Feature

January 20, 2021

Driving engagement through patient activation in 2021

Clinician engaging with patients on the computer.

In my life, I have spent many years as a physician and as an ice hockey coach. Though both have a goal of bettering those around us, the approach is quite different. As a physician in training, I spent thousands of hours learning how to diagnose and treat patients. There were countless days both in the books and on the wards, all to learn how to make an ideal treatment plan. Though developing treatment plans is a critical component of learning, it lacks one major aspect: is the patient willing and able to take the necessary steps to execute this plan?

As a coach, it is understood that everything we do for our players is to make them better. We cannot go join the game and play for them, so we focus on empowering them with the skills necessary to succeed. The emphasis is less on drawing up the perfect play, but instead executing on the play at hand. In fact, I have found in coaching that once our players develop the fundamental skills of the sport, the plays we implement become even less important. The players learn to recognize their situation and adapt to it. Instead of looking for prescriptive instructions, they begin to rely on their coaches and fellow players to support them, continually improve their skills, and motivate them over time.

Coaching and activation leading to success in hockey.

As a coach, it is understood that everything we do for our players is to make them better.

What is patient activation?

Over the past decade, the healthcare field has realized the importance of understanding, measuring, and supporting patient activation through more efficient engagement and communication. As a pioneer in this area, Judith Hibbard defines patient activation as the “patients’ willingness and adaptability to take independent actions to manage their health and care.” Without bludgeoning you with the details, it should come as no surprise that educated patients have better outcomes and better well-being.

So, what do we need to do to improve patient activation? In my opinion, we need to meld our role as a “prescriber” with that of a coach. This approach is a far cry from what was emphasized in medical school and residency. Whereas I know that most of my fellow clinicians work hard to implement coaching into our work, we are often swimming against the current to do it right.

How to improve patient activation

With that being said, here is my quick start guide to improving patient activation:

Educating on both ends

Patient education is not a one-way street from the clinician to the patient. The clinician needs to learn information about the patient’s individual situation and access to resources. For example, does the patient live in an area where there is a safe space to go on a walk or jog at a time of day when the patient can exercise?

Information overload can also be a detriment to learning. Providing the patient with the right information at the right time in steps can be much more helpful than handing the patient a big packet of information at once. Personalization of the messaging is also important. Patients can be frustrated by sifting through irrelevant information (e.g. smoking cessation information given to a non-smoker). Effective patient activation truly starts with having the right means of communication, ensuring a mutual understanding of the needs of the patient, and providing the patient with actionable and insightful information.

Allowing for real-time patient assessment

Timely, individualized information based on how a patient is doing at that particular moment can greatly impact patient outcomes. When coaching a game, players receive feedback immediately after taking an action because the coach is there watching the practice or the game. Clinicians, on the other hand, can only give delayed feedback in the current healthcare model. Surveys that assess how a patient feels from one day to the next might predict post-surgical infection faster than waiting for the patient to become so sick that he or she needs to contact the doctor or go to the emergency room.

Alternatively, assessing a patient’s medication intake on a daily basis may more accurately reflect compliance than a 3-month recall at the next clinician visit. Taking this action will not only ensure that clinicians have a better understanding of the patient’s recovery, but the patients can know much sooner if something is going wrong, or if an additional action needs to be taken. For example, more frequent assessment of glucose levels allows for more accurate diabetes management in between patient visits. Assessing a patient’s progress on a regular cadence and acting on those targeted assessments provides a ripe opportunity for improving patient outcomes. Further, having this consistent flow of communication will allow the patients to take more educated steps towards recovery.

Improving activation through motivation

Finally, a coach’s key role is motivating players. Rewarding a player’s hard work at practice, not just whether the team won or lost, can push the player to want to work even harder. In medicine, patients typically receive feedback based on their test results, not on the actions they took over a period of time that led to those results. Why? One answer may be simply because the clinician doesn’t know what those actions were with certainty. For patients aimed at weight loss, focusing on a specific outcome of weight may not be as effective as rewarding daily actions. Ideally, coaches and clinicians can reinforce correct behaviors and intervene with incorrect and missed behaviors. Some people may do well just by completing physical therapy exercises every day on their own. Others may be motivated by seeing that they have had a 5-day streak of exercising and want to continue so that they do not break the streak. Still, others might need to have a daily reminder of their missed activity as motivation to get back on track. To drive the point home, more can be done when there is a more frequent stream of communication between the clinician and patient, and when the patient is well-educated on the correct practices for recovery.

Patient taking their medications consistently.

Assessing a patient’s medication intake on a daily basis may more accurately reflect compliance than a 3-month recall at the next clinician visit.

Get started with patient activation

Hopefully by the end of this article, you have a better understanding of what patient activation is and how you can focus on improving it in your practice. Incorporating patient education can be challenging, but will be accomplished with a proper plan. Start with the tips I’ve shared with you today by providing the right information to patients at the right time, being able to assess their recovery in real-time, and motivating them to take necessary steps to recover properly. Consider using technology such as digital assistants, telehealth visits, and remote patient monitoring tools like Ayva Ortho to supplement education, assessment, and motivation for patients.

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Shane Andreasen

Bravado Health

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