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Patient and family engagement: Healthcare's two-way street

March 19th, 2015

by Jason A. Wolf

A lot has been written and materials developed of late around the idea of patient and family engagement. One of the most significant and important contributions in this effort has been A Roadmap for Patient & Family Engagement in Healthcare, produced by the Gordon and Betty Moore Foundation and the American Institutes for Research. This comprehensive publication identified patient and family engagement as "bringing patient and family voices to decisions about care, to healthcare organizational design and governance, and to public policy" and it offered the goals of engagement are aligned with the Triple Aim: patient experience of care, better population health and lower cost.

The engagement conversation is a critical one for healthcare, but from many perspectives continues to ring of something healthcare delivery organizations should "provide." It suggests a one-way responsibility to create engagement. Yet, engagement in the simplest of terms is powerful in that it is focused on fostering a sense of involvement, understanding and ownership from those in an interaction. In healthcare, this level of involvement in care, understanding and ownership comes from more than working to create engagement--it is born from the very experiences patients and families have with the system and how they choose to respond.

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The one thing individuals in our healthcare system have is an experience: the integration of quality, safety and service encounters, and inclusive of the implications of cost on their healthcare decisions and broader health outcomes that influence choices driving their care. So while engagement is a means to positively impact the Triple Aim, experience in healthcare is what encompasses all aspects of it. Consider this: right now millions of people around the world are having a healthcare experience, in clinical and non-clinical settings and the spaces in between. We have the opportunity to either actively make that experience inclusive of all voices or let it happen on its own.

Engagement in healthcare is not and should not be a passive concept. Rather, healthcare organizations must constantly create opportunities in which people feel invited and welcomed to engage and contribute. They too must recognize engagement is ultimately an individual's choice.

I'll share a recent personal experience to highlight this perspective. I was scheduled for a physical exam with my primary care physician. I had to wait for almost four months for this wellness visit appointment. Two days prior to my appointment I received a thoughtful automated voice mail reminding me of my appointment time and informing me of my responsibility to be on time and also noting there could be potential costs for a missed appointment. On the day of my appointment I arose early to an ice storm (as many did last month) as I began my pre-appointment fast. With the bad weather I decided it best to contact the physician's office to confirm the appointment and I called just after the office's scheduled opening hours. The phone rang endlessly without response and after 25 minutes of trying, the phone was answered by the answering service for the practice. In inquiring about my appointment I was told, "Sir, all I can tell you is the office will be closed today." In asking about my appointment, the response was, "You will need to call back and talk to scheduling for a future appointment. I am sorry we cannot help you with that." I am not questioning the work of the answering service or even the decisions to close for the safety of all involved. Rather, I look at the experience provided by the office itself. In acknowledging what we aspire to achieve via "patient and family engagement," I was an "engaged" patient. But my experience was at best frustrating and even inconsiderate. I have yet to receive a call about my appointment or any effort to reschedule. That, too, has been left to me.

Engagement is not something we can or should just expect of patients and families. Engagement, from this perspective, is a two-way street. We create the best opportunities for engagement by committing to provide the best in experience for all those we work with, care for and serve. This is why contributions such as the important work shared above are critical as we continue to expand the conversation. I also hope we remember that accountability for engagement and ultimately experience is in each and every one of our hands. That is the ultimate roadmap as we strive to create the best in healthcare outcomes for all involved.

Jason A. Wolf, Ph.D., is president of The Beryl Institute, a global community of practice focused on patient experience improvement and founding editor of Patient Experience Journal. Follow Jason @jasonawolf, The Beryl Institute @berylinstitute and Patient Experience Journal @pxjournal on Twitter.

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