What Is Patient Engagement Anyway?

Everyone wants to engage patients in the hope they can improve outcomes and drive down costs. Unfortunately, many unvalidated assumptions and barriers are getting in the way and there is a cacophony of conversations going on between people talking at — rather than to – each other. One of the issues is that we don't all agree on the definition of "patient engagement"

Employee engagement can be defined as a workplace approach designed to ensure that employees are committed to their organization’s goals and values, motivated to contribute to organizational success, and are able at the same time to enhance their own sense of well-being. If we apply that concept to patients, then some define engagement as "actions individuals must take to obtain the greatest benefit from the healthcare services available to them." This definition focuses on behaviors of individuals relative to their healthcare that are critical and proximal to health outcomes, rather than the actions of professionals or policies of institutions.

There are several things we need to consider in the conversation if we agree on the definition:

1. We should do a better job of defining the intended use of specific interventions.

2. We need to target sub-segments who are more or less willing and able to be proactive about their health.

3. We should focus on the low-hanging fruit and be clear about intentions. Many argue that we should help patients help themselves because it is the right thing to do. In fact, if we are successful it will add costs, not reduce them.

4. Engagement is a proactive state of mind. It is not compliance.

5. Engagement is not the same as things designed to improve the patient experience.

6. Changing noxious health habits involves much more than health interventions including education, nutrition, and economic development.

7. Engaging patients can be misconstrued or perverted into manipulating patients using marketing or behavioral economic techniques that border on being unethical.

8. Changed behaviors have a limited half-life if not reinforced. Recidivism is high and exacts a high price.

9. Many overestimate the willingness and ability of patients to improve their health and insurance IQs.

10. 20% account for 80% of most problems.

Here's a list of 10 behaviors that engaged patients should be able to do. Like many drugs, no intervention is likely to have the same effects on all patients or address all the "intended uses".

We have a lot to learn about what works in whom and how and it is likely that we are all in for a long engagement before we know.