My neurologist brain is having a hard time. My brain — and yours — likes order. Yet trying to make sense of the rampant use of health care buzzwords like engagement, experience, consumerism, activation, etc., is causing major brain freeze.
The field of patient experience has exploded. At the same time, as population health efforts multiply, efforts to engage patients in their own health have become very popular. Yet these two concepts seem disconnected. Health care professionals talk about engagement in health, but not always the experience of it. We talk about the experience of our patients, but not always their engagement. So . . . what are we really talking about? Do we even know?
To further thicken the plot, technology vendors have leapt into the engagement space and are designing many intelligent, empathic solutions to drive engagement and experience. Yet, in a recent conversation with the CEO of an engagement technology company, I asked how he measures patient engagement. His response: “number of downloads or clicks.” I felt pretty sure that the academic community would find that inadequate. Download frequency may be a helpful metric for engaging people in technology, but not necessarily their health.
Here is my (left) brain’s attempt to differentiate engagement and experience, based on my roles as a practicing neurologist and Chief Experience Officer of the Cleveland Clinic.
Clearly, there are significant differences between the two concepts. Yet the comparison raises important, head-scratching questions for clinicians and patients alike:
- Who is at the end of what we are talking about? Focusing only on patients is limiting. It seems people engagement might be more fitting, as it is rare that the patient is navigating his or her health alone — clinicians, communities, and the patient’s friends and family likely also have a significant role in patient care.
- Is the patient an active or passive participant? As a colleague of mine has pointed out, an engaged patient interacts with their health or the delivery of care, but a patient experience can be passive. In that way, experience is something that happens to On a roller coaster, for example, patients can get on the ride, close their eyes, and wait for it to be over; or they can scream and throw their hands in the air and have fun. Both takes are valid.
- What’s the context? Engagement means to interact with something, so what and who is the patient interacting with? The options include his or her own health, a clinician, the health care system, a community, and/or technology. This context matters and defines the measurement.
- What is the locus of control, and who decides what the engagement looks like? If health care systems are held accountable for managing populations and will be reimbursed based on whether patients are engaged or not, then what happens to patient choice? Alternately, if a patient doesn’t want to engage, will we respect this or enforce our engagement strategy regardless? I often use the example of a young mom with multiple sclerosis who works full time. She doesn’t want to be reminded she has MS and actively minimizes her touchpoints. That doesn’t mean she is “noncompliant” or disengaged — it means she has choice.
- What’s the ideal state of engagement? If a clinician has highly engaged patients who order their own tests, schedule appointments online, and get all preventative care, but the care team is completely burned out, the power of relationship-centered care is absent.
For patients to be truly engaged in their health, they must demonstrate certain behaviors that reflect their engagement. The best statement I have seen builds on a behavior engagement framework put forth in 1996 by the Center for Advancing Health, based on the work of J.H. Hibbard and others on patient activation. It defines engagement as “actions individuals must take to obtain the greatest benefit from the health care services available to them.” In other words, a patient must engage with the resources available in order to maximize his or her own health. I like it.
In the end, patient engagement and patient experience both have this funny word in front of them: patient. Ultimately, patients must play a significant role in these definitions.