Patient Engagement

There are many different types of patient engagement. The most obvious and most common patient engagement methods are things such as surveys or questionnaires, though some healthcare providers may also opt for informal feedback face-to-face, or perhaps more formal interviews or focus groups. 

Other patient engagement examples include patient portals (for managing appointments, ordering prescriptions, or checking test results), text/email notifications, and remote GP calls. These all encourage action from patients to play a part in their own care process. 

What are the four key measures of patient engagement? 

1. Control – is the patient in charge of their own wellbeing and care decisions? 
2. Maintenance – is the patient actively looking after themselves and making appropriate decisions about their health and wellbeing? 
3. Informed – does the patient understand their symptoms or conditions?  
4. Support – is the patient confident and able to ask questions, find answers, and address any health concerns?

The World Health Organisation’s guide to patient engagement highlights what factors influence patient engagement. WHO states that there are five groups affecting patients: 

1. The patients themselves, in terms of their demographics 
2. The patient’s conditions and severity 
3. Clinicians, in terms of knowledge or attitude 
4. Tasks: “e.g. whether a required patient safety behaviour challenges a clinician’s clinical abilities” 
5. Healthcare setting, i.e. primary or secondary care 

Managing these factors can be problematic, but patient activation and patient engagement go hand in hand (as we explain in the next section).  

By better training healthcare professionals, clinicians, and more to be better communicators the relationship between patient and provider can improve. The World Health Organisation points out that “patients may fear being labelled ‘difficult’” but with the right clinician approach a patient can be put at ease and made comfortable to ask questions, query decisions, and allay concerns. 

This is why a patient engagement model is a good idea; to ensure that the processes or programs are in place to better train staff which in turn then avoids any roadblocks for patient engagement. One such example is with NHS England, who has a patient engagement framework which revolves around three tiers of engagement; information, involvement, or partnership.

The importance of patient engagement in healthcare can be inferred from the benefits of the patient experience feedback. It’s crucial for healthcare professionals to have ever more insight into a patient’s needs and their preferences. 

The National Library of Medicine (NLM) states: “the need for patient engagement is posited as foundational because most adults spend little time in health care facilities and frequently are on their own to make appropriate, daily health decisions. This means patients need to be in control and the drivers of their health.”  

This is the crux of patient engagement: it’s important to have the individual on side, interested, and active. With a patient onboard for their own care, clinicians can learn more about how a patient manages their care. This highlights what works, what doesn’t, and what can be improved on.

What is the difference between patient activation and patient engagement? 

Patient engagement is when a patient is informed of, involved in, or even a partner to their own care provision. Patient activation is specifically about the patient’s desire to be involved; how willing are they and how capable are they to take action regarding their own care. 

NLM goes on to advocate the importance of patient engagement regarding ethics, self-confidence, and education, highlighting the fact that “countries with higher levels of engagement had better quality of care, lower medical error rates, and greater satisfaction in the experience of care.” 

The King’s Fund also backs this up, with their patient engagement research showing that “there is a proven association” between engaging patients and their ability to better manage their condition, utilise information resources to answer questions before approaching a clinician, and to follow the treatment plan. This last part is important, because failure to stick to these plans costs money through patient readmission or condition deterioration. There’s also the aspect of patients opting for less interventionist treatments (at a lower cost) because they’re more aware of the treatment/recovery process and what it will need from them or what they can manage. 

Ultimately, by changing the clinical approach from asking “what the matter is” to “what matters to you” there’s a whole new framing that onboards patients.  

This is especially impactful in areas of depravation or lower income. Education may be a problem, which in turn can hinder both patient engagement and patient activation. If a patient doesn’t know how to explain themselves, how to describe their issues, then how is a clinician to best help? This is why patient engagement is important. It’s a means to achieving better health equality; something that can be easily forgotten in the midst of the sheer levels of demand affecting healthcare provision in the present day.  

Greater healthcare quality is the ultimate pursuit, but it shouldn’t be ignored that patient preference is also becoming more prevalent. Consumerism has built a culture of greater engagement in other aspects of our lives, and as such healthcare is seeing more demand for it to be accessible and personalised akin to online shopping or banking services. Choice and flexibility are more popular than ever.

The benefits of patient engagement in healthcare are clear then. By working with patients to gauge their thoughts, their fears, their opinions on aspects of the care provision, a clinical setting can adapt to the needs of both the individual and the broader community.  

• Better understanding of the patient’s needs improves care quality. Care outcomes improve too. The chance of readmission decreases, which itself reduces costs as well as the care burden.
• Patient engagement builds trust, which in turn educates both parties.
• The clinician learns about the patient more and the patient understands what the clinician is looking for in diagnosis or doing to help.
• There is a mutual understanding and accountability, which reassures patients about their safety and wellbeing.  

There is still an onus of instigation for the healthcare professional; they must broach the subject and encourage discussion. Their ‘bedside manner’ must be compassionate, and they must show an interest in what the patient has to say without being dismissive.

Patient engagement vs patient experience 

Patient engagement is the degree of involvement for a patient in their own care. The patient experience is the result of this care process; how well did they feel cared for, how safe did they feel, how satisfied are they with the overall outcome.

The NLM’s research is applicable here too. They found that by incorporating a patient’s own wishes or ‘goals’ into a treatment program, behavioural change or discipline was better achieved. It sounds so simple, and in a way it is, but it’s a bigger picture evolution of the doctor-patient relationship at a base level. The medical expert has always been seen as the intellectual and the authority. This isn’t to say that has changed, but that power dynamic is weakening.

The conclusion then is that patient engagement is an avenue worth pursuing. It may take some minor investment to enable some engagement pathways, and perhaps some additional training, but the benefits to patient care outcomes, patient satisfaction, and costs are too good to pass up.

This is the first in a series of articles exploring patient engagement, as we delve into how to measure patient engagement, the best strategies for it, the best software solutions, and how healthcare providers can increase patient engagement.