Doing Patient Engagement For The Wrong Reasons Doesn’t Work

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I recently came across an interview with Stephen Beck, MD, Chief Medical Information Officer (CMIO) at Catholic Health Partners. Dr. Beck was being interviewed on the subject of patient portals and patient engagement.

Here’s a quote from that interview.

“While we have many enrolled patients in our patient portal, it’s not simply the enrollment but the actual use in Stage 2 that meets the criteria. Although the threshold is fairly low, there is still ongoing concern about how we can encourage patients to use the portal regularly…. We want patients to use electronic communication rather than pick up the phone. For many patients this transition will take quite some time to achieve. I have confidence the patients will see the light — the question is: How quickly?”

No wonder Catholic Health Partners is having trouble getting 5% of their patients to “use” their portal for secure messaging, etc. They are doing patient engagement for the wrong reasons.  And as we as have seen with Mayo Clinic and others…Catholic Health Partners is not alone.Get To Know Me

There Are Two Reasons For Doing Patient Engagement

There are two reasons why an organization should get involved with patient engagement. The right reasons and the wrong reason. The use of the terms right and wrong is not intended to imply any moral connotations.  Rather it refers to the likelihood that one’ engagement efforts will succeed or not.

The Right Reason

If your engagement efforts are done principally for the patient’s benefit (patient-centered) then you are doing it for the right reason. Examples of the right reasons include:

  • Ensuring that each patient is as involved as they want in their own care,
  • Reducing patient risks of infection or injury due to medical errors or safety issues
  • Helping patients make health decisions that are right for them
  • Providing patients with important self-care skill, and so on.

You get the idea.

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The Wrong Reason

If you are trying to engagement patients principally for the benefit of someone else (health care executives, physicians or regulators) then you are doing it for the wrong reasons…and patients will quickly sense this. Examples of the wrong reason abound and include:

  • Doing it to achieve Stage 2 MUEngagement Quote 1
  • Off-loading work heretofore done by clinicians to patients via a patient portal
  • Engaging is shared decision-making to coach the patient away from costly service requests
  • Putting a patient or two on an advisory committee as window dressing
  • Requiring that patients view their physician notes on the patient portal or health app before allowing them to find what they really want

 

Sure you can rationalize that everything ultimately is for the patient’s benefit but come on. Patients aren’t stupid. They know when something benefits them and when it really is for someone else’s benefit. Forcing patients to go online to use secure messaging to communicate with their health care provider instead of calling is a pretty transparent way of trying to eliminate staffing costs and achieve Stage 2 Meaningful Use. But from a customer service perspective it’s not very smart. Person-to-person interactions are much more meaningful from an engagement perspective than “going online.” Heck even the airlines let you call and speak with a reservation agent if you don’t want to book your flight online.

The Take Away?

Remember, many patients (people) are already engagement in their health albeit in ways that differ from the way providers tend to define engagement, e.g., patients doing what we provider consider to be the right thing.  Following the admonition to “do no harm” the health care providers job is to be engaging and avoid pissing off the patient and disengaging them.

Also remember that for every action there is an equal and opposite reaction – call it unintended consequences. In this case Catholic Health Partners might not only fail to achieve Stage 2 MU but also increase patient dissatisfaction in turn disengaging more patients than they actually engage.  I doubt that their patients will ever see the light as Dr. Beck hopes.   But then patients are not the one’s who need to “see the light” are they….

My advice is you do something nice for your customers – something that they find to be a benefit – you can never go wrong.

That’s what I think. What about you?

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8 Comments

  1. Sgrey says:

    Totally agree, Stephen. Our research proves it over and over. Shirley

  2. Sgrey says:

    Totally agree, Stephen. Our research proves it over and over. Shirley

  3. MakeThisLookAwe says:

    This is an amazing article, thank you so much for raising these points. See, I come from a completely different point of view — I work with developers and I’m a patient. So when an institution says it’s patients are to blame for not using their website, I just look at the millions of hours people have dedicated to useless things like FarmVille and think, “Really… You think poor response to your portal is your patient’s fault?”
    Let me give you some perspective. The EHRs and other tools they force doctors to use are outrageous in their hideous, unintuitive designs. I’ve seen brand news software packages and they look like they came from a Windows 4.1 platform from 1993!! But as health professionals, you are paid to put up with crap tools for the purpose of security, regulations, and cost. You get paid to put up with that hideous design, you have staff that supports you in their use, maintenance, troubleshooting, and you’re healthy.
    From the patient’s perspective, there’s no transparency to know that anything is working the way it’s supposed to. I push the button and it goes off into the aether. Even if there is a button or a pop-up, that doesn’t actually mean anything.
    Only if I’m actually talking to a human being do I know that a job is being done, and even then, I don’t know that it’s being done right! I cannot get in to see an endocrinologist in the state of Colorado because a doctor was missing an MRI from my file, even though I had tole and written the records technician to also pull the file from my married name!
    One little screw-up creates a wake of devastation. They had a patient portal. They still managed to screw up the labs so bad that lab admin walked the paperwork between, herself.
    All it takes is one bad burn and you’ll never trust you’re health to anything less than human.

  4. bcmanning says:

    Great post, Stephen. When building a patient-facing piece of software:

    1. Good approach: you build the software to meet the needs of a patient
    2. Bad approach: you build software to meet the needs of providers
    3. Horrible approach: you build the software to meet the needs of the government

    Unfortunately, the most common approach to patient portals is number 3 — vendors are frantically building software to satisfy meaningful use as laid out by the government, rather than to serve an identified patient need.

    This is a recipe for bad software and bad patient experience — and it’s validated anecdotally (try using one of them) and quantitatively (check out the star ratings in Apple’s app store for those vendors that offer a mobile version).

  5. MakeThisLookAwe says:

    You’re assuming some big things in those three…..
    1) Is there value in using software over currently used practices? Are all the patient’s needs known? Are they all the same? Can software provide those solutions? Can the customer afford to pay for those features and have them available?
    2) The provider is the one using and paying for the software and they shouldn’t have any say in how it’s designed or how it performs….. Really?!?
    3) Do you really think you can write patient software without government oversight? The FDA has already told software developers that we need approval from them before we go live with our product if there is any risk to patient health.
    You’re list is a beautiful ideal that has already been crushed and obliterated by the industry…. I wish is wasn’t so, but we’re too late.

  6. bcmanning says:

    MakeThisLookAwe  Thanks for the response.  In some ways I agree it’s too late.  My comment was really only intended to point out the challenge of having software development being driven by the government, rather than user (patient) demand. I wrote about this topic in much more detail here:  http://briancmanning.com/2014/01/07/prioritizing_the_user/

  7. MakeThisLookAwe says:

    I completely agree that government should NOT be driving the bus, especially since it was /their/ “standards” set out by Medicare that got us into this mess. The solution to the problem of too much government interference is not more government interference. And Harvard economists should not be telling us how to run medicine, but that’s what happened, that’s why we’re here, and I fear only a major catastrophe nation-wide is going to fix it.

  8. Excellent and challenging post Stephen! You clearly drew “the line in the sand” that I believe is there for optimizing healing healthcare!! Thanks for the inspiration!

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