Hospitals say best patient engagement programs start simply, target conversations

As hospitals and health systems invest heavily in patient engagement initiatives to deliver a better clinical experience -- and in many cases, to drive revenue -- sometimes just changing how medical professionals interact with patients can have the biggest impact.

At the Barnabas Health System in New Jersey, a major goal is to foster a culture that inspires trust and confidence in the staff, according to Maureen Harding, RN, who has a background in oncology and has been leading efforts a to strengthen the clinician-patient relationship there.

"One of the things that we do to help with improving the patient experience is to really coach our employees to engage with the patient, and make sure they're connecting with them on a personal level," said Harding. "One of the best ways we can do that is to introduce ourselves. This is not a grassroots thing; you acknowledge the patient and anyone else in the room."

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It's a seemingly small measure, but Harding said it has made a large difference in how patients perceive the facilities in the system. It started with a "prescriptive plan" for nurses on staff, who had been coached to ask key questions about a patient's level of pain and personal needs. Once it started yielding positive results, the prescriptive plan was expanded to all areas of the system, including at the executive level.

"If you don't have leaders who are mentoring their employees, it's not going to help," said Harding. "You need to make sure your leaders are passionate about this, and buying into it, and leading the way."

At the staff level, a certain amount of preparation and training goes a long way toward achieving that end. Mock scenarios are implemented. In one such scenario, a patient room is set up, an iPad is at the ready, and a nurse walks in and simulate how they would care for the patient, with the entire episode recorded on video; another staff member then reviews the footage to analyze the performance and coordinate with the nurse to determine what they did well, and what could be improved.

Harding says the investment is slowly helping the system reach its ultimate goal: reaching the 90th percentile in the Hospital Consumer Assessment of Healthcare Providers and Systems survey ratings.

Deborah Larkin-Carney, vice president of quality at Barnabas, said the successful implementation of a patient-centric culture is personal.

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"I knew we were winning when my dad was in one of our hospitals, and my brother said, 'What did you do? Everyone is so service-oriented, but you feel like it's genuine.'"

Larkin-Carney said the health system is trying to build off of that success. "We keep building the next step, and the next step. That's been invaluable for us, seeing us move the needle."

Patients' opinions matter more than ever, and so do measuring those opinions, said Thomas Lee, MD, who practices primary care at Brigham and Women's Hospital in Boston and is chairman of the board at Geisinger Health System. He said the likeliness of a patient to recommend a particular hospital or doctor is one of the most important considerations in gauging their experience.

"Likelihood to recommend reflects the peace of mind that their care is optimizing their outcomes -- and I think that is the bottom line from the patient's perspective," Lee id sain an email. "From a business perspective, high ratings on this variable suggest that patients are likely to stay with the provider, and encourage others to go there -- thus preserving or growing market share."

The measures that drive this likelihood to recommend, he said, are similar across all settings of care. Patients want good clinicians they have confidence in; they want teamwork and good coordination among those clinicians; they want good communication; and they want empathy. After those variables are taken into account, said Lee, other variables have little or no impact on likelihood to recommend -- including pain control and waiting time.

To see how their efforts are paying off, Lee said, hospitals are turning to data. In fact, most are pulling data from every patient, not just the relatively small number required by regulators. Instead of simply resting on quality assurance, making sure nothing is terribly wrong, the emphasis is on driving improvement.

Lee said these initiatives are resulting in concrete care delivery improvements.

"I'm happy to say that it is clear that patient experience is getting better and better," he said. "In fact, the dark side of that message is that if you are not improving, you are falling behind.  Organizations are using the data in new and creative ways, and adopting standards such as hourly rounding, doctor-nurse rounding and communication training."

According to Lee, the standard has moved beyond making sure nothing terrible is going on, but on constantly improving regardless.

Tools exist to help with patient engagement initiatives. One offered by Pharos Innovations is designed to engage patients in their self care on a daily basis. The approach identifies patients with moderate or rising risk factors, where most avoidable admissions and 30-day readmissions lie. The patients are then enrolled in a program to help them manage either a specific chronic condition or a transition out of the hospital. Clinical variances trigger an automatic alert to the patient's care team, allowing a care manager to follow up directly, possibly averting a heath calamity.

Paul Berrisford, chair of the finance committee at Community Health Network in Minnesota, said that engaging with patients in a more direct fashion cut readmission rates in half.

"It's a relatively low investment, and it happens to fit well with accountable care organizations, because we're about driving higher quality at a lower cost," said Berrisford.

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"We didn't know how it was going to work out. We just had suspicions. How do you focus your limited resources? We can't have care manager calling every patient to ask them how they're feeling. We figured if we had a system that identified patients who were most likely in need of care management assistance, we could manage our resources more effectively."

The biggest challenge, said Berrisford, was getting physicians on board with having an outside entity becoming involved with their patients. But after educating them about the patient engagement strategy, Berrisford said physicians now endorse the program, and the system is reaping the financial benefits.

"It looks like savings will continue," said Berrisford.

Twitter: @JELagasse