services require physicians to offer electronic health record access to at least half of their patients to avoid penalties in its Meaningful Use program for the adoption of health IT, but are patients actually using this access? While CMS initially considered requiring as many as 10 percent of patients to use this access in order for providers to fulfill the Meaningful Use criteria, the agency quickly recognized that such a requirement was unrealistic. For 2016, CMS will be satisfied if providers can get one single patient to log on. (The requirement jumps up to five percent next year.)
However, portals can cement patient engagement: Kaiser Permanente has signed up 70 percent of its patients, and many are active users. In fact, one out of three physician-patient encounters occur through the portal’s secure e-mail function. Users of the portal are 2.6 times more likely than non-users to remain Kaiser Permanente members.
Leveraging Surveys for Broader Action
Chicago-area health system Advocate Health has begun to measure patient loyalty–patient engagement by another name–using techniques developed in the retail industry. It zeroed in on its patients’ “likelihood to recommend” responses in CMS’s mandated Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Advocate created a Patient Loyalty Score, based on the percentage of patients who would definitely recommend, minus those who would probably or definitely not recommend. It computed comparable scores for its competitors, and set itself a goal of achieving the 75th percentile in its local market within two years. To accomplish this goal, Advocate plans to focus on three areas initially: improving its pricing transparency; creating more convenient ways to access its services through expanded hours, locations and electronic visits, and improving transitions of care.
There’s no single path to greater patient engagement: a healthcare organization in a competitive market will have a different task from one that’s the sole or dominant provider in its community. But the path always starts with figuring out what your patients need and how you can be a better healthcare partner for them. And as the most often encountered face of the healthcare organization, nurses will continue to play a big part in cementing relationships between patients and their healthcare organization.
What has your healthcare organization done lately to promote patient engagement?