Abstract – Objective: Patient engagement has been credited with contributing to improved outcomes and experiences of care. Patient engagement has become a widely used term, but remains a poorly understood concept in healthcare. Citations for the term have increased throughout the healthcare-related disciplines without a common definition.
This study seeks to define the concept by identifying its attributes in the context of its use. Methods: A concept analysis of the scientific literature in the health disciplines was performed using the Rogers method. Results: The analysis revealed four defining attributes of patient engagement: personalization, access, commitment and therapeutic alliance.
Patient engagement is defined as the desire and capability to actively choose to participate in care in a way uniquely appropriate to the individual, in cooperation with a healthcare provider or institution, for the purposes of maximizing outcomes or improving experiences of care.
- Conclusion: Patient engagement is both process and behavior and is shaped by the relationship between the patient and provider and the environment in which healthcare delivery takes place.
- Practice implications: The definition and the identified attributes serve as a heuristic in designing patient engagement strategies and as a basis for future development of the patient engagement concept in healthcare.
Keywords: Concept analysis; Health information technology; Patient engagement. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
What is the role of patient engagement?
3.3. Implementing patient engagement for decision-making – While some medical decisions are straightforward with one clear “right” choice, most decisions have multiple options each with a different set of advantages and disadvantages for patients and clinicians to consider.
For some decisions, it is important to incorporate clinical information such as individual patient risks, the specifics of the condition, comorbidities, and potential prognoses. While this may be done by clinicians without much patient engagement, often patients may be the only source that knows, or has at least experienced all their medical history.
Patient engagement is critical to ensure that all the medical information is being incorporated into these decisions. For other decisions, it may be more important to include patient’s values, preferences, likelihood for adherence, and life circumstances.
This scenario clearly involves patient engagement as only patients know this information. Effective discussions include both clinicians sharing clinical information about the options and patients sharing information about themselves. Common examples of medical decisions include whether and how to make a health behavior changes, when to start and how to get preventive screening, management for acute or chronic conditions, how to prioritize competing health needs, and even when to change or stop a treatment.
Some decisions are routine and occur frequently in practice such as when to start screening for breast cancer or how to be tested for colorectal cancer, In one US primary care setting, nearly one in five patients seen for an office visit faced a routine decision about preventive care,
Other more major decisions, such as how to treat localized breast cancer or manage an abdominal aortic aneurysm, may only occur once in a patient’s lifetime. Traditionally, clinicians engage patients in decision-making during in-person visits. This may work well for major decisions, which occur infrequently, have obvious consequences, and may be amenable to clinicians and patients meeting on several occasions to make the decision.
More routine decisions that are part of an office visit during which multiple issues are discussed are often overlooked by patients and clinicians. When asked, more than two thirds of patients report that they would like to share decisions with their clinician – routine and major.
Sadly, this happens less than half the time ; conversations between clinicians and patients rarely include all elements of a good decision ; and while patients consider themselves knowledgeable about decisions, patients frequently have a poor understanding of the medical facts and often over-estimate the value of medical care,
One solution is to use decision aids and supports to help patients make medical decisions. These tools can ensure patients receive information in a standardized format that includes all critical content, presents information in a culturally appropriate manner, and uses language and images to ensure understanding across a range of health literacy needs.
- Decision aids are not routinely used in clinical care,
- Ey barriers include time, expense, perceived legitimacy, capacity, ability to integrate into workflow, lack of clinician training and comfort with decision aids, and an environment that has not made routine use a cultural norm,
- Despite these barriers many good decision aids have been developed.
A host of organizations have cataloged and made available a range of high quality decision aids tailored to a range of literacy levels and cultural norms as well as trainings and resources to help clinicians better implement shared decision-making (see Table 1 ).
What factors influence patient engagement?
Conclusion – Patient engagement behavior has been shown to be influenced by both external (opportunity) and intrapersonal variables (capability and motivation). Those prescribing exercises within a rehabilitation program need to discuss these factors with their patients and co-design the exercise rehabilitation program in partnership with the patient, since this is likely to improve patient engagement, and thereby result in superior health outcomes.
What are the 5 P’s of patient care?
One day during a leadership round at Harris Health System’s Lyndon B. Johnson Hospital in Houston, Texas; I visited with a patient and asked if her nurse or patient care assistant was visiting her every hour. The patient seemed a bit confused with the question.
She then responded, “Well if you mean is someone checking on me, I guess so.” The patient explained that during a visit with her pastor, “Someone popped their head in and asked me, ‘Baby are you ok?’ and then walked out.” The patient’s pastor asked her if she knew the individual who had just appeared.
When the patient said, “no,” the pastor became concerned for the patient’s safety. An Aha Moment When this story was shared with nursing leadership it was apparent that our nursing hourly rounding needed improvement. This began our journey to master purposeful hourly rounding (PHR) on all units.
- We began with a pilot program on a medical surgical unit.
- The patient satisfaction project manager collaborated with nursing leadership to create a purposeful rounding program that would help improve efficiency, decrease nurse fatigue, and also improve the patient experience.
- Since the introduction of the PHR program in the summer of 2018, our nursing units have seen an increase in their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measure of “Responsiveness of Hospital Staff.” In fact, there has been a significant decrease in patients using the call light system and now a typical comment from patients is, “I never have to use the call light because someone is always checking on me!” An Evidence-Based Approach Nurses always want to meet the demands of their patients and deliver high quality exceptional care.
However, their list of required daily tasks can present a real challenge. In 2012, a study conducted by Stimpfel, Sloane, and Aiken associated a correlation to nurses who work shifts of 10 hours or more with a higher level of burnout and patient dissatisfaction.
The impact of those long work hours can result in increased fatigue and a focused effort should be spent on strategies to maximize efficient use of time by providing clustered care and purposeful rounding (Kelley, 2017). Our Recipe for Successful Purposeful Hourly Rounding: The Six P’s During hourly rounds with patients, our nursing and support staff ask about the standard 5 Ps: potty, pain, position, possessions and peaceful environment.
When our team members ask about these five areas, it gives them the opportunity to proactively address the most common patient needs. A sixth P was recently added as a reminder to look around and “pick up” any trash near the patient’s bed or bedside tray.
We found that the six Ps have been influential in helping us improve the HCAHPS dimension scores for Quietness and Cleanliness. Practice of Presence The unstated, but most powerful, “P” used by the nursing staff is presence. Before our nurses enter a room, they are told to to pause to take a minute to clear their mind and focus their attention solely on the patient.
This allows them to use their time with their patients more effectively and the patients receive full attention. The art of presence enhances the nurse-patient interaction and draws on a model of true patient-centered caring (Sutterfield & Stern, 2002).
A Continuous Effort Our nursing team rounds on patients every hour during the day and every two hours at night. The Responder 5 Nurse Call system is used and features a green, yellow, or red light in the hallway outside a patient’s room. The green light defines an hourly round has been completed within the hour, yellow identifies the round occurred within the last 45 minutes, and a red light appears if the patient has not been rounded on in over an hour.
With an update to the call system and a change in the rounding process this has been influential in helping to ensure rounding is effective. In addition, the health unit coordinator on each unit is also a partner in this and makes an announcement at the top of each hour as a reminder for nurses to complete their hourly rounds.
Benefits In the short time since the implementation of purposeful hourly rounding, we have seen improvement in the majority of the HCAHPS dimensions scores. Many of the patient care units have met or exceeded the goal—and most importantly, they sustained it. Percentile rankings have also increased. In fact, some units have reached the 82nd percentile, while others have reached up to the 99th percentile.
Alicia Hernandez, administrative director of nursing, Acute Care, states, “Our purposeful hourly rounding program combines great communication skills with a few simple, but very impactful actions that greatly improve the patient experience.” 1. Kelley, C.
(2017). Time management strategies: purposeful rounding and clustering care. MedSurg Nursing, 26(1).2. Stimpfel, A., Sloane, D., Aiken, L., & Stimpfel, A. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs (Project Hope), 31(11), 2501–2509.
https://doi.org/10.1377/hlthaff.2011.1377 3. Sutterfield, R., & Stern, L. (2002). Nursing Presence. The American Journal of Nursing, 102(12), 13–13. Brian Bustoz, serves as the project manager of patient satisfaction at Harris Health System’s LBJ Hospital. In this role, he works as a patient experience consultant and strategic partner to executive, nursing, operational, and physician leadership teams. Alicia Hernandez, MSN, RN, serves as the administrative director of nursing, acute care services at Harris Health System’s LBJ Hospital. She has more than 20 years of nursing experience in operations, education, and nursing administration. She has also previously served in a role as a nurse consultant for international countries focusing on improving healthcare globally.
What are the five phases of the patient engagement framework?
5 Steps to Patient Engagement, a NeHC Framework is Created The National eHealth Collaborative (NeHC) has released the patient engagement framework, a five-step model that will attempt to help providers, payers, and other healthcare entities on the path to engaging patients.
- A few of the stakeholders who helped develop this newly created framework recently discussed the tool on a NeHC-sponsored webinar.
- Jeff Donnell, president of NoMoreClipboard, a personal health record (PHR) vendor, said the framework was created to bring a natural road map to an area that has become like “the wild west.” Donnell mentioned how payers, providers, and other healthcare organizations interested in patient engagement want to go from a “crawl to a sprint” rather than a natural progression.
This framework, he said, “will bring law and order to a chaotic space.” “The framework represents a journey,” Donnell said. The five steps or phases to engagement that make up the framework include “inform me,” “engage me,” “empower me,” “partner with me,” and “support my e-community.” According to Leslie Kelly Hall, NeHC board member and one of the leaders of the framework’s development committee, and senior vice president of policy for Healthwise, the steps were created in a way that allows for a natural progression of engagement for providers.
- The first step, “inform me,” Hall said, is about attracting new patients with various electronic patient education information sources.
- It leads into the next step, “engage me,” which is about attracting those patients and then retaining them.
- This means providing them with patient specific education and access to their records through such devices as the Blue Button (made famous by the Department of Veterans Affairs).
According to Hall, the third step, “empower me,” is about retaining those patients and then partnering with them to create efficiencies. She says that this step represents the “shifting of power” from the provider to the patient. This includes allowing patients to view, download, and transmit (VDT) their record in an interoperable environment.
She used examples from Beth Israel Deaconess Medical Center (BIDMC) and Iora Health. The fourth step is the natural progression from a patient perspective, Hall said. It involves creating synergies with interoperable records in multiple care environments. The last step, “support my e-community,” is essentially the final step in the map, an environment where “the patient defines their community,” he said.
Thanks to health IT, through interoperable health records, a patient can interact and engage with their healthcare in multiple environments in multiple ways. The full patient engagement framework is available here:, What’s important for providers, payers, vendors, and anyone else involved with the business of patient engagement is that the framework “won’t stifle innovation,” Donnell said.
- Rather, it gives these stakeholders a constructed set of guidelines and a common language to work off, he added.
- Donnell gave a few examples of products and pilots where patients have successfully been engaged.
- In one example, researchers at the Howard University Diabetes Center were able to lower blood glucose levels (and consequently ER visits and readmission rates) in diabetes patients through a mobile PHR.
In an effort to curb the fears of many providers, he said there have been examples where older patients have used PHRs just as much as teenagers and young people. Eva Powell, director of health information technology programs at the National Partnership for Women and Families, said the framework shows how patient engagement “goes beyond that initial step.” She stressed the importance of engagement in multiple levels such as care, redesign, governance, and in communities.
What is the meaning of patient engagement?
‘Patient engagement’ is a broader concept that combines patient activation with interventions designed to increase activation and promote positive patient behavior, such as obtaining preventive care or exercising regularly.
What is the difference between patient involvement and engagement?
What is Patient and Public Involvement and Public Engagement? — NIHR School for Primary Care Research Patient and public involvement entails research being carried out ‘with’ or ‘by’ members of the public, rather than ‘to’, ‘about’ or ‘for’ them. The word public can refer to patients, potential patients, carers and people who use health and social care services, people from organisations that represent people who use services as well as members of the public.
- Patient and public involvement is often abbreviated to PPI.
- Public engagement encompasses the various ways in which the activity and benefits of higher education and research can be shared with the public in a two-way process.
- Engagement encourages researchers to listen and interact with the general public.
Whereas patient and public involvement focuses on a specific research project, programme or process, engagement can connect with the public discussing science on a more general level or addressing topics like research ethics. Public engagement can also include opportunities for researchers to discuss their preliminary ideas for future studies or get people involved as contributors and conducting part of a research project as citizen scientists.
The following academic journals are dedicated to publishing examples and commentary on patient and public involvement and engagement: •
• : What is Patient and Public Involvement and Public Engagement? — NIHR School for Primary Care Research
What are the categories of patient engagement?
Factors Influencing Engagement – Patient engagement is influenced by three categories of factors: the patient, the health care organization, and society. The degree of patient engagement can vary depending on a patient’s beliefs about their role, health literacy, and education level.
How do you evaluate patient engagement?
Consumer Assessment of Healthcare Processes (CAHPS) – The Consumer Assessment of Healthcare Processes is another tool that can be used to measure patient engagement in value-based care. This is the most widely used survey in assessing a patient’s experience throughout the United States and has been used since 1995.
- This survey differs from patient satisfaction surveys because it focuses on the patient’s experiences as a whole and produces objective and actionable information for practitioners.
- These surveys measure and assess communication between the patient and the provider, the patient’s knowledge and their overall satisfaction with the hospital/clinic environment.
These surveys are conducted after the patient has already left the providing facility so there is no real-time course correction if patients are unsatisfied but the collected data can still be useful for healthcare providers. Patient engagement has become one of the essential pillars of value-based healthcare and health care providers must assess and understand the degree to which their patients are engaged.
It is vital to their healing process and beneficial for therapists and doctors because their patient’s recovery time is shortened. Patient engagement is directly correlated with faster recovery. It can also help clinics save money and promote a loyal relationship between patient and provider. AC-Health makes patient engagement easy and provides valuable insight for providers.
Some of the other benefits to healthcare providers for measuring patient engagement are making better staffing decisions, providing patients a resource outside of the clinic setting, making improvement efforts where they are needed, and even potentially reducing malpractice suits.
If you are interested in testing out the benefits of a patient engagement platform for your clinic and seeing the results for yourself then please contact AC-Health With the latest in intuitive mobile interface, AC Health assists providers in making sure their patients are adhering to their medical instructions and receiving the best care possible.
It will also help to measure patient engagement and provide key data to practitioners. AC Health is the only HIPAA-compliant provider-to-patient platform designed specifically for creating and scaling custom content – from simple text to videos and photos – to support patients between sessions while saving providers 10-20+ hours every week.
- With an NPS of 91 from thrilled patients, it’s no wonder that providers uploaded 20,000 instructions in the first year alone.
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What are the 6 C’s patient Centred care?
What nouns beginning with C do you think might be essentially important in delivery of health and social care? So, the 6Cs are care, compassion, competence, communication, courage and commitment.
What are the 4 habits of patient centered care?
The Four Habits are: Invest in the Beginning, Elicit the Patient’s Perspective, Demonstrate Empathy, and Invest in the End.
What do the 4 P’s stand for healthcare?
Abstract – So-called “P4 Medicine” (predictive, preventive, personalized, participative) represents the cornerstones of a model of clinical medicine, which offers concrete opportunities to modify the healthcare paradigm: the individual‘s participation becomes the key to put into practice the other three aspects of P4 with each patient.
What is the 5p model in nursing?
Findings The results suggest a novel framework for the patient experience including five critical dimensions as follows: provider, physician, patient, personnel and periphery.
What are the 4 measures of health status?
Measures of Health Status – The health status of a population can be measured by a wide range of factors: birth and death rates, life expectancy, quality of life, morbidity from specific diseases and conditions, environmental risk factors, use of ambulatory care and inpatient care, financial and geographical accessibility of health personnel and facilities, health insurance coverage, and many other factors.4 While no single set of measures can completely characterize the health of a large and diverse population, the Centers for Disease Control and Prevention (CDC) and other health agencies worldwide consistently have viewed life expectancy and mortality data as indicators of overall population health because they represent the cumulative effects of social and physical environmental factors, behavioral and genetic risk factors, and the level and quality of health care.
Indicates the current health status of a population. Reflects the overall state of maternal health, as well as the quality and accessibility of primary health care available to pregnant women and infants.