True Engagement Puts the Patient in the Driver’s Seat

By Kindred Healthcare


 Eric Coleman, MD, MPH, ACSF, FACP speaks to the 2013 Clinical Impact Symposium attendees. Eric Coleman, MD, MPH, ACSF, FACP speaks to the 2013 Clinical Impact Symposium attendees.


Kindred Clinical Impact Symposium speaker Dr. Eric Coleman challenged attendees at the event to step out of their comfort zones to really look at what it means to say, “We are patient-centered” or “We are involved in patient engagement.”

The key is to focus on what patients want for themselves, not just on what providers want for them, he said. Caregiver involvement is also vital.

Dr. Coleman is the founding director of The Care Transitions Program, a national program that aims to improve quality and safety at times of transition across settings for patients. This is his second year speaking at the symposium.

He acknowledged that patient engagement takes time that providers may not feel they have, but that not investing that time on the front end can lead to readmits, rework and other “re” words that will end up taking as much, if not more, of the patient’s and provider’s time. In his two decades of work, he has seen and heard numerous definitions of patient engagement and found there is often a disparity in how the ideas behind patient engagement translate in actual practice.

Dr. Coleman explained that the perception of the patient as a passive participant is at one end of the spectrum. At the other end, patients play an active role in their care. They collaborate with their providers, and help shape and design the care they receive. Helping patients move in this direction means taking into account the language we use, the process patients and their families go through, and, of course, the patients themselves. Ultimately, it leads to better patient outcomes.

Often, when Dr. Coleman visits facilities and views what they are doing through the lens of the Chronic Care Model, the emphasis is on what the facility is doing for the patient, not on how the patients or their families are involved in their care. He sees the need to create more informed and activated healthcare consumers by focusing on what happens when the provider isn’t in the room, or when the patient goes home.

This is where the idea of the “transitions coach” comes in. It’s not the kind of coach that will lead a team to a national championship, but a coach geared for skill transfer to the patient. These coaches are the ones who won’t give you a fish, but will teach you how to catch one. Dr. Coleman makes the analogy that doing things for the patient puts the patient in the back seat of the car, educating puts the patient in the passenger seat, but coaching gets that patient into the driver’s seat.

It means providers must look beyond their goals for the patient and understand what the patient wants. The provider may want to reduce hemoglobin A1C levels by 2 percent, but the patient simply wants to be able to walk to the corner store. We can deliver many of the same care messages to the patient, but they need to be tailored to the patient’s goals, not our own, he said.

Dr. Coleman said a particularly effective method called “teach back” is rapidly becoming a best practice for providers. You talk to the patient and then ask him or her to repeat what you said in his or her own words. You can gauge the health literacy of the patient and see if there are gaps in understanding. This isn’t framed as a test for the patient. Instead, the provider asks for feedback on how well the information has been explained, Dr. Coleman said.

Another key area of patient engagement is to change the perception of the family caregiver as either invisible or annoying. Family caregivers should be treated as part of the care team. They provide 80 percent of chronic and long-term care, and they are handling medical and nursing tasks, managing medications and coordinating care. Dr. Coleman notes that they often receive zero preparation or guidance for performing these tasks. In feedback, caregivers often say, “I don’t feel ready. Things weren’t clear. I didn’t know what to expect.” To help bring these family caregivers on board, Dr. Coleman suggests scheduling discharge instructions at a time when the caregiver is available so his or her questions can be addressed along with the patient’s.

Ultimately, patient engagement can only be achieved by actually involving the patients and their family caregivers. We cannot assume they have the same goals that we as providers have or that they will be happy with the types of work flow that work best for us, Dr. Coleman said. What works best for patients is something only they can tell us, and opening up the opportunities for those conversations is the first step for success.