Patient Engagement

Survey Snapshot: Who’s in Charge of Patient Engagement?

Insights Report · September 15, 2016

We talked to executives, clinical leaders, and clinician members of the NEJM Catalyst Insights Council for a closer look at who should lead patient engagement efforts and the expected impact on quality and cost.

 

Who should head up patient engagement initiatives?

At Avera McKennan Hospital and University Health Center, a 450-bed tertiary care facility based in Sioux Falls, South Dakota, the Chief Medical Officer and Chief Nursing Officer have been jointly tapped to lead patient engagement.

Top Positions Leading Patient Engagement

Patient Engagement Insights Report. Click To Enlarge.

Avera McKennan’s tasking of the CMO matches 38% of respondents to the NEJM Catalyst report Patient Engagement Survey: Far to Go to Meaningful Participation. Slightly less than a fifth (19%) of respondents said CNOs should head up the charge.

“Both have time devoted as part of their jobs to lead such ventures,” says Nate Miller, MD, an internist and hospitalist at the medical center who is also Chief of the Hospitalist Division at the University of South Dakota Sanford School of Medicine. The CMO and CNO are aided by the Avera McKennan health system, he says, which has a multidisciplinary team devoted to increasing patient engagement.

Staff physicians ranked second in the survey, with 35% of respondents saying they should head patient engagement efforts. At Avera McKennan, staff physicians focus more on day-to-day care but will get pulled in for input on patient engagement at appropriate times. Hospital leadership “will need to involve physician leaders and other groups to help develop ideas,” he says.

Allison Suttle, MD, Senior Vice President and CMO at Sanford Health, an integrated health system headquartered in North Dakota and South Dakota with 43 hospitals and nearly 250 clinics in nine states and three countries, agrees that the CMO “plays a major role in getting better outcomes,” but thinks positions such as Chief Quality Officer and Chief Medical Information Officer also have important contributions to patient engagement.

“I don’t know that there is one person who is fully in charge of patient engagement — it has to be everyone’s priority,” she says. For instance, the CMIO, which some respondents included as an “other” in the NEJM Catalyst survey, can lead patient portal and data collection projects.

Engaging Patients Through Technology

Suttle says buy-in from staff physicians is essential because “patients aren’t going to get engaged unless the physicians want them to.” For example, physicians have to buy into utilization of mobile devices, portals, and other technologies as a way to change patient engagement in their practice, she says.

“The patients that move to digital love it,” she says, adding that Sanford Health has improved patient engagement by offering video visits that allow patients to Skype with a physician, and e-visits that use patient-submitted questionnaires about their health issues to help clinicians diagnose them online.

Sanford has nearly 400,000 patients active on its portal. “We are making sure there is value to the patient so they have a reason to use the portal,” she says.

Patient portals were the top patient engagement initiative in the NEJM Catalyst survey; 88% of respondents said their organizations are currently using or plan to implement portals, and 38% said portals are the most effective tool for increasing patients’ meaningful participation in care.

Most Effective Patient Engagement Initiatives at Increasing Patients' Meaningful Participation in Care

Patient Engagement Insights Report. Click To Enlarge.

The Importance of Clinicians

Eric Fleegler, MD, MPH, FAAP, a pediatric emergency physician in the Division of Emergency Medicine at Boston Children’s Hospital, a 404-bed comprehensive center for pediatric health care, says that no matter if you pursue a top-down approach with the CMO or a bottom-up approach with staff physicians and staff nurses, “the individual provider will make or break patient engagement.”

Patient engagement “has to come in a process that is collaborative,” says Fleegler, who is also an Assistant Professor in Pediatrics and Emergency Medicine at Harvard Medical School. “It cannot come as a mandate from above, but rather providers must develop an understanding of what ‘patient engagement’ means in their clinical environment and develop a plan to make their interactions more meaningful and guided by the patient.”

Fleegler is eager for patient engagement to continue to develop in his department so that he can have better feedback about his quality of care. “In emergency medicine, we engage with patients while in the ED, yet we have minimal feedback after the patient leaves. We don’t know how good our laceration care turned out or whether the prescribed medications worked. The only time we know is if the patient bounces back to the ER within 72 hours,” he says. “Patient engagement needs to move beyond the exclusive realm of the clinical encounter.”

The Cost of Patient Engagement

While Fleegler is confident that better patient engagement will lead to better care, like many respondents to the survey, he is not sure there will be a positive impact on the cost of care. In the NEJM Catalyst survey, cost fell considerably below quality in respondents’ ratings of the impact of patient engagement initiatives.

Impact of Patient Engagement Initiatives on Quality and Cost Outcomes

Patient Engagement Insights Report. Click To Enlarge.

“Much of patient engagement can improve quality of care, perception of quality of care, and . . . health outcomes, but that’s not necessarily going to be fully reflected in cost,” Fleegler says. “Eventually, if patients become more engaged and we do improve their health, we will hopefully see costs decrease.”

Quality and cost must go hand-in-hand, Suttle says: “I don’t think you should ever look at quality without cost.” She says organizations must address quality first and have a target that they expect. But as quality improves, she believes the “natural byproduct” will be lower costs.

Miller also thinks that health care organizations should expect a positive impact on costs. For example, through better patient engagement, physicians can sometimes dissuade families from ordering expensive tests such as CT scans or MRIs when they are unnecessary.

“The focus should be on quality, but the end result will be improved quality with decreased costs,” he says.

Call for submissions:

Now inviting expert articles, longform articles, and case studies for peer review

Connect

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

Learn More »

More From Patient Engagement
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.

The Patient Engagement Capacity Framework

The Patient Engagement Capacity Model: What Factors Determine a Patient’s Ability to Engage?

Patient engagement assessments often don’t dig deep enough to identify why patients don’t participate in their own health care. We present a new model to help providers pinpoint the reasons for lack of engagement and address them more effectively.

Organizational Mindset Is the Biggest Barrier to Engaging Patients as Consumers

Survey Snapshot: The Patient-Physician Relationship Is Key

Both parties involved in a consumer-facing transaction have access to important information about the product or service — but this isn’t the case with health care.

What High-Need, High-Cost Patients Say About How to Reduce High Utilization of ED and Inpatient Services

High-Need, High-Cost Patients Offer Solutions for Improving Their Care and Reducing Costs

More home health care and after-hours clinics, telemedicine, and home delivery of medications are among top solutions.

Top Physician Pain Points Identified by Chronic Patients

Unmet Needs: Hearing the Challenges of Chronic Patients with Artificial Intelligence

With natural language processing and machine learning, researchers are identifying patient emotional and medical needs that are not being met by clinicians and patient advocacy groups.

Connect

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

Learn More »

Topics

Angel Robot and a New Smart…

The Jingde Experiment’s Angel Robot illustrates how continuous, closed-loop learning symbiosis between doctor, AI, and…

Creating “One-Stop Shop” Care for Parkinson’s

Integrated Practice Units (IPUs) can revolutionize the care of specialty disease conditions, and Parkinson’s disease…

Patient-Centered Care

269 Articles

No Place Like Home: Bringing Inpatient…

Providing home-based acute care improves patient satisfaction and care quality while reducing costs.

Insights Council

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

Apply Now