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10 January 2019
By Dennis Joseph, MSW, M Phil (HHSM), CPHQ, Director of Quality, Royale Hayat Hospital, Kuwait
The care for patients has shifted from a home setting to a more sophisticated super specialty hospital setting since the turn of the last century. As the family doctor was fully aware of the conditions and ailments, treatment at home was comfortable in a way for patients and their families.
However, there are innumerable advantages both for patients and their relatives with the development of hospitals as many an ailment, which need intervention of specialists is available under one roof.
Technological advancement in medicine has revolutionised the diagnosis, treatment and patient care. The network technology has added another dimension to partnerships, communication and accessibility of specialists across locations.
The hospital setting, as we know, brings together patients, their families, doctors of various specialties, nurses, pharmacists, support staff like technicians, dieticians, physiotherapists and others. Insurance companies and Third Party Administrators (TPAs) nowadays play an important role in decision making too. Keeping this in view, there is a need to enhance engagement of all involved in the process for an effective healthcare delivery system. The patients and their families’ engagement could be enhanced using the 4P’s - Person, Problem, Place and Process, a framework frequently used in professional social work.
1. Person: A patient who approaches a hospital with expectation that the care giver would resolve the health problem. The patient is unique, a product of nature and nurture. The care givers have to take into account the patient in his entirety to plan out the engagement process to personalise the treatment and recuperation process.
2. Problem: The patient comes with a problem or ailment and this could be physical or may have many overtones of psychological or emotional stress. Their individual perception of the problem could vary as each individual is unique.
3. Place: The place or the environment where the treatment or services are rendered may vary between organisations and the programmes.
4. Process: The process involves Study, Assessment, Intervention, Discharge and Evaluation or Follow-up. It gives an impression that these steps are to be performed in sequence but these steps are woven in and out, one process paralleling another.
All these four components are almost common both to healthcare delivery and for social case work. But with reference to the engagement process, there are some major differences which are examined here under:
Generally counselling is done by a single trained professional who knows how to use the principles and components wisely whereas in a healthcare setting, it is a whole team of professionals along with less experienced proletarians that include the frontline staff. Professionals such as doctors and nurses are experts in their own domain like medicine and nursing. Though they are trained in their own specialties, many lack required skills in using the 4Ps efficiently, especially when it comes to crisis management, whereas, most of the frontline staff doesn’t have any formal specialised coaching on utilising the 4Ps. It is important that the entire care delivery team, both professionals and frontline staff, be proficient in using the above four components and casework principles wisely for engaging patient and their families to enhance quality of care. It’s a big challenge to train people to use these elements and get the intended results.
Patient Engagement means providers and patients are working together to improve health delivery system. When we deliberate based on this definition, all the care givers have an important role in engaging patients and their families in a broad range of activities. The requisite ambience needs to be created and the care givers should realise that the process is a dynamic activity and involvement in safety is the right of a client. Organisations also vary significantly depending on the structure, access, services and the programmes. Some are public, while others are private, profit centred, charity organisations, primary care, tertiary and/or super specialty hospitals. All these organisational differences also adds to the problem of the client.
Care givers are always familiar in using their own vocabulary that’s incomprehensible for most of the patients and their relatives and this situation is not conducive for seeking clarification. Moreover, in order to save time, some of the care givers utilise this as an opportunity that compromises patient engagement. Leadership of various healthcare organisations, mostly private profit centred hospitals influence professionals to achieve specific targets that conflicts with patient objectives. Fear of losing a customer is another roadblock for the service providers. In few instances, we come across situations wherein, care givers develop a feeling that patients are hostile and ungrateful. Some of the care givers also have reservations about the patient’s capacity to contribute. In addition to the above challenges, time constraints and dearth of informal opportunities for detailed discussion compromises effort in building trust between core care giver and the client.
The concept of continual improvement theory applies in patient engagement. Patient engagement is continuous and it is an important factor to maintain momentum while all efforts are in place to improve for the long-term success of an organisation. The more we try to increase patient engagement, the better our patients will be prepared to ask right questions. The support staff plays an important role in improving patient engagement and it is the responsibility of the core service provider to introduce and empower his colleagues so as to build confidence amongst patients for better outcome.
Employees are the main source of inspiration and strength of any organisation and its most valuable assets. Respect for people and continuous improvement should be embedded in the organisational culture. Creative ideas of frontline staff should also be taken seriously and implemented to improve wellness at the workplace. Leaders have to provide them with world-class working conditions and opportunity for them to grow and excel. Ensure a work environment where trust is foremost.
Common Tools for Engagement
Nowadays, since the healthcare organisations give much attention to patient engagement, many IT vendors have started specialising in patient engagement technology. Biometric wireless devices such as wireless scales and glucometers communicate the data through EMR. Many applications help patients to manage their medications and access their records for better outcome. Some of the IT vendors have developed medication adherence tools to remind patients to take their medications on time. Most of the hospitals have started using SMS appointment reminders and of course, social networks are useful for patient education and as an engagement tool. All these systems, both mobile and fixed, are prone to various types of attacks and it is important to ensure confidentiality and security of pertinent protected health information. This is another major challenge for the organisation. Patient portals and eloquent information leaflets developed and shared by various agencies, checklists and informed consent forms are few tools that help the patients and their families to raise relevant questions for clarification.
We all agree that patient engagement is beneficial for the patient, clinician, and healthcare organisation and to the society at large. It helps to deliver more detailed and comprehensive care, better and easier communication and improves customer satisfaction. It helps to increase efficient service delivery and improves healthcare outcome as there will be more clarity in decision making. In addition, it reduces cost to the patient and increases revenue for the organisation as there will be enhanced continuity of care. The highly engaged patients are more likely to take preventive measures, will have regular health check-ups and participate in immunisation programmes. It is more likely that people will start eating healthy foods, exercise regularly and avoid risks such as smoking.
All these tools will help to improve patient experience, compliance to healthcare management strategies and provide better outcome of care and add value by making it more personal, convenient and interactive. While these tools and techniques enhance the ability of the service providers to interact with patients, real patient engagement requires a shared understanding and an open mind for including patients’ needs, expectations and beliefs. This is required in each encounter from the ‘point of first contact’ till discharge and subsequent follow up and it requires an empowered team of specialists who are proficient in using the 4Ps.