7 Ways to Create a Culture of Engagement

(and Tackle Some of Healthcare’s Biggest Problems at the Same Time)

Get the “engagement” piece right and you’ll help solve many issues: improve quality of care, save money, prevent physician burnout, and more. Craig Deao, author of The E-Factor, says healthcare organizations can engage leaders, care providers, clinicians, and patients…simultaneously. Here are seven ways to make it happen.

Engagement has never been a hotter topic, and no wonder. Great clinical quality depends on it. Price pressures demand it. And where engagement doesn’t exist, all stakeholders suffer: Employees leave, clinicians burn out, and patients neglect their care plans, lose trust in their caregivers, or drift away altogether. These are incredibly costly problems, as most of us know firsthand—so if engagement is the so-called “simple” fix-all that can help solve them, healthcare organizations better get engaging. Right?

Right. But as Craig Deao, MHA, points out, we all know what we should be trying to achieve. It’s the how that trips most of us up.

“Many converging market forces—government programs, competition from other industries, the trend toward personalized medicine, the increasingly loud voice of the consumer—make creating high-engagement cultures absolutely urgent,” confirms Deao, author of the new book The E-Factor: How Engaged Patients, Clinicians, Leaders, and Employees Will Transform Healthcare (Fire Starter Publishing, 2017, ISBN: 978-1-62218-080-6, $28.00) and senior leader at Studer Group®, a Huron solution.

“Yet few organizations know how to engage all stakeholders—from care providers of all stripes to patients and families—and nurture that engagement over the long haul,” he adds. “Typically they resort to inconsistent, scattershot approaches that make little or no lasting impact.”

In The E-Factor, Deao lays out a unique and progressive four-pronged model that demonstrates how engagement cascades from the top of an organization: It starts with leaders, flows down to employees and clinicians, and finally reaches (and activates) patients and families.

“When you infuse this model into your organization, you can engage all four groups simultaneously,” he says. “It’s not easy but it’s worth the effort. By making engagement a core competency and a visible strategy, you can reduce turnover, prevent clinician burnout, improve clinical outcomes, and make preventable readmissions far less likely.”

Here are just a few of Deao’s insights and words of advice:

Realize that engagement and satisfaction are NOT synonyms. Twenty years ago, healthcare finally started listening to our patients in a meaningful way. Back then all we had were satisfaction surveys, which are valid and important measures of how patients perceive the services they received. Today, we have more options, from experience surveys that ask how frequently patients observed evidence-based care practices happening, to the most exciting measures of patient engagement. Each of these provides unique and meaningful insights. But they’re not the same.

“While satisfaction is a one-way street, engagement is a two-way street,” explains Deao. “It’s about putting forth effort, even when no one is watching. It’s about deciding: Will I take a specific action…or not?

Leaders can’t engage anyone. They can only create environments that facilitate engagement. While it’s true that leaders are at the top of the engagement cascade, they can’t really engage anyone. That isn’t their job. Their role is to create a work environment that makes it easier for clinicians, employees, and, ultimately, patients to engage—to implement strategies that help them over barriers that may be blocking engagement.

“Leaders can stay focused on the organization’s mission, vision, and values and role model the behaviors espoused in those documents,” says Deao. “They can ensure appropriate compensation and benefits to attract and retain the right workforce. They can reward and recognize. They can communicate, set clear expectations, provide consistent feedback. But engaging is an inside job.”

Start thinking of patients as consumers. Then, design systems around their needs, not yours. Like it or not, patients have stopped being so, well, patient. Like shoppers in all industries, they are asserting their needs and wants and choosing healthcare providers that can meet them. That’s why retailers like CVS MinuteClinic™ have become so popular: They’re open seven days a week (holidays and weekends included), no appointment needed. This is a sea change driven by another sea change—the shift from patients being patients to patients becoming consumers.

“Consumers value convenience more than they do seeing a doctor,” notes Deao. “Given the rise of telehealth, many don’t even have to see anyone in person. Ask yourself if your system, hospital, or practice organizes around patients…or does it organize around consumers? Typically, the answer is neither. We tend to organize around our own needs as practitioners—and that’s a problem.”

Embrace technology in a way that helps patient engagement (not hinders it). The relationship between technology and patient engagement is a complex and confusing one. Many organizations just put up a portal and consider that an “engagement strategy.” This is a huge misconception at the very least (we know that only already-engaged patients use portals). But there are plenty of examples of technology actively hindering engagement.

For example, the electronic health record (EHR) has gotten so painstakingly detailed that it can detract from the patient encounter. Similarly, consider the diabetic patient who spends so much time monitoring glucose that he neglects other critical components of his care, like diet and exercise. The key, says Deao, is to use technology in thoughtful ways that enhance the patient experience.

“In The E-Factor I discuss a Michigan children’s hospital that uses the Pokémon GO mobile app to get kids out of bed and moving around,” he says. “Another example of technology that engages patients is email reminders. In a UCLA trial, researchers found that when they shared physicians’ notes with patients—and sent them email reminders to review the notes—patients demonstrated better recall of their medical plans, felt more in control, and took medications more reliably.”

If you can do only one thing to engage employees, make it rounding for outcomes. This tactic—which is one of Studer Group’s “Must Haves®” connected to its Evidence-Based LeadershipSM execution framework—is the number one most powerful tool at a leader’s disposal. In a nutshell, rounding for outcomes is an action-packed list of communication practices bundled together in a single, ten-minute conversation once a month between a supervisor and direct report.

“More than any other tool or practice we prescribe, rounding for outcomes moves the metric of employee engagement and reduces turnover,” asserts Deao. “It directly responds to the number one reason employees say they leave: a poor relationship with their supervisor. This is a powerful relationship builder. It’s especially great for engaging millennials because it meets their needs for a personal connection, understanding the importance of what drives their work, and constant, specific feedback.”

Focus on the one thing that matters to physicians (and that we always forget). That “one thing” that too often gets overlooked is simply this: Physicians are driven by a sense of purpose. They went into medicine to make a difference in the lives of patients. It’s the meaningful interactions with patients—the “wins,” both big and small—that really drive physicians. Therefore, organizations must be intentional in celebrating these moments privately and publicly. And we must remove as many distractions from achieving them as we possibly can.

“Lately, I’ve found myself talking quite a bit about the challenges that occur when technology disintermediates the physician from the patient,” notes Deao. “A well-intended strategy is to help them practice ‘at the top end of their license’ and scale their work. Unfortunately, it also means that at times they miss out on the little moments of joy that buoyed them through the tough days, like celebrating when Mrs. Jones finally lost a few pounds after previous months of trying.”

Use PAM scores to tailor care for patients with different activation levels. Engaging patients is all about personalizing their care. The E-Factor describes various ways to do this. But the most meaningful measure we can use by far is differentiating our engagement approach based on an individual’s patient activation (a way of describing his or her “readiness for engagement”). Deao says a number of organizations are tracking the Patient Activation Measure (PAM scale) developed by Dr. Judith Hibbard’s research team and tailoring customized care pathways based on their level of activation.

“Basically, organizations can use PAM scores to determine which patients need more intensive support, one-on-one attention, or access to services,” says Deao. “It’s a way of meeting individual patients where they are and spending limited resources in a smarter way.”

These are just a few of the many strategies and tactics Deao shares in his book. While no organization can implement them all at once, we must hit the “engagement” message hard across all groups of stakeholders. And we must start at the top.

“It’s the leaders who must provide the environment for the care team to be focused on caring for patients with moments of communication and empathy, without systems and processes getting in the way of the healing they sincerely want to provide,” he says. “Every decision we make must be aimed at keeping everyone in the organization connected to their sense of purpose and to the knowledge that their work is worthwhile and makes a difference.”

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