Getting Clearer on Patient Engagement: What You Said

In a recent post on patient engagement, I made the point that as a field, we really need to clearly define what patient engagement is and isn’t. After all, how can we improve it, if we’re not clear what “it” is?

Accordingly, I proposed a definition for patient engagement along with a rationale, and invited you to comment and add your definition. Many of you did, providing interesting ideas and much food for thought. Thank you all.

We aggregated what you said (only slightly edited for grammar) and are sharing it here to further the conversation. Let me know what stands out for you, and any new ideas or definitions that come to you.

Joeri GredigWe see patient engagement as the most valuable driver at maximal low costs to achieve faster recovery. Technology developed with focus on patient perceived value will boost caregivers effectiveness.

Leslie Rees: Hard to define with different attitudes of both patient and clinician and often determined by circumstance funding and time.

Marian BondPatient engagement is very different from listening to a patient worry about their health or takes action to improve their condition. Patient engagement is about giving your time to actually hear what is being said and acting as a conduit for that patient to grow in knowledge and spirit. Engagement is the illusion of time for that patient – making them feel like they are the only one in the universe and making them feel fully heard. Care and comfort is a lost art in medicine. It is something that a lot of facilities are trying to teach, but best taught by example.

William Hannon: You can never replace Empathy. Doctors, Nurses, Device Designers, Architects all need to embrace a sense of EMPATHY with the patient. It is a sad state of affairs when a whole new profession UX ‘User Experience appears out of nowhere.

Rafael Goeting: Engagement happens when we give our patients a greater sense of control over treatment, care, and outcome. This type of engagement is not limited to just the patient but also includes their loved ones.

Mahendra Bhandari MD,MBA: Patient engagement is a perpetual support to a patient, outside the period of ‘in person’ contact with the healthcare provider. Wireless medicine and technology is poised to play a major role. This engagement has to continue beyond the treatment of illness to wellness.

Dawn Stewart: In my opinion patient engagement comes in different forms and at different levels. This can consist of a patient taking interest in their condition, seeking out information around treatment and management, understanding their medications…rather than just letting the healthcare professionals treat them. It’s about taking some kind of active role in the disease, condition and therapy.

Sk Ray: I think patient engagement is the tool to share the information which are beneficial for any individual who is suffering due to illness or who is health conscious.

Thomas Calloway MBA: Great topic, Mr. Engelberg. I have always considered “patient engagement” the attitudinal decision that stimulates a commitment to modify deleterious health behavior. If you like, when patient and doctor decide to work together.

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Note that to some of you, patient engagement is about patient attitudes toward their health. For others, it’s about tools, or interaction between providers and patients. A couple of you highlight empathy as the critical ingredient. And several focus on behaviors or actions patients take to improve their health or healthcare.

I’ll keep working on refining the definition of patient engagement so we can move to an industry standard. I welcome your ongoing feedback and input.

Once defined, the next question becomes… how do we measure patient engagement? The fun continues!

Happiness as Competitive Advantage? A Challenge for Health Companies

company_happinessYou may be familiar with the Kingdom of Bhutan’s Gross National Happiness (GNH) index. This small Himalayan nation is the only country in the world that measures and aims for national happiness as its most important objective. The intent is to build an economy and culture based on spiritual values more than on material wealth. It prioritizes GNH over GDP. Bhutan’s commitment inspired the United Nations to pass a resolution that placed “happiness” on the global development agenda.

What does this have to do with you and the success of your company that’s in the business of health?? Potentially, a lot. As you read what follows, consider the notion of balancing both profitability and happiness as guiding values and major indicators of success.

Bhutan’s young King Khesar put it this way in his coronation address: Yet we must always remember that as our country, in these changing times finds immense new challenges and opportunities, whatever work we do, whatever goals we have – and no matter how these may change in this changing world – ultimately without peace, security and happiness we have nothing. That is the essence of the philosophy of Gross National Happiness. Our most important goal is the peace and happiness of our people and the security and sovereignty of the nation.

Most companies in the health industry base major business decisions on financial metrics like ROI to shareholders, quarterly numbers, and EBIDTA. Which makes sense. You need to be successfully financially and deliver a return to investors to be a going concern.

Money matters, no matter how dedicated your company is to improving health and saving lives. “No margin, no mission,” as the late Sister Irene Kraus, former CEO of the $3 billion Daughters of Charity National Health System, is credited as saying.

And, and… maybe happiness can matter just as much as money, and measurably contribute to your company’s financial success.  Especially since you’re in the business of health. Many start with employee happiness and well-being. Kaiser, Genentech, Mayo Clinic are a few of the health companies that have a reputation for really investing in the well-being –  and thereby the happiness – of their employees.  And there’s much further to go.

Let’s do a thought experiment: What would if happiness of your employees was a measure of your organization’s well-being? What about delivering  happiness to your customers?  Can you imagine happiness as part of your brand promise? Part of your unchanging core values? A key differentiator in highly competitive market? A metric you proudly talk about to shareholders and investors?

Be happy??

Companies in Healthcare: What Could Make You Disappear??

The healthcare industry is changing at an incredible pace. That means winners and losers. New companies emerging and existing companies going away. What could make your company disappear?

To be clear, by “make your company disappear” I don’t mean some super-powered ray gun or a natural disaster that would ‘poof!’ make your company suddenly vanish, dissolve, or fade away.  I’m asking seriously what could make your products, services, or company irrelevant, obsolete, or undesirable?

And I apologize. I know disappearing can be an unpleasant thing to think about. But it’s really important to think about, especially when you’re doing well. As you know, there is a plethora of products, services, and companies that were once great, and then succumbed to forces that made them disappear.

In today’s healthcare environment, just consider the impact of Meaningful Use or the MEDTECH Act; the shift toward value-based reimbursement or growing influence of GPOs; the proliferation of wearables and monitoring devices; and the health plays of leading tech companies like Apple and Google.

Any of these forces can position a few as market leaders, necessitate radical restructuring for many, make other companies disappear, and launch countless new startups to replace them. You want to stay strong. Be proactive. Don’t be one of the disappearing companies or a victim of circumstances.

First consider your company’s relationship with the market and healthcare business environment. Start with these five questions:

  1. What change in the market can make my products or services irrelevant, obsolete, or undesirable?
  2. What technological innovation can make my products or services irrelevant, obsolete, or undesirable?
  3. What shift in consumer behavior can make my products or services irrelevant, obsolete, or undesirable?
  4. What policy or regulation can make my products or services irrelevant, obsolete, or undesirable?
  5. What competitor can make my products or services irrelevant, obsolete, or undesirable?

Your answers should help you look beyond the present, see threats to your long-term viability, and proactively make plans to preserve your company’s existence and well-being. Think big picture, not just about what might replace your offerings, but what might integrate your technology into something bigger, like smartphones have integrated the functions of MP3 players. Consider too getting input from KOLs and customers to give you a more well-rounded perspective and greater certainty in your conclusions.

Now take a look at your own internal practices and beliefs, that if unchecked, can prevent you from being agile and responsive, and ultimately make you disappear. But don’t do this assessment unilaterally, get feedback from your team. Drawing on the innovation work of Dartmouth professor Vijay Govindarajan, think about these three traps that can make even highly successful companies flop. Do any apply to you?

  1. Major investments in systems or technologies can make it prohibitively expensive for you to move to newer and better tools. But the longer you stay with what you have, the harder it is to switch. Some call this the “sunk costs” fallacy.
  2. Fixation on what brought you success blinds you to new things that can threaten or displace you. You don’t see it until it’s too late. Then you respond with desperation. Sometimes “if it ain’t broken, don’t fix it” just does not apply.
  3. Hyperfocus on today’s marketplace can lead you to ignore new trends and market forces, and future opportunities and threats. You may be too wrapped up in the business to focus on the business. You’re all about today, and lose out on forward thinking.

Combine your answers to the first set of questions about your company’s relationship with the market and external environment, with your assessment of traps based on internal practices and beliefs. Be honest.

Stay strong. Don’t disappear!

Med Tech Product Managers: Persuading Your Management To Support Your Innovation

innovationJames is an experienced product manager at a large device company. He has a winning new population health idea supported by a strong business case.

James knows his new initiative will pivot the company well for the future of value-based reimbursement. He also knows that maintaining the status quo will be a death knell as the fee-for-service paradigm gradually disappears.

James has solid ROI projections and trend analytics to back it all up. He also knows his idea fits and delivers on the CEO’s stated vision for the company’s future.  He has pitched the idea up the management chain internally on several occasions.

The problem is James is not getting the support he needs from upper management. He gets heads nodding but no action. No commitment. Overall lukewarm reception.

Why? Because even though what James is proposing is sensible, timely, backed by facts, and aligned with the corporate vision,  it requires going in a direction that is unfamiliar to the company. It is perceived as an unknown. It is therefore seen as risky business.

What should James do? It doesn’t make sense to simply repeat the same arguments and expect a different result. He already made the best case he could. But he knows the window for competitive advantage is slipping away.

James needs other voices to give his bosses enough confidence to say yes and invest in what they know is a good idea and necessary for the company’s long-term viability, despite their concerns. These other voices need to be strong enough to overcome fear of change, fear of moving into an unfamiliar space.

James doesn’t need a large quantity of voices. Survey numbers won’t make his case more persuasive. The status quo thinking he needs to overcome is not rational. He needs to strategically manage relationships with his internal customers. Persuasion at an emotional level if required.

Specifically, James needs smart, influential people that genuinely share his thinking and who his bosses will listen to with open minds. That means select key opinion leaders and perhaps several important customers who will voice their agreement with three things: 1) The underlying premise about healthcare’s inevitable shift toward population health management and value-based reimbursement. 2) The recommendation to take proactive action now in order to be positioned to serve healthcare customers in the impending new business reality without losing viability in the current fee-for-service environment. 3) The reality that not taking action is the riskier choice.

The insights and recommendations need to be delivered carefully and strategically to be heard and take hold. Even if these influential voices are only echoing what James already said, when management hears it from them, it has a different impact.   It shifts the perception of risk away from stepping into new territory, and toward missing the boat by not moving forward with Jame’s idea.

There’s a lot of science and research behind how and why this works from studies of persuasion and decision-making. But bottom line, and like-it-or-not, James needs to marshall additional resources to persuade his upper management to move forward and with sufficient investment. The end result is management’s initial fears of change are allayed, they feel reasonably confident that they are moving forward in the right direction, and most likely, they say yes!

Patient Engagement: What Is It Really?

patient_engagementWhen a patient worries about their health condition, is that engagement? What about when a patient tracks their condition with wearables? Is a provider required for patient engagement to happen? Or is it only engagement when a patient is taking action to improve their condition?

A few years ago, health IT strategist Leonard Kish called patient engagement the “blockbuster drug of the century.” At HIMSS last week, there were numerous presentations on patient engagement and countless vendors offering patient engagement solutions. Yet, there is still no clear agreement as to what exactly patient engagement is, what it does, and how to measure it.

Let’s try to fix that. This first post in the series will focus on what patient engagement is.

We’ll start by defining what a patient is. (Interestingly, the word “patient” originally meant ‘one who suffers’ according to Wikipedia). The most common definition of a patient is simply someone receiving medical care. Note there is a connotation of passiveness in the notion of receiving care. The other relevant point is that receiving care requires interaction with someone who is providing the care. That means patient engagement requires a provider, not just a patient alone. So to be a patient, all someone needs to do is accept care from a provider.

What is engagement? I see engagement in degrees, from caring to understanding to acting. A patient is minimally engaged by virtue of caring about her health. She is more engaged when you actively work to understand her health. And she is deeply engaged when she is taking action – doing things – with the intent of improving her health.

One more component to add: Most patient engagement definitions include: a) participation, use of resources, and interaction with a provider, b) a goal of positive health behaviors, and c) an end result of health management or health improvement.

Put in all together and we have this definition of patient engagement:

Active participation of a person in their health and healthcare, which includes using resources, working with their provider, and taking action to understand, manage and improve their health condition.

How does this definition work for you? Any suggestions for improvement?

Now that we have a good working definition, we can move on to what patient engagement does, and how to measure it. Stay tuned!

Hot at HIMSS 2016: Interoperability, Population Health, Telehealth, Patient Engagement

I just got back from a jam-packed few days in Vegas for HIMSS 2016. Just me and 40,000 of my closest HIT friends.himss16

The mix was 2/3 vendors, 1/3 healthcare systems, I heard. Lots of excitement, lots of energy, lots of promise. Lots of walking.

As I step back, I see four main themes jump out: Interoperability, population health, telehealth, patient engagement. Here’s my quick take on each.

Interoperability: Getting devices to talk to each other, share data, and play nicely together for the higher good- better care, better outcomes. Along with improving mediating outcomes like workflow and reducing errors. Kudos to device and IT companies for sharing and letting go of turf. It’s certainly time.

Population health: All about prediction to figure out whom to provide what services to. Seems to be a modern version of managed care in terms of bottom line purpose, but driven by predictive analytics and with far more tailoring of care. The key piece still under-estimated is how hard it can be to get people to change health behaviors.

Telehealth: Keeps evolving to let more and more care and monitoring happen remotely (or “out-of-person” vs. “in-person”). Now it’s not just connecting provider and patient, it covers connecting providers and providers, providers, payers, and patients, etc. This will challenge our paradigm about what monitoring, diagnosing, and treating can only be done in-person. I think the litmus test for clinical care is empathy – to what extent can a provider truly empathize and thereby deeply understand a patient through mediating technology.

Patient engagement: Though it’s been around since the earliest days of healthcare, it now means all kinds of things and is catalyzing a wide variety of new products and services. Key issues here are about defining what it is and isn’t, developing objective metrics, and making it not a separate “thing,” but an integral and unavoidable part of every healthcare interaction.

Better interoperability behind the scenes, plus telehealth to enhance and extend relationships, combined with population health to focus resources, improves patient engagement to make it all matter.