Wednesday, October 16, 2013

Patient Engagement through Involvement: Patient-Centric Design


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Patient engagement is a buzzword that has been coming up everywhere recently. 

The Center for Advancing Health recently published A New Definition of Patient Engagement defining engagement as "actions individuals must take to obtain the greatest benefit from the health care services available to them." They go on to clarify that "engagement is not synonymous with compliance. Compliance means an individual obeys a directive from a health care provider. Engagement signifies that a person is involved in a process through which he harmonizes robust information and professional advice with his own needs, preferences and abilities in order to..."

Have I lost you yet? 

Where in that lengthy definition does the patient play a role? How do I harmonize robust information when I am too weak to eat, much less weigh professional advice with my own need,s preferences and abilities? 

Leslie Kernisan, MD, MPH offers her current take on this "hot buzzword" by providing an example: "supporting patient engagement means fostering a fruitful collaboration in which patients and clinicians work together to help the patient progress towards mutually agreed-upon health goals." 

This definition is (more) succinct, and indeed involves the patient. But what happens when you have multiple patients, each one coming in with distinct, personalized health goals. In consulting, we learned to value and feel comfortable with the 80/20 principle. But when it comes to something as complex as human health, can you ever satisfy 80% of your (patient) audience? And how do we even define the word "satisfy"?

The argument is endless.

However, one key factor we've missed in our attempts to define the "patient engagement beast" is the very reason a definition is so hard to pin point: the mercurial nature of human motivation. 

Molly Mettler is a Senior VP for Healthwise, a not-for-profit consumer health information company in Boise, Idaho
As Molly Mettler, Senior VP for Healthwise, points out in a 2011 CFAH interview, patients engage with their health, most significantly, when they are forced to. She points out three critical times in a woman's life that a female patient is most likely to become engaged, when:

- having a baby
- at the time of a critical diagnosis of serious illness, and 
- end of life planning, if she is not actively denying this is needed

Mettler puts it simply when she says, "these are points in the life journey where health comes to the forefront and people are ready, even eager, to be engaged."

Now let's examine that statement once again:"...even eager to be engaged..." isn't that the original goal? To get patients eager to be engaged - with their diet, their exercise, their mental well-being, their medical records, even healthcare bills? 

How do we encourage patients to get involved preemptively - before the baby, before the heart attack, or cancer diagnosis, or other serious illness. Before... the end?

Each stakeholder along the healthcare value chain - from patient, to provider, to payer, to pharmaceutical company to our government - is responsible for involving other key stakeholders as each designs their own patient product. 

As a small startup with large ambitions to eliminate unnecessary costs and fix medical imaging, we are attempting to involve patients through educational workshops at patient support groups, interviews with patients and thorough user testing as we continue to mold and design our patient product. 

There's always going to be more work to do. And, until our broken healthcare system is fixed from the top down, small businesses like us are going to have to do our part to heal from the bottom up, involving patients each and every step of the way. 

Are you a patient in the LA area interested in getting involved with design of our patient product? Reach out to mika@nephosity.com. 

Are you another small business? A physician passionate about patient engagement? How are you involving patients in patient product design? Please leave questions and comments below. 


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