Patient Engagement: Movement or Fad, Solution or Slogan?

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As noted here before, the patient experience has become a something of a “growth industry”.  Many healthcare institutions have appointed a chief patient experience officer or even created a unit with that title.

A related concept is “patient engagement”.  “The New Era of Patient Engagement” is theme of the February 2013 issue of Health Affairs, which rates to be very influential; it’s already been cited by the British Medical Journal.  In the introduction, Editor-in-Chief Susan Dentzer (now with the Robert Wood Johnson Foundation) calls patient engagement “the blockbuster drug of the century”.

money pillsIt is interesting to note what says in its definition of blockbuster drug:  “An extremely popular drug, usually one that generates annual sales of at least $1 billion.  A blockbuster drug can be highly profitable, but it has some potential disadvantages. If the drug is discovered to have serious side effects, a company may actually lose money on it.  Also, like all drugs, a blockbuster drug eventually loses patent coverage, and the company that developed the drug no longer has exclusive rights to it.”   A cynical prophet might thus predict that patient experience will become a fad that will make some people lots of money but eventually will lose efficacy and that those who developed it will move on to some other two-word catchphrase and job title.

But let’s move on to the Evidence & Potential section of the issue.  First we learn that “there is a growing body of evidence showing that patients who are more activated have better health outcomes and care experiences.”  In case you were not aware, “Patient activation is a term that describes the skills and confidence that equip patients to become actively engaged in their health care.”  It is not enough that doctors, nurses and technicians have skills in what they do: those they treat must also have skills in becoming good patients!

Next we find that “in an analysis of 33,163 patients of Fairview Health Services, a large health care delivery system in Minnesota, we found that patients with the lowest activation levels had predicted average costs that were 8 percent higher in the base year and 21 percent higher in the first half of the next year than the costs of patients with the highest activation levels, both significant differences.”   While the word “predicted” perhaps raises at least part of an eyebrow, still anything that can enable hospitals to lower costs certainly will receive attention.

Many of the articles describe the difficulties in activating patients, such as “overworked physicians, insufficient provider training, and clinical information systems incapable of prompting or tracking patients through the decision-making process”.  The traditional office visit, “in which the patient is passive, trusting, and compliant,” needs to be reformulated.  In this connection, it can be noted that  there is a PAM (Patient Activation Measure) that is said to be a valid, highly reliable, unidimensional, probabilistic Guttman-like scale that reflects a developmental model of activation” and thus a tool for the removal of such barriers.

One article notes that “for patients to be engaged, they will need meaningful and comparable information about the quality and cost of health care”. Yet another one reports money graphthat focus groups show “many patients object to clinicians’ focusing on costs”.  That shows another problem in the assumption that patient engagement lowers costs: are the interests of consumers and providers of healthcare actually in alignment?

Surely the patient engagement idea is valuable.  Like the empowerment movement in management that began with Peter Block’s The Empowered Manager, it reflects the fact that we have been more educated and therefore less accepting of being directed.  And just as empowerment in organizational development has proved to be much more difficult to bring about that its originators probably thought, patient engagement faces many large obstacles.

That’s why selling patient engagement as a means to cut healthcare costs seems so questionable.  Everyone in healthcare needs to relearn their job and change their attitude; every healthcare recipient needs to think and act differently.  Does that sound like to a way to reduce expenses?

If patient activation is to be advocated, it is probably to better to focus on its ability to provide better health outcomes. If people take more responsibility for their care and have a better understanding of their health, it surely seems plausible that they will be healthier, though the need for studies on the question is apparent. And better outcomes is something everyone involved can agree upon as a goal.

Indeed, would we not perhaps all be better off if reducing the cost of healthcare were not such an obsession? A heretical thought, perhaps, but it could be that focusing on the positive goal of better health is actually more effectively economically than a quite possibly quixotic emphasis on cost cutting.

Jim murphyJim Murphy has a solo consulting practice called Management 3000, focusing on organizational development and change management. Formerly he led the Massachusetts Bay Organizational Development Learning Group, was Human Resources Director for the City of Boston Assessing Department, and served as a consultant with the Boston Management Consortium.  His consulting practice includes management coaching as well as research and writing on employee relationships, leadership, healthcare and collaborative practices.  Having produced newsletters for several organizations  and being a frequent content writer for the”Confident Voices in Healthcare” blog, he is interested in writing and research opportunities, as we all consulting and coaching.







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5 Responses to Patient Engagement: Movement or Fad, Solution or Slogan?

  1. Pingback: A Second Question for Creating the Ideal Healthcare Organization: Respect and Compassion

  2. Jim Murphy says:

    Martine’s comment inspired to do a little investigating on the issues of reducing healthcare costs. It is a complex and vexatious topic!

    That “the US far outspends on healthcare than other countries” is not perhaps that surprising, given that we outspend other countries in so many ways – military expenditures, for example. A year ago the Commonwealth Fund did an excellent analysis on why the United States has higher per capita healthcare costs (but not healthier people) than other developed countries. It cited three factors: higher prices, more technology, and greater obesity.

    As to higher prices, in other countries the government runs the healthcare system and can control coverage and prices. For healthcare costs to decline in the United States, there would have to political and economic changes that at present would appear highly unlikely to occur.

    We can find ways to reduce costs, but perhaps the only way that healthcare spending would ever decline would be for the population to become healthy and thus need less care. That’s why when contemplating patient engagement or other such causes, “will this make people healthier” seems more important than “will this cut costs”.

    • Hi Jim and Martine,
      I think asking, ”Will this make people healthier?’ is a key point and would add that as we make healthcare decisions we should also ask ”Will most people be able to afford it’?’ Make health the priority while keeping in mind cost-effectiveness. Beth

  3. Hi Martine,
    Thanks for your astute feedback. We have my friend and colleague in organizational development, Jim Murphy to thank for this post and I agree it is insightful and thoughtful. My comments for both his post and your ideas are that there seems to be an insidious and pervasive relationship between revenue and healthcare in this country as well as very challenging and big societal issues that manifest in our healthcare system because we don’t prevent them elsewhere. In my mind, what we have are strong driving forces to make profit from illness and a lack of driving forces that optimize health. Poverty, lack of education, lack of resources to eat healthy, exercise etc will sooner or later end up as expensive patients. The Movie “Escape Fire” is so good at painting this picture, I think. Our incentives are screwed up! We have bigger or more powerful incentives to make money but not as powerful ones to be healthy. Soooooooo I think this equation infiltrates everything…We can see good stuff in patient engagement and empowerment and then also how it get’s misused. We spend so much time and energy debating about ACA and unfortunately continue to dance around the underlying problem of fortune-making in heathcare. As long as we permit that to be such a strong focus, the scales will always tip in that direction. It is hard to wade through all the smoke and mirrors. at times….we fix one problem but b/c we don’t get at the underlying one, it just shows up elsewhere….I believe that the more informed and responsible consumers are, the more effective their influence will be on positive change. (and I have my own view on what that is….i.e. decent, safe, compassionate care for everyone.)That is why empowerment and responsibility as you so aptly describe in your book, “The Take-Charge Patient” is such a vital contribution to the evolution of our healthcare system.
    For readers here are links to reviews of your book and “Escape Fire”.

    Thanks again for your thoughtful comments.

  4. Beth,
    Great blog post and very thought provoking. Agreed that focusing on empowerment for patients as a means to increase quality of care and patient safety is probably a more effective focus for the movement than focusing on the reduction of costs. Although because the US far outspends on healthcare than other countries, dedicating more than 17 percent of its gross domestic product (GDP) on health care and considering how much we are in debt, people are looking for any way to reduce spending and maybe it’s surfacing in the patient empowerment movement as a possible selling tool. Who knows.
    Thanks as always for an insightful and thoughtful post. Martine

What are your thoughts?