Patient Engagement

Patient Engagement Survey: How to Hardwire Engagement into Care Delivery Processes

Insights Report · May 14, 2017

Analysis of the fourth NEJM Catalyst Insights Council Survey on Patient Engagement. Qualified executives, clinical leaders, and clinicians may join the Insights Council and share their perspectives on health care delivery transformation.

Advisor Analysis

By Kevin Volpp and Namita Mohta

For patient engagement to be truly effective, it must be integrated into the core of health care delivery processes. While newer options for patient engagement solutions are emerging, including tapping into a patient’s social network and gathering data from remote and wearable devices, our latest NEJM Catalyst Insights Council survey finds that most organizations still expect health care teams to do the heavy lifting.

Nearly two-thirds (63%) of Council members list “care teams devoted to complex patients” as their top approach to embedding patient engagement strategies into care delivery. Health care teams outpace patient engagement technology tools (e.g., remote devices) and social networks (e.g., with other patients), which 44% and 24% of respondents say their organizations use, respectively. Our respondents also say care teams are the most effective method of engaging patients, with a combined 91% calling them extremely effective, very effective, or effective. Patient engagement technology rates second, with a total of 72%.

More than half of respondents (59%) believe that effective patient engagement strategies have a major impact on quality of care, and 40% believe they have a major impact on cost of care.

As health care delivery organizations continue their efforts to positively influence patient engagement, they would ideally have care teams bear less of the load while technology tools and social networks provide more support. In support of this shift, survey respondents say “time investment by health care team” is the biggest challenge (indicated by 63%) in incorporating patient engagement into care delivery.

Patients are the most important participant in design efforts, Insights Council members say by a large margin (chosen by 91%). However, more than half (54%) cite patient adoption as the biggest design challenge.

Health Care Teams Are the Leading Method of Embedding Patient Engagement Solutions into Care Delivery

Patient Engagement Insights Report. Click To Enlarge.

So how do you get patients to take part in care design while also alleviating some of the time pressure on health care providers? (Nurses and care teams are considered the second most important participant in patient engagement design, at 63% of respondents, followed by physicians at 58%.)

Organizations must learn to better leverage patient engagement technology and social networks. The health care team approach is personnel-heavy, making it costly to sustain. By using technology tools and social networks, that cost can be reduced while improving quality of care. And, when care delivery is designed well, patients are positioned to advocate effectively for their own care.

As one of us (KV) wrote in The New England Journal of Medicine in 2012, “Wireless technologies that can provide a kind of ‘automated hovering’ offer considerable promise in this area, in part because they may be less expensive and allow for easier daily monitoring and feedback than approaches involving clinical personnel.”

Two studies co-authored by KV, using financial incentives to promote patient adherence, show the value of a more patient-centered approach. One study involved peer mentoring for African American veterans with diabetes; the other studied home health monitoring for patients with poorly controlled diabetes through wireless devices to measure glucose, blood pressure, and weight. In both instances, patient adherence increased and health outcomes improved — with minimal extra work from clinicians.

Insights Council members, in their verbatim responses to the survey, acknowledge their desire for technology tools and social networks to play a greater role in patient engagement. “I would incorporate the patient/family into all education processes related to care,” one respondent says. Another says organizations should “enable patients to contribute directly to their record and help curate their charts.”

The relatively low adoption of technology tools (indicated by 44% of respondents) and social networks (24%) within health care organizations constitutes a tremendous opportunity for improvement, which we expect to see in the near term. Most organizations have yet to use these approaches to a high degree. We expect that as they embrace these approaches, the task of fostering patient engagement will be better shared among health care teams, family and friends, and technology.


If you as an individual could do one thing to improve patient engagement in your organization’s processes, what would it be?

“Be direct. Don’t assume. Ask the patients how to improve patient engagement. Do this in person, not by a survey.”
— Clinician at a mid-sized teaching hospital in the South

“The only thing that may be more [important] than the physician-patient relationship and TIME to develop that relationship may be financially incentivizing patients by insurance companies to develop more healthful lifestyles and habits, and improving mental health resources.”
— Clinician at a small for-profit clinic in the mid-Atlantic region

“Change the incentives from mostly medical to behavioral, environmental incentives.”
— Director of a small for-profit provider in New England

Download the full report for additional verbatim comments from Insights Council members.

Charts and Commentary

by NEJM Catalyst

We surveyed members of the NEJM Catalyst Insights Council, comprising health care executives, clinical leaders, and clinicians, about current trends in hardwiring patient engagement into care delivery processes. The survey covers various approaches to embed patient engagement solutions into care delivery, and rates their effectiveness; the most important participants and the biggest challenges in efforts to design patient engagement into care delivery; the most valuable means of capturing patient input; the most effective patient engagement tools, programs, and technologies; and the impact of good patient engagement on different aspects of health care. In total, 555 completed surveys are included in the analysis.

Health care teams devoted to complex patients are the top approach to embedding patient engagement solutions into care delivery, selected by 63% of respondents. More executives and clinical leaders than clinicians say their organizations use this approach. The same is true for use of patient representatives. Patient engagement technology tools, which include remote devices, come out well down the list at 44%. And social networks — an approach that many in health care believe could increase adherence among patients with chronic conditions — are used by only 24% of organizations, with the South (16%) far behind the Northeast (29%), Midwest (28%), and West (25%) in use of social networks. One respondent adds that “physicians focused on innovative practices engaging patients directly” should be considered an important approach.

Download the full report to see the complete set of charts and commentary, including data segmentation, the respondent profile, and survey methodology.

Check NEJM Catalyst for monthly Insights Reports not only on Patient Engagement, but also on Leadership, Care Redesign, and the New Marketplace.

Join the NEJM Catalyst Insights Council and contribute to the conversation about health care delivery transformation. Qualified members participate in brief monthly surveys.

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