How can we increase patient compliance? By providing actual solutions, according to Punam Keller, Associate Dean for Innovation and Growth at the Tuck School of Business at Dartmouth College. No barrier is too small when it comes to a patient’s difficulty with following instructions for better health. Take patients who need to weigh themselves — what if they can’t see the scale? Or, what if they’re supposed to track individual pounds, but they can’t tell if they’ve gained two or lost three because their scale only shows five pound intervals? For an individual in danger of a heart attack, for example, these difficulties become major barriers. “So many of the patients we spoke to said they couldn’t even tell if it was two or three pounds, and that is unfortunately all it takes,” Keller says.
So what can we do? Keller lays out three steps:
Step 1: Identify patient barriers.
Identify all the barriers that patients are facing, Keller says.
Step 2: Identify solutions to overcome those barriers.
“This is where your service providers can help, and that includes the physicians,” Keller says, describing how she’s working with a team to help patients in wheelchairs weigh themselves by using a tire pressure gauge.
Step 3: Create behavior change tools for service providers.
Keller conducted a study during which these kinds of examples, such as inability to weigh yourself, were shared with patients directly. Then, patients were asked if they could foresee any similar challenges, or wanted to address challenges they’ve already had. These were written down on cards, with “concerns” and “solutions” clearly labeled — “we didn’t say ‘barrier,’ we just said ‘concern’ because that’s much nicer,” Keller explains — and the cards were then given to the patient as they exited the hospital.
From the NEJM Catalyst event Patient Engagement: Behavioral Strategies for Better Health at the University of Pennsylvania, February 25, 2016. Watch Part 1, Part 2, and Part 4 of Keller’s talk.