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”.
It is interesting to note what BusinessDirectory.com 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 that 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 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.