Patient Engagement Is Everyone’s Responsibility
By Suzan Miller-Hoover, DNP, RN, CCNS, CCRN, contributor
Increasing patient engagement has been shown to increase patient satisfaction and improve positive outcomes. Patient engagement involves “actions individuals must take to obtain the greatest benefit from the health care services available to them." (Center for Advancing Health, 2010). Patient engagement involves patient activation, or the patient’s ability, and/or willingness to participate in their medical care (James, 2013).
Between 2009 and 2010, the Agency for Healthcare Research and Quality (AHRQ), surveyed the healthcare community and the research literature to develop the Guide to Patient and Family Engagement: Enhancing the Quality and Safety of Hospital Care (Guide). The AHRQ Guide was developed, tested, and published with the input of patients, family members, clinicians, hospital staff and hospital leaders. This free document is available to the public as well as healthcare systems (AHRQ, 2014).
The Guide acknowledged the following findings:
1. Healthcare workers acknowledge that patients and families should play an active role in the care they receive from the healthcare system.
2. There is a large gap between these groups as to how much of a role patients and families should play.
3. Patient and provider support for participation becomes more uncertain when patient engagement includes a higher level of involvement.
a. Patients are more likely to engage when they want specific information regarding the care.
b. Patients are less likely to engage when faced with behaviors that appear confrontational or new, e.g. asking providers to wash their hands or mark surgical sites.
The AHRQ Guide also identified barriers to improving patient engagement from both the patient and the provider perspective.
Patient and family members’ barriers include:
1. Fear and uncertainty
2. Low health literacy
3. Provider reactions
Providers’ barriers include:
1. Professional norms, biases, and experiences
2. Fear of litigation
3. Perceived level of effort
What can healthcare providers do to ensure that we are doing all we can to support patient engagement? What can you do to promote and encourage patient engagement in your practice?
First of all, it is important to be aware of our own personal biases surrounding patient/family engagement. Nurses should encourage open and honest communication regarding the patient’s condition and plan of care. This is important because it fosters a positive relationship with the patient or family member who expects to be included in their plan of care.
Communication and education are also key to making it easier for patients and families to engage in their care. When appropriate, every patient and family member should be included in patient rounds so that they have the opportunity to ask questions and gain clarification.
Orientation to the unit should include “permission to and the expectation of” patient and family questions. Patients and families need to understand that it is safe to ask questions and that there will not be any repercussions when information is sought. For example, it should be encouraged to remind a provider to wash their hands, to mark a surgical site, to repeat information, or to have an appropriate non-family translator.
Discharge planning is another great tool for encouraging patient/family engagement. It is started upon admission and reassessed throughout the hospital stay. During this time, patients and family members should be invited to participate in teaching opportunities to learn how to manage care after discharge.
How do we make this happen? It begins and ends with the education of healthcare staff, including medical providers. This education should be serial and frequent. Policies should be written with patient engagement verbiage included where appropriate. Unit leadership should also make patient engagement a priority. Some examples of this include providing display white boards that contain areas for questions in patient rooms, and supporting rounds that focus on making sure the patient/family’s needs for participation and information are being met.
Moreover, hospital leadership can support patient engagement by reporting patient engagement goal achievement on a consistent basis, such as in the annual report. How you treat your patients today and moving forward can lead the way to increased patient satisfaction, increased quality of care, increased positive outcomes, and increased staff satisfaction. You can make a difference.
Learn more about patient engagement and patient satisfaction by taking The Nurse Manager’s Role in Enhancing Patient Satisfaction, offered on RN.com.
AHRQ. (2013). Guide to patient and family engagement in hospital quality and safety. Retrieved from: http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/index.html
AHRQ. (2014). Guide to Patient and Family Engagement Environmental Scan Report. Retrieved from: http://www.ahrq.gov/research/findings/final-reports/ptfamilyscan/index.html
Center for Advancing Health. (2010). A New Definition of Patient Engagement: What is Engagement and Why is it Important. Retrieved from: http://www.cfah.org/pdfs/CFAH_Engagement_Behavior_Framework_current.pdf
Guide to patient and family engagement in hospital quality and safety. (2013). Retrieved from: https://www.jointcommission.org/guide_to_patient_and_family_engagement_in_hospital_safety_and_quality_/
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