Originally published March 2015
Most doctors would likely agree that today’s patients and families are increasingly engaged in their own healthcare. How can physicians support this positive development that may ultimately help improve patient outcomes?
Patient engagement at different levels
Patient engagement is typically viewed as the participation of patients, and often families, in healthcare. It can lead to patients having greater knowledge about their health, a better understanding of healthcare options and the healthcare system, and possibly better outcomes. Engagement can take place at the individual level (the patient’s own health and healthcare), at an organization or institution level, or at the level of the entire healthcare system.
Helping the individual patient
For the individual patient, engagement means taking specific actions to benefit from healthcare. Engaged patients will be more involved than other patients in such activities as searching for appropriate healthcare, communicating with doctors and other providers, becoming informed about their health, actively promoting their own good health using preventative care, making informed treatment decisions, organizing their care, participating in treatment, and planning for end-of-life care.
While some patients are motivated and able to participate and manage their own health, others face barriers. Obstacles include being afraid, or too ill; lacking support from physicians and healthcare providers; or not knowing how to engage effectively or to navigate the different healthcare providers, healthcare organizations, rules, and processes.1 Coaching and education can encourage patients to take a more active role in maintaining and improving their health.
The main approaches to helping patients get engaged are, first, to communicate clearly and effectively, which includes taking time to use active listening techniques (e.g. focusing attention on the speaker, suspending initial judgment, and limiting other internal mental activities) and listen carefully, and second, to actively involve patients in their care. These approaches can help patients and families understand and use health information, and the patient-centred communication can also promote shared decision making.2 Physicians should ensure that patients know to ask questions when something is not clear or when they have concerns. Doctors can also offer information, education, patient decision aids, and encouragement to help patients make informed decisions about care and treatment. Resources can come in different formats, such as printed brochures or relevant online websites.
Determinants such as income and social status, physical environment, and personal health practices and coping skills may play a significant role in a patient’s health. Doctors can help patients understand how these factors affect their health and encourage them to look for ways to change them. For example, a physician may have diabetic patients who need to improve their diet but are finding it difficult because of the financial cost. The physician may make such patients aware of the effect a poor diet is having on their health, and suggest how they could access social support programs that could provide healthier food.
If appropriate, doctors may educate the members of their office staff on patient engagement and explore how they also can offer support. For example, staff may be able to remind patients to bring necessary health records or medications to medical appointments. As well, they may speak with patients about how to obtain test results, get prescription refills, and access medical care outside clinic hours.
In addition, having patients involved when they move from one healthcare setting to the next can make the transition safer. Before the change, physicians can consider asking patients to agree to an action plan with details such as how to prepare for their next step in care, how to manage their conditions, when to call their doctor, and how to promote a healthy lifestyle. In many instances, working with patients and other healthcare providers as part of a team to deliver and ensure continuum of care is relevant.
Patient engagement in healthcare institutions and organizations
For physicians working in hospitals, institutions, or regional health authorities or networks, there are additional opportunities to support patient involvement that go beyond supporting individual patients’ engagement. In these settings, patients, families, and clinicians can partner on projects to improve department-specific or organization-wide matters. Physicians can become familiar with the work of patient councils, children’s advisory councils, or resident and family groups, as appropriate, to support the integration of patient input into specific activities or initiatives.3
There are numerous examples where this patient involvement has had a positive impact on healthcare institutions, such as changes to hospital visiting hours, improved patient waiting areas, better patient education materials, new safety programs such as hand hygiene, and the establishment of condition-specific support programs for patients and families.4 These achievements can often be based on key questions to promote engagement, such as:
“What do patients think?”
“How do patients wish it had been?”
“What are patients’ suggestions?”5
Patients should also be encouraged to participate in quality improvement reviews where failures in the healthcare system result in patient safety incidents. The patient’s and family’s perspectives on what occurred can be important to the success of these reviews.
Speaking up in healthcare institutions may not always be easy for patients and families. Some find it hard to share their ideas or to talk about difficult experiences. Key patient attributes that facilitate patient involvement in safety programs, for example, include health literacy, willingness to speak up when confronted with unsafe situations, and ability to recognize error-prone situations.6 As a result, healthcare providers seeking patient engagement must establish an atmosphere of caring and mutual trust.
Opportunities for patient engagement in the broad healthcare system
Increasingly, patients are becoming involved at the broader healthcare system level. Many take on advisory roles to positively impact the care in their community. Participation at this level can include helping to redesign care, develop policies, or formulate major system changes. In these settings, patients are more engaged in advocating for the health of their communities, helping others navigate the healthcare system, and advancing health equity.7 Patient participation may also be geared toward setting priorities, informing resource allocation, and playing a role in governance. In certain medical faculties, patients and family representatives provide advice on the development of future physicians and collaborative practice.
At the system level, the ongoing challenge is for healthcare leaders and other decision makers to determine how to truly engage the population, how to ensure fair representation on committees, and whether the patients involved are acting in a consultative or decision-making capacity.
The bottom line
Physicians can support patients’ engagement in their healthcare by clearly communicating health information and by actively encouraging and inviting patients to be involved. Improved engagement can ultimately lead to better outcomes for patients.
Center for Advancing Health, “What is patient engagement?” 2014. Accessed October 17, 2014 from: http://cfah.org/engagement/
Brown, S.J., “Patient-centred communications,” Annual Review of Nursing Research (1997) Vol. 17, p.85-104
Second Annual National Forum on Patient Experience. (2014). Key challenges and solutions in patient experience.
Krames Staywell. (2013). “Creating successful patient engagement within your ACO.” Retrieved on October 7, 2014 from: http://www.kramesstaywell.com/docs/white-papers/aco-white-paper-oct-2013.pdf?sfvrsn=2
Canadian Foundation for Healthcare Improvement. (2014). Patient and family engagement webinar series. See information at: http://www.cfhi-fcass.ca/Elearning/OnCall/patientengagementseries2014
Buetow, S., Davis, R., Callaghan, K., Dovey, S., “What attributes of patients affect their involvement in safety? A key opinion leaders’ perspective,” BMJ Open (2013) Vol. 3, e003104
Regional Primary Care Coalition, “Patient Engagement: A Framework for Improving Health and Lowering Cost, June 2012.” Accessed on October 17, 2014 from: http://www.regionalprimarycare.org/assets/rpcc_patient_engagement.FINAL_.07.2012-2.pdf