Learning From PatientsEngaging Patients in Primary Care

Tanya Lord, PhD

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Learning Objectives

By the end of this module you will be able to: Demonstrate the difference between

engaging patients in their own healthcare and practice improvement

Describe three ways that engaging patients can be valuable to your practice (own healthcare and practice improvement)

Understand/use patient engagement methods

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“Nothing about me without me.”

"Nothing about me without me" was the concept of a five-dayglobal seminar held in 1998 to develop ideas for

improving the quality of healthcare by involving patients.

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Patient Engagement

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Stages of Patient Engagement

Clinical Relationship Practice Improvement

INFORM Give information Give information

INVOLVE Use patient preferences to inform patient care

Ask for opinionsfrom patients

PARTNER Making treatment decisions with patient

Design, implement and evaluate improvements with direct patient input from the beginning

Engaging PatientsClinical Relationship

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Clinical Relationship:Why Engage Patients?

Patients are becoming more informed!

Improves communication Improves diagnosis Improves family history Provides better understanding

Barriers to care Adherence to treatment and medical advice

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Clinical Relationship:How to Engage Patients?

Inform Provide information on diagnosis and treatment plan Provide health education

Involve Ask patient’s opinion Discuss options based on patient’s

Priorities, preferences, perspectives Use patient portals or other IT methods to connect

Partner Share understanding of expectations Solve problems and set goals jointly Share decision making

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Shared Decision Making:Partnering with Patients

Providers and patients exchange important information

Providers help patients understand medical evidence about the decision they are facing

Patients help providers understand their needs, values, and preferences concerning these decisions

After time to reflect, patients and providers decide together on a care plan consistent with medical science and personalized to the patient

Reference: Gafni 1997.

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Clinical Relationship: Involve

AGENDASETTING

FORM

Clinical Relationship: Involve

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WHATELSE???

Clinical Relationship: Partner

Behavior Changes“Do you mind if I give you

some advice about that?”

Treatment Changes

“Do you mind if I give you some recommendations regarding your treatment”

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Engaging Patients Practice Improvement

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Practice Improvement: Why Engage Patients/Families?

Provide unique insights and perspectives on practice policies and procedures

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Practice Improvement: Why Engage Patients/Families?

Provide unique insights and perspectives on practice policies and procedures

Provide innovative ideas for improvement

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Practice Improvement: Why Engage Patients/Families?

Provide unique insights and perspectives on practice policies and procedures

Provide innovative ideas for improvement Maintain a tireless passion and interest

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Practice Improvement: How to Engage Patients/Families?

Inform Tell patient improvements being made on their behalf

Involve Solicit patient input (suggestion box) Choose initiatives based on patient input Ask patients after an improvement initiative

Did things improve? What worked? What didn’t? Partner

Include patient at the beginning of initiatives Create patient advisory council

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Effective Engagement

Basic Principles: Designate a staff member or key contact for

working patients

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Effective Engagement

Basic Principles: Designate a staff member or key contact for

working patients Provide opportunities where patients can make

a real difference

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Effective Engagement

Basic Principles: Designate a staff member or key contact for

working patients Provide opportunities where patients can make

a real difference Clearly define expectations, including timelines,

deadlines, and responsibilities for both patients and staff

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Ready to Partner with Patients?

Can you answer ‘yes’ to these questions?I believe that patient opinion and input are valuable

to this practiceI believe that patients and family members bring a perspective to a project that no one else can provideWe are able and willing to make time to engage patients We have patients who have expressed opinions, just not in a formal methodI am willing to create a culture where patients feel comfortable to speak freely

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PROMISES: Patient Engagement Informing Patients

Patients are educated about what to ask at the pharmacy

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PROMISES: Patient Engagement Involve Patients

Patient surveysSuggestion boxes

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PROMISES: Patient Engagement Partnering with Patients

Including a patient in planning how to improve rates of colonoscopy

Offered insight

about trust and

relationship with

clinicians

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Other Ideas—Invite Patients:

To attend evening meetings to discuss improvement planning (1/month, 1/quarter)

To speak at a staff meeting To attend your improvement discussions

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Recruit Patients That:

Have patient experience in your organization

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Recruit Patients That:

Have patient experience in your organization Have concern for more than one issue

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Recruit Patients That:

Have patient experience in your organization Have concern for more than one issue Can express their experiences constructively

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Recruit Patients That:

Have patient experience in your organization Have concern for more than one issue Can express their experiences constructively Are representative of your patient population

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Ready to Partner with Patients?

Can you answer ‘yes’ to these questions?I believe that patient opinion and input are valuable

to this practiceI believe that patients and family members bring a perspective to a project that no one else can provideWe are able and willing to make time to engage patients We have patients who have expressed opinions, just not in a formal methodI am willing to create a culture where patients feel comfortable to speak freely

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Getting Ready!

Ask: What internal changes are needed to become open to having patient input?

Discuss barriers to partnering with patients Evaluate staff readiness Brainstorm how patients could be valuable

to the practice PDSA: Start small and test each idea

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Stages of Patient Engagement

Clinical Relationship Practice Improvement

INFORM Give information Give information

INVOLVE Use patient preferences to inform patient care

Ask for opinionsfrom patients

PARTNER Making treatment decisions with patient

Design, implement and evaluate improvements with direct patient input from the beginning

“The greatest asset wehave underutilized is all

the assets of the patient.”

Maureen BisognanoPresident and CEO

Institute for Healthcare Improvement

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Our Greatest Asset

Thank You!

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Thank you

for your time

and attention today

A Few References Charles C, Gafni A,Whelan T. Shared decision-making in the

medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44(5):681–92.

Salzburg statement on shared decision making. BMJ 2011;342:d174.5

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