Patient Engagement and Nursing

By Rose O. Sherman, EdD, RN, FAAN

It has been described as the blockbuster drug of the 21st because of the potential it has to improve patient outcomes, reduce healthcare costs and make care environments safer. Yet, this blockbuster drug will not come from the pharmaceutical industry. Instead, it will be happen as a result of changes in the healthcare culture. The potential blockbuster drug is patient engagement. And while it may seem obvious that patient engagement should always be a part of healthcare delivery – historically, this has not always happened and has sometimes been actively discouraged. All of that is changing with the implementation of the Affordable Care Act. Patient engagement is now the new imperative and the failure to achieve it will result in lower rates of reimbursement.

Patient Engagement = Better Outcomes

Research compiled by organizations such as the Agency for Healthcare Research and Quality (AHRQ) indicates that when patients are engaged in their care, it can lead to measurable improvements in safety and quality. To promote stronger patient engagement, AHRQ has developed A Guide to Patient and Family Engagement in Hospital Quality and Safety. This guide is an evidence-based resource that can help nurses to work as partners with patients and families.

Patient Engagement = Higher Rates of Reimbursement

Reimbursement for health care is rapidly shifting from a system based on the volume of care delivered to one based on value. Current and future reimbursement is impacted by factors such as the patient’s perceptions of their experiences and the willingness of patients to access their electronic health records. The quality and safety of care given will also drive reimbursement. To reduce costs in the health care system, we will need to improve the actions that patients take for their own health by encouraging active participation in health care decision making. Stage Two of the Electronic Health Record Meaningful Use legislation includes requirements that for full reimbursement, providers must offer patients online access to their records AND be able to demonstrate that a certain percentage actually logs in.

Shifting the Culture

Full engagement of patients in their care will mean a change in culture for both patients and healthcare professionals including nurses. Dave deBronkart “e-Patient Dave”, is a well known writer on this topic. He has observed that “our culture assumes that doctors know everything and patients can’t add anything useful”. This needs to change and he offers some practical tips for nurses:

Stop referring to patients in the third person as if they are not in the room.
Let patients and families fill in the blanks on things that might be missing from their records.
Recognize that googling about one’s diagnoses is a sign of patient engagement.
Adopt the belief that patients will perform better in managing their care if they are better informed.
Understand that information alone is not enough – make it easier for patients to do the right thing by designing easy interventions and reminders.
Work to clarify and simplify your messages when giving patients information.
See the value in patient networking – patients with similar problems know what patients want to know.
Welcome family interest in the patient’s care.
Let patients scour the earth for information on their health problems and appreciate their efforts.
Let patients help with quality and safety by valuing their questions and reminders.

New Opportunities for Nurses

Nurses are in a unique position to help their organizations with initiatives to improve patient engagement. Mary Jean Schumann is the executive director of the National Alliance for Quality Care (NAQC), a partnership of leading organizations and consumer groups that has developed Guiding Principles for Patient Engagement. She points out that nursing practice has always been patient-centered. As nurses, we spend countless hours at the bedsides of patients and in discussions with their families. As the most trusted profession, families and patients are comfortable with nurses in advocacy roles. But do this effectively, we will need to reevaluate our personal nursing philosophy and principles influencing their own practice behaviors. The environment of care may also need to change. Organizational policies and practices have a direct influence on the patient’s ability to engage and become an active partner in their care. Open family visitation policies, bedside rounding and patient-centered interdisciplinary discharge planning all promote patient engagement. Patient/Family advisory councils are also recommended based on evidence from the Institute for Healthcare Improvement. Moving forward, organizations will look to nurses to help engage patients in their care because now it is not only the right thing to do – it is an imperative.

Read to Lead

D debonkart. Let Patients Help: A Patient Engagement Handbook for Doctors, Nurses, Patients and Care Givers. Creative Space Publishing Platform; 2013.