Patient Engagement
Driving and Sustaining Behavior Change

Improving Patient Involvement in Care

Article · April 4, 2018

With a perspective that spans direct patient care and health system leadership, Gary Kaplan, MD, Chairman and CEO of Virginia Mason Health System, says that if health care providers are truly committed to patient health, then they must deepen their commitment to prevention, patient engagement, and care redesign.

Kaplan lays out several essentials for clinicians and health care leaders.

Understand the Patient at a Deep Level

“Understanding the patient’s capacity is critically important,” Kaplan says, referring to factors such as a patient’s living situation, challenges, literacy, financial status, health care coverage, support structure, behavioral and social functioning, and any chronic diseases. “A deep understanding [of capacity] is important to our ability to really engage the patient as a mutual partner in their health and health care journey.”

Develop Care Road Maps

Clinicians need to develop robust plans of care — customized road maps that go beyond a single episode of care or office visit, even multi-year plans, he says. These plans make clear what the provider needs to do, what the patient needs to do, and what they need to do together to help the patient stay healthy.

“Unless we are explicit with our patients, I think we’re sub-optimizing and perhaps not giving them the information and the tools they need to manage health and well-being in between their episodic health visits.”

Make Patient Information Accessible

“I think having prevention and screening available and actionable at every touch point is critically important,” Kaplan says. By starting with a deep understanding of its care processes, and using the Virginia Mason production system tools, the health system partnered with its electronic health record vendor to create a health maintenance module. “When I go in to see a patient, that health maintenance module is the first screen on the computer for every patient, every time; and it’s customized to that patient’s specific prevention and screening needs and indications.”

That same module is available to call center operators. “So, using our tools, on top of good processes, and making the screening visible and actionable at every touch point for the patient, really helps a lot,” he says.

Use the Power of the Portal

The patient portal can be a powerful tool to improve engagement. If, for example, a patient has a weight-loss goal, clinicians can check in with the patient at appropriate intervals on progress. “Making their targets and their progress visible gives us a chance through the portal communication to give them encouragement and positive feedback,” Kaplan says. “Kudos on their successes. Because the patients need those just like all of our team members do; they need to feel valued and to feel that they are making progress.”

Virginia Mason also uses OpenNotes. “We have all of our notes fully visible to our patients through the portal, so that is further engaging,” he says. “Having the patient understand their screening needs on their own website is very engaging for our patients.”

Educate and Empower Patients

Meaningful education is very much part of shared decision-making, Kaplan says. “Shared decision-making is really about engaging the patient in understanding their choices and that they do, indeed, have choices. That the doctor is not in charge and that the patient’s in charge . . . if we engage patients that way, we can make better decisions together.”

Find Creative Partnerships

“One of the things we’re doing is partnering with the YMCA of Greater Seattle so that I, as a primary care doctor, can actually order directly a consult with the YMCA’s weight-loss program right out of my electronic health record,” Kaplan says, noting that this option may be more convenient for the patient.

Structure the Right Team

It is important to consider the care team itself. “How do we best leverage the primary care teams so that we’ve got the right people doing the right work? One of the things that our Virginia Mason production system has taught us is how important skilled task alignment is to optimal flow and to optimizing the patient experience,” he says. For example, medical assistants can schedule preventive testing using the health maintenance module, and they can also routinely screen for depression, anxiety, and other factors.

Nurses are probably the best trained and positioned caregivers to engage in coaching and conversations that empower patients to reach their goals, Kaplan says. Pharmacists can counsel on appropriate medication dosing. “It’s about having the right people do the right work and fully leveraging all the team members.”

Become Sustainable

Another important player in health care is the payers. It’s essential that a provider organization’s innovative efforts be reimbursed.

“That’s a challenge in today’s payer/payment environment; it’s a piece of the puzzle,” Kaplan says. “We think we’ve got to do the right thing for our patients and ultimately this will help us. If we were paid capitation, for example, it would make it that much easier, but our market’s not going there any time soon, so we have to do the best we can with what we have.”

“We’re not saying, ‘Woe is us.’” Rather, he says, “We’re saying, as professionals, we have to do what’s right for our patients and figure out how to make it into a sustainable business.”

New call for submissions

Now accepting submissions for NEJM Catalyst Innovations in Care Delivery, our new peer-reviewed journal

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

More From Patient Engagement
PROMs Usage Is Limited but Growing

Patient Engagement Buzz Survey: PROMs Use Is Growing, but Implementation Takes Effort

While clinical outcomes lend themselves to measurement, quantifying how an individual patient experiences symptoms or a loss of function can be more challenging. One promising approach is the use of Patient-Reported Outcome Measures (PROMs).

Taxonomy of the Patient Voice Table

Taxonomy of the Patient Voice

While health care pursues the important trend of putting patients at the center of care, the terms used to describe this goal are proliferating — and muddying the discourse. This taxonomy attempts to classify some of these terms and make some distinctions.

Agarwal01_pullquote handcrafting the patient experience

Handcrafting the Patient Experience

Health care organizations can take cues from consumer-facing companies like Airbnb to creatively insert convenience and surprise into patient encounters.

Screenshot of Tidepool daily diabetes data

A Taxonomy to Engage Patients: Objectives, Design, and Patient Activation

Health information initiatives will succeed only if they focus on patients’ motivation to engage and reflect the type of engagement they seek.

Ghafur01_pullquote -digital health health care consumer patient experience

Engaging Patients Using Digital Technology — Learning from Other Industries

Providers can benefit patients and disrupt health care by learning from the experience of other industries.

Mission Hospital Virtual Sitter - Drawing of the Virtual Bed Zone and Rails

Reducing Inpatient Falls and Injury Rates by Integrating New Technology with Workflow Redesign

How Mission Hospital scaled a virtual sitter pilot and reduced unassisted falls by 44% and fall-related injuries by 40%.

Health Care Providers Should Incentivize Patients

Survey Snapshot: Patient Financial Incentives — There Are No Quick Fixes

The NEJM Catalyst Insights Council agrees that while financial incentives are a common strategy to engage patients in healthy behaviors, they are not necessarily effective.

Support of Family and Friends Is More Effective Than Clinician Support in Realizing Health Goals - From the Patient Engagement Insights Report: Why No Single Health Incentive Works.

Patient Engagement Survey: Why No Single Health Incentive Works

Initiatives to improve patient engagement come in a variety of forms. While insurers, employers, and health care providers are all involved in using financial incentives and penalties for engagement efforts, improvement in health outcomes has been elusive. Achieving that ultimate goal will usually require a combination of financial and social approaches.

Health Systems Attending the Nudge Units in Health Care Symposium - Penn Medicine

Key Insights on Launching a Nudge Unit within a Health Care System

Leaders are finding that making higher-value choices easier through subtle changes to choice architecture can have an outsized impact on medical decision-making.

Barriers to Providing an Oustanding Patient Experience

Buzz Survey Report: Patient Experience

An independent NEJM Catalyst report sponsored by University of Utah Health on barriers to achieving an excellent patient experience.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Patient-Centered Care

282 Articles

Assessing and Addressing Social Needs in…

Lincoln Community Health Center improved care quality by measuring and responding to upstream social and…

Information Asymmetry: The Untapped Value of…

The knowledge and preferences that patients could — and should — share with clinicians would…

Proactively Catching the Declining Patient

A coordinated effort by UCLA leaders to identify a high-cost population with chronic kidney disease…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now