Patient engagement is internally recognized as important and now is considered a cornerstone of high-quality healthcare, improving health outcomes and reducing healthcare costs. The Institute of Medicine (IOM) has adopted patient centred care as one of their six pillars of quality care. IOM recommends that patients should receive access to health information and knowledge, enabling them to control healthcare decision making (Al-Tannir, Al Gahtani, Abu-Shaheen, Al-Tannir & AlFayyad, 2017). This also aids in respecting patient’s autonomy and promoting self-determination. Studies show that patient engagement improves patient adherence to care plans, better clinical outcomes and increased satisfaction while reducing healthcare costs via reduced hospitalization, prevalence of complications and fewer re-admissions to hospital.
Al-Tannir, Al Gahtani, Abu-Shaheen, Al-Tannir and AlFayyad (2017) conducted a study involving 36 patients and 46 family members along with nurses and physicians. The study took place in Saudi Arabia and patient’s experiences on engagement with healthcare services along with physicians’ and nurses perceptions on the engagement.
The physicians and nurses in this study and predominantly believe that actively listening to patients’ concerns was important/extremely important. However, patient health literacy may be a limitation in their self-management therefore the use of health information and incorporating patient’s and family members will encourage a change in their knowledge and healthcare system behavior. 73% of the test group felt they were being engaged by hospital staff and 80% felt they were partners in the treatment plans, while 40% of the physician/nurse group felt patient engagement improved health outcomes.
Sharing in decision-making and active participation in process is heralded in healthcare. However, there are struggles which prevent this ideal (Sloan & Knowles, 2017). Lack of medical knowledge or health practitioner’s incorrect understanding of the patient’s values can impede the relationship. Patient engagement “patient participation means involvement of the patient in decision making or expressing opinions about different treatment methods, including sharing information, feelings and signs and accepting health team instructions”. Patients may become overwhelmed with health information, therefore giving patients/families’ time to process the news and educating patients on their conditions are important to re-engage them. Close ended questions, limiting depth of share information and prolonging patient uncertainty obstructs patient involvement.
Enabling behaviors: sharing information with patients in a discussion-oriented, open ended format. This method allowed for transparency of views to be shared by health professionals and patients/families.
- Physicians that supply educating, honest information to patients about their diagnosis, prognosis, treatment options and quality of life stimulate patient participation.
My research has led me to initiatives in Ontario regarding Ontario patient engagement framework (Health Quality, 2017). The hallmarks of this framework are:
- To create a strong culture for patient, caregiver and public engagement in Ontario to support healthcare quality.
- Core Principles for success: Partnership, transparency, learning, responsiveness, empowerment and respect
- Health professional’s partner to ensure care plans that best reflect a patient’s needs wants and circumstances.
- Healthcare professional’s effectively engaging patients in personal care and health decisions leads to a better relationship between professional and patients, increased capacity to manage health conditions and greater adherence to care plans which all ultimately better health outcomes.
- The framework works for program and service design to better serve a community. Involving stakeholders in the process will ensure adequate accessibility to services.
- The framework assist in policy, strategy and governance allowing a partnership with patients will identify and bring forth health priorities and policies along with new governance models.
Health Quality Ontario Patient Engagement Framework outlines approaches to engagement:
- Sharing information
- Consult
- Deliberate
- Collaborate
Enabling patient engagement:
- Ongoing communication to inform areas of improvement
- Access to easy-to-understand health information
- Commitment to health equity and cultural competence- understanding patient’s view on health equity
- Research and evaluation-evaluating processes of patient engagement to assess effectiveness
References
Al-Tannir, M., AlGahtani, F., Abu-Shaheen, A., Al-Tannir, S., & AlFayyad, I. (2017). Patient experiences of engagement with care plans and healthcare professionals' perceptions of that engagement. BMC Health Services Research, 171-9. https://doi:10.1186/s12913-017-2806-y
Health Quality Ontario. (2017). Ontario’s patient engagement framework. ISBN 978-1-4606-9801-3 (PDF). Retrieved from http://www.hqontario.ca/Portals/0/documents/pe/ontario-patient-engagement-framework-en.pdf
Sloan, A. G., & Knowles, A. (2017). Patient engagement: qualitative narratives illustrate patient engagement behaviors. Journal Of Communication In Healthcare, 10(2), 78-87. https://doi:10.1080/17538068.2017.1340541