Engaging patients at Intermountain
Nearly two years ago, leaders at Intermountain Healthcare, a 21-hospital system based in Salt Lake City, made a seemingly small but critical wording change to its organizational strategy. The system replaced the term “patient experience” — which long had been one of the six dimensions of care featured in its internal documents— with “patient engagement.”
The change acknowledged the growing consensus that empowering patients to take greater responsibility for their health is a more powerful goal than just focusing on patient experience, and that it can produce improved outcomes, said Kim Henrichsen, Intermountain’s vice president of clinical operations and chief nursing officer.
But when Intermountain convened a steering committee to explore strategies for achieving the new goal, it quickly became clear that people had vastly different ideas about patient engagement. “One of our biggest challenges organizationally was just making sure we were all on the same page and had the same understanding of what patient engagement means,” she said.
The rhetorical focus on patient engagement has grown enormously throughout the healthcare industry. One consultant said that “if patient engagement were a drug, it would be the blockbuster drug of the century.” But confusion still abounds about what patient engagement means and how best to achieve it.
Survey results released in 2012 by the National eHealth Collaborative showed widely varying interpretations of the term. Some respondents thought it’s the way patients use educational materials and resources. Some thought it’s how patients discuss their care with their doctors. Others focused on whether patients have access to electronic communication portals.
At Intermountain, Henrichsen and her colleagues decided that a clear, organization-specific definition of patient engagement was essential. After much discussion, they agreed on this definition: “The effective partner- ship between the patient, the family and the healthcare team to collaboratively achieve the patient’s healthrelated goals.”
That definition provided a jumpingoff point for the initiatives the system has undertaken since, said Tammy Richards, Intermountain’s operations director for patient and clinical engagement. Those efforts have included improving patient-education materials, which the health system is working to integrate into the electronic health record. “Patients are receiving stacks and stacks of paper and it’s overwhelming,” Richards said.
Intermountain also has established a patient and family advisory council that regularly weighs in on issues related to patient engagement. For instance, hospital leaders recently sought the council’s feedback on asking hospital patients to sign a form stating they would not get out of bed without first calling a nurse. The council said fine— as long as the hospital pledged that a nurse would be in the room within five minutes of the call. “It’s a two-way commitment,” Richards said.
A year ago, Intermountain launched a shared-decisionmaking pilot to test ways to better engage patients. Funded by a grant from the CMS Innovation Center, the multisite pilot assesses patients being treated for five condi- tions, including total joint replacement and diabetes, at Intermountain’s clinics run by its employed physicians. The goal is to see how patients’ views and decisions are affected by enhanced education tools and support.
“We’re evaluating things like, ‘How well do you understand the information?’ ‘Do you feel like you had enough information?’ and ‘Did your decision change based on that information?’ ” Henrichsen said.
Results from the pilot are just starting to trickle in. Of the first 170 patients to receive the additional education, 21% changed decisions about their care. Some pursued more-aggressive treatments and some less aggressive ones, Richards said.
Intermountain has been emphasizing the importance of shared decisionmaking and shared accountability across the system. That has met with pockets of resistance.
“This is an area that is still difficult for some providers,” Richards said.
In the pilot, some really understood shared decisionmaking and bought into it, while others said, “I just don’t have time for this,” or “My patients just want me to tell them what to do.” It will continue to be a challenge, she added, because of financial incentives and patient expectations. “But we’re making progress.”