En­gag­ing pa­tients at In­ter­moun­tain

Modern Healthcare - - BEST PRACTICES - By Mau­reen McKinney

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.”

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