Patient Engagement: A Two-Way Relationship | E. 77

The Healthcare Leadership Experience

Why do healthcare providers struggle to develop meaningful connections with patients? Lonnie Hirsch explores the key barriers to building relationships with Jim Cagliostro.

Episode Introduction

Lonnie shares the ‘’three lacks’’ that get in the way of effective patient engagement, why patients must be empowered to take ownership of their own health journeys, and reminds us that, while healthcare is episodic, health is a constant. He also explains why patient engagement is not a marketing issue, why its highest purpose is outcomes, and the need for hospitals to ‘’care for the people who care for their patients.’’

Show Topics

• Strengthening relationships between patients and healthcare providers

• The ‘’three lacks’’ in patient engagement

• Effective marketing is a one-on-one conversation

• Patient engagement begins with trust

• The highest purpose of patient engagement is outcomes

• Understanding the emotional weight on your customers

04:26 Strengthening relationships between patients and healthcare providers

Lonnie outlined his motivation for focusing on patient engagement.

‘’Certainly, what gets me going is anything that contributes to solving the challenges that are standing in the way of more people having more awareness and access to affordable, high quality healthcare. That's a big deal, and it's become an increasingly more important focus for me is how can I help, how can Forefront help with that message and that connection? Secondly, I'd say anything that helps people navigate the really cumbersome healthcare, I call it a labyrinth. Many people find the whole experience of trying to navigate their healthcare to be enormously confusing, convoluted, maddening, mystifying, certainly, very frustrating. So those issues are very important to me and increasingly a priority focus. I'm also big into educating and empowering more people on ways they can live healthier lives and avoid preventable disease. And if I had to name one other thing that gets me going in the morning, I'd say it's building or strengthening relationships between patients and the healthcare professionals who are providing their care.’’

09:09 The ‘’three lacks’’ in patient engagement

Lonnie outlined three key reasons why healthcare misses the mark with patient engagement. ‘’

‘’And there are three that I would put in that category of what I call lacks. I'll explain what I mean by that. The first is the lack of enough time for healthcare providers to interact meaningfully with their patients. And if I had to prioritize the challenges for better patient engagement, that would probably be at the top of the list. But close behind would be the lack of belief and trust by the patients based on their experience that the people trying to get them to engage, really know them. Understand them as individuals understand their concerns, their fears, their motivations, and frankly, really care about them. It's hard because there's so many people that need the help and organizations that are providing that care are under a lot of time pressure, which goes back to my first lack. But that issue of a patient not really believing that anyone in the organization really knows them or even cares to know them is a big challenge in terms of getting patients to engage. And the third lack that I would prioritize is the lack of human interaction between episodes of care, not just during them, by the healthcare organizations to make sure that patients understand and feel understood and heard regarding what they can do or need to do to improve their health and live healthier lives. Not just when they're sick or feeling poorly, but at all times.’’

13:19 Effective marketing is a one-on-one conversation

Lonnie said that a personalized approach is needed to overcome barriers around issues such as language, traditions, and education.

‘’…But I would say that the cultural issues are the biggest challenge, and that's because what we call culture really includes language, meaning, someone's first language, education, family history and traditions, people's biases and beliefs. All of that really goes into culture. And that obviously requires a very personalized approach that isn't easy to scale or automate as we were talking about. You can automate text-based communications based on things like the primary language of the patient, but the other cultural influences are really much harder to scale. And again, it goes back to what I said before about effective engagement, requiring the patient to be and feel understood and cared about as an individual. ….when you're effectively marketing, you are really having a one-on-one conversation with someone else, even if that message is going out to thousands or tens of thousands of people at the same time. And increasingly more of the marketing is being more personalized as well, if you will, according to individuals or smaller cohorts. But if it isn't a one-to-one conversation, it's not going to resonate with the patient and just makes the effort to get more engagement, more difficult.’’

16:15 Patient engagement begins with trust

Lonnie said that healthcare providers don’t offer the time required to build trust with their patients.

‘’…this really goes to the heart of patient engagement or the challenges when engagement isn't happening. Because at its core, patient engagement is all about trust and all about relationships. No relationship, no trust. No trust, no engagement. And the other part is people don't trust an institution. They don't trust a hospital or a system. I mean, trust is a human emotion, so you can't cultivate trust with an entity or an organization. The trust is between people. So patients are only going to trust people who they believe understand and care about them. I'm kind of repeating myself here to make a point. But they believe that they have some kind of a connection to somebody or some people who understand them, care about them, and what's best for them. And I certainly think that most people who are working on patient engagement in healthcare organizations understand that, but they don't really have good solutions because of this inability to provide the time that's required to build that trust between the patients and the healthcare clinicians and other professionals who provide their care. Which includes specialists by the way, not just primary care providers. So when you talk about what does a lack of trust look like, it looks like patients who don't follow through on what is in their treatment plan, patients who don't take their medications or even fill the prescriptions, patients who don't respond to attempts to schedule their appointments, patients who express their frustration in other ways. In most cases, it's passive disengagement. It's not like they're out there banging on your door or complaining. They're just not emotionally connected. And so they don't feel there's trust, they feel they're on their own, they access the care they need the best way they can figure out how to access it when they need it. But there's no relationship, so there's no trust.’’

22:15 The highest purpose of patient engagement is outcomes

Lonnie said measuring outcomes is a more important metric than surveys, appointments, and medications.

‘’…. If a patient is engaged, you're going to see it in the outcomes. You're going to see it in medication adherence going up. You're going to see it in health improvements related to the treatments. You're going to see it in follow through on their scheduling their colonoscopies or their mammograms or their prostate checks. You're going to see it in reduced A1C levels or reduced triglyceride levels. Ultimately, isn't that the highest purpose of patient engagement? Or at least to me it certainly should be. And as far as assigning or building patient engagement teams or patient engagement leaders, it's part of the process, but it's also a trap. I see this happen in healthcare organizations a lot with what is categorized under also patient experience, which is closely related to patient engagement. And a health system will hire a head of patient engagement or maybe a couple of people to lead their patient engagement efforts, and give them that title and that responsibility, but then it becomes kind of an impression that it's somebody else's job. "Oh, well, our patient engagement director or our VP of patient engagement or whoever holds the title, they're the ones who are responsible for moving the needle.” It's an impossible task and a trap, because patient engagement and patient experience and all of those issues happen at the point of care. So everybody has to be involved in it, or it really doesn't take hold and it doesn't resonate.’’

28:20 Understanding the ‘’emotional weight’’ on your customers

Lonnie said healthcare providers can build connections by acknowledging the pressure on their patients.

‘’But you have to remind yourself when you're in that setting that every patient who's in front of you is carrying an emotional weight, and they're bringing that into that encounter. They may show it, they may hide it, but it's there. And so thinking about this being just, this is my day and this is how many patients we have to see, and this is what we have to get done, and this is the documentation we have to provide, and this is the next room that we need to move into for the next patient. Yes, all of that is necessary to have a functional organization. But when you lose the perspective on the emotional weight that customers, and I'm going to call patients' customers here, bring into each encounter, you're losing the chance to have that connection. You're losing the chance to build trust. You're losing the chance to have patients want to engage, want to take more ownership in their own health, want to feel like you are on their side. And I'm not saying it's easy, but I see it all the time. I understand it, and it's a big challenge in terms of this whole topic of why patients don't do what they really should do, even if they understand the reasons that they should do it.’'

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You’ll also hear:

Lonnie’s definition of patient engagement: ‘’…patient engagement is about empowering patients to actively take ownership of their own health journeys and supported by and in collaboration with their care providers. And to have access to the information and resources that enable patients and their loved ones to be and feel more in control of their health and healthcare.‘’

Healthcare is episodic, but health is a constant. Why healthcare organizations need to be part of a patient’s lifelong journey to increase engagement.

Why patient engagement is not a marketing issue: ‘’Even though that's often where patient engagement initiatives land, patient engagement is a relationship issue between individuals and their care teams. If you don't solve for that, all the best marketing tactics and communications won't really move the needle.’’

Patient engagement has a business case too: ‘’But if you need a business framework or a business rationale for it, improving patient engagement goes to the financial bottom line and profit line of the organizations as well or doesn't, depending on whether they're effective with it or not.’’

Leadership wisdom: Why healthcare providers must prioritize ‘’taking care of the people who take care of your patients.’’

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