Patient Engagement Strategies

Put this sub-heading into a search engine and very quickly you’ll be greeted with a multitude of webpages from NHS trusts across the UK detailing their own evidence-based patient engagement strategies. Most healthcare providers now have some form of patient engagement strategy, and given that patient engagement relies on a good care experience, it’s only logical to combine the two goals. 

For example, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust states that its strategy “sets out the Trust’s intention to ensure the best possible experience of person centred care for all patients.”  

We discussed what a patient engagement strategy is in our introduction, and the Doncaster & Bassetlaw document goes on to detail what the strategy aims to achieve: 

• Ensuring staff understand their responsibility to patients for both clinical care and personal interaction; an expansion on bedside manner for greater familiarity, empathy and compassion.  
• How to achieve this 
• How to monitor this
• How to involve and engage patients 

This is welcome proactivity towards improving care and being a better operator, but potentially misses out a crucial area of also incorporating patient feedback. These are the people using the healthcare services regularly, and their testimony is crucial in understanding gaps where patient engagement was lacking, or the patient experience was poor. 

The strategy document from James Paget University Hospitals, another NHS Foundation Trust, does state the impact of patient feedback, citing concerns or at least issues with: 

• communication and information 
• staff values and behaviours
• admissions and discharges 
• appointment delays and cancellations 

Within this lie issues with healthcare professionals not listening to patients or speaking to them with due respect, clumsy communications, problems with hospital cleanliness, faults in care coordination, a lack of consultation and onboarding of the patient in their own care, and delays to appointment times or treatments. 

A patient experience and engagement strategy must be an ambitious plan for the future of healthcare without dismissing the present faults, in order to ensure a high quality baseline for care across the board. It must have clear goals and an explanation of the purpose of these goals, as well as the benefits they offer and a plan of action to develop and enforce changes in care culture.

Patient experience is what a person encounters during their care journey; from first interaction with a doctor or nurse, to diagnosis, and through to treatment. Many organisations will be wondering how can the patient experience be improved. Below we walk through why it matters and how to enhance the patient experience. 

Why is patient experience important?

Patient experience is important because you need individuals to trust you in order to achieve the best care outcomes. A patient is not going to properly engage with you – or a care regimen – if they’ve had a horrible time in a GP surgery, clinic, or outpatients department.

An NHS England guide from 2013 clearly states: “patients who have a better experience of care generally have better health outcomes”. This has a financial impact in cases of poor patient experience, with poorer care outcomes or readmission or deterioration of longer-term conditions.

It’s not just patients that suffer when the patient experience is poor though. Staff bear the burden of criticism and unhappiness, which in cases has become physical and violent. The British Medical Association reported in 2021 that almost 15% of NHS staff had experienced physical violence from patients, their family members, or even the public.

Beyond this, it’s also common knowledge in business that a bad experience has much more of an impact via word of mouth – and now social media – than a positive experience does. Even if a healthcare provider isn’t thinking compassionately, the damage poor patient experience can do for reputation is extremely detrimental. For NHS it’s damaging, for a private healthcare provider it could be serious enough to collapse the business.

What makes a good patient experience?

It’s difficult to truly define what makes a good patient experience when everyone’s impression of care and treatment is subjective, but there are some provable positive points we can highlight.

Perhaps the most important factor is control: when people have more control, or more involvement, with their own care then they feel more empowered and reassured that things are being taken seriously and they are receiving good quality care. It’s difficult to sit back and just be told what’s going to happen, and modern healthcare is undoing a lot of the old habits of past clinical actions by informing patients about their treatment and the choices or options they have going forward.

This empowerment comes through education, and can be continued afterwards to encourage more self-care and the preservation of wellbeing. This is a great opportunity to get family and friends involved in care too. People often rely on their nearest and dearest to help with daily life if they are recovering or managing a condition. The more these people know, the more they can help and accommodate the individual.

Aside this, things such as respecting patient values (religion or culture) and their preferences should be considered. Staff should reflect the best values of compassion and empathy, and care should be delivered in a coordinate fashion that’s not wasting a patient’s time or messing patients around. One way to do this is via telehealth, or telemedicine.

How does telemedicine improve patient experience?

Telemedicine, or telehealth, improves patient experience through the sheer convenience of being able to engage with healthcare professionals without having to leave a home setting.

Telecare became much more prevalent in the pandemic as a way of minimising the exposure to Covid-19 for patients and healthcare professionals alike, but the flexibility and – in many cases – cost-effective approach (travel or parking costs) has meant the popularity has continued to grow in the months and years since.

Why is the NHS patient experience framework important?

The important thing is knowing how to provide a safe and positive experience for patients, and one of the ways the NHS does this is with the NHS patient experience framework.

The NHS National Quality Board (NQB) established the patient experience framework in October 2011 as a way to define what the patient experience is, what a good patient experience looks like, and the ways to overcome challenges during the patient journey.

How can the NHS patient experience framework overcome challenges?

The NHS patient experience cannot alone overcome challenges, but it does serve as a simple, one page document to inform healthcare professionals and NHS trusts as to their operating principles. This framework is a guideline for staff to work from and refer back to when they’re dealing with patients, to ensure that it’s not just the clinical activity that is being delivered at a high standard but the softer skills of compassion, trust, empathy and more that are mixed in to reassure and convince the patient that you are the right team to provide them with the right care. 

Now we know what the strategies are we can move on to patient engagement initiatives; how do healthcare providers encourage patients to engage, to become an active participant in their own care?  

Some initiatives are subtle, such as multiple language choices available for using NHS services or a GP surgery. In Birmingham, England for example there are options for English, Polish, and Arabic. Other areas would also consider French, Romanian, and even Pidgin – all based on local migration and demographic needs. 

More obvious initiatives are things such as healthy eating programmes or GP surgeries partnering with local gyms to encourage better self-care and wellbeing management, but social prescribing is also appropriate too; a community approach to collaborative care at the basic level to ensure a rounded care experience that raises the base level of care received by a patient. They are being supported beyond just a hospital or a doctor’s surgery, which can hopefully improve wellbeing and morale and prevent more serious conditions developing or deterioration in existing long-term issues.

Patient engagement activities: 

There are a range of activities or actions that patients can be engaged via too. Patient feedback is one of the most obvious ways, and is a commonly used pre-existing function within healthcare. Having clinicians and other healthcare professionals take feedback from the point of care delivery, sending out surveys in the post or by email, social media outreach, or even patients communicating with an independent body like the Care Quality Commission (CQC). All of these outlets send crucial data back to the healthcare provider for them to then act on, but more importantly they engage the patient with their own care; they get to have their say, feel heard, and hopefully see changes based upon their feedback. 

Then there is patient engagement through care management. Patient portals are a hub of patient information; what appointments you have, what medication you’re on, and the option to book more appointments or repeat prescriptions – as well as in some cases access information about medical conditions to further your understanding. Patient portals are a great way to onboard patients into their own care, and cut down on a lot of the back-and-forth that a patient would typically have with receptionists at a surgery.  

To refer back to the James Paget University Hospitals strategy, “What is crucial, is that we embrace all feedback received, collate it, analyse it and use it as an opportunity for learning."

Marketing strategies and patient engagement go hand in hand, and this is the foundation of a patient engagement framework. NHS England’s Always Events framework is one example of a structured approach to engagement, but providers all have different approaches. 

There are typically five stages to a patient engagement framework: 

1. Vision
2. Culture
3. Pick tools & tech
4. Plan
5. Review/amend/evolve 

Vision: 

The starting point has to be establishing what you want to do or achieve with a patient engagement strategy. Goals should be set for things such as patient satisfaction, reducing costs, and a timeline for implementation. 

Vision should also focus on patients and staff (including leadership, directors etc) and the impact proposals will have on them. These link back to the issues discovered from patient feedback:  

• Communication and information 
• Staff values and behaviours 
• Admissions and discharges
• Appointment delays and cancellations 

These points should help tailor a framework and aim to correct concerns or issues with the patient engagement and inclusion. Engagement has many benefits, as discussed in our Patient Engagement explained blog, but it can’t be introduced at the expense of healthcare professionals and making their jobs harder. 

There also needs to be ideas about how the organisation intends to engage; will it be done at the point of care or digitally, and how will each be approached? Factor in patient engagement metrics too. For example, if you’re using a patient portal, how many patients actually login and use it? Which sections of it get used the most?

Culture: 

With ideas in place it’s then up to a healthcare provider to encourage or foster the new patient engagement culture. Discuss proposals with staff, take their feedback on board, and educate people – through training preferably – as to why patient engagement is important and beneficial. 

Embedding any kind of cultural shift is not easy. It should stem from your vision (above) which should act as your guiding star. Think about how patients are discussed, and the language used around them - do they demonstrate the organisation is taking patient engagement seriously? Is patient engagement commonly considered as part of decision-making processes, and do the outcomes of patient engagement activities inform those processes? 

These are just a couple of examples of where you and colleagues can self-assess whether you are prioritising patient engagement to the level you want to.

Tools & Tech: 

Next comes deciding what types of tools you want to use for engagement and finding the software solutions to achieve your goals. 

Patient portal solutions have been heavily discussed, and can be delivered in browser or application editions. Email or text alert systems are also quite commonplace, and these same email managers can also be used to send patient feedback surveys. 

According to Evisit, “A majority of patients would like online access to their medical records. If they had this access, about 57% of patients who don’t currently use patient portals say they would take interest and be more proactive in their healthcare.” 

The adage “if you build it, they will come” springs to mind, but it’s a simple reality: people often don’t know they want an innovation or solution until it’s available to them, and a healthcare provider can encourage this engagement.

Plan: 

Perhaps the most straightforward part of a patient engagement framework is the planning phase. This is basically establishing a timeline for the goals and plotting where things like onboarding the software solutions and training staff fit in, as well as confirming which staff will be needed to work with these new solutions and when patients can be informed of the availability of these new opportunities.

Review, amend, evolve: 

Thus concludes the patient engagement framework. This final section is about reflecting on the work done. Some of it will happen straight away, based on immediate patient feedback, but more will take place over time as more data is generated and analysis can properly identify trends. 

Healthcare providers should account for failing to meet targets in this self-assessment, and have plans or options in place for how to adjust their approach accordingly. Failing to meet a goal doesn’t mean that progress hasn’t been made, so there’s a flexibility needed to balance ambition versus reality.

Patient engagement outcomes can simply be described as what works within these strategies and frameworks to get patients involved in the care process. The four core tenets are: 

• Communication (from healthcare professionals to patients) 
• Responsibility (of individual staff or teams to the patient) 
• Observation (as an organisation to ensure & improve engagement) 
• Education (to enable patients to be more actively engaged) 

Successful patient engagement will demonstrably show an increase in communication between patients and healthcare professionals, as well as usage of patient portals and other health support applications. 

The best patient engagement strategies are ones that ensure patients have the opportunity to engage and guarantee that their feedback will be taken onboard. More solutions will likely present themselves in the future, but for now patient portals, messaging services, live chat, and educational materials have to be the aim for healthcare providers in connecting with patients. They’re provably popular and the evidence shows improvements to care outcomes.