By Debra Wood, RN, contributor
July 23, 2012 - “Patient engagement” has become one of the buzz phrases associated with creating a more sustainable health care system, and aiming to guide nurses and other clinicians, the Nursing Alliance for Quality Care (NAQC) has released a list of guiding principles for delivering high-quality, patient-centered care.
Mary Jean Schumann, DNP, MBA, RN, CPNP, urges organizations to educate their members about the patient engagement principles.
“Nurses can help to lead this change,” said Mary Jean Schumann, DNP, MBA, RN, CPNP, assistant professor of nursing and executive director of NAQC, an organization of consumer advocacy and nursing organizations based at The George Washington University (GW) School of Nursing in Washington, D.C.
However, she added that nurses could do more to improve and enhance the engagement of patients. To facilitate that, NAQC developed Guiding Principles for Patient Engagement, which nurses and other providers can use as a foundation for building patient engagement. Many of the nine principles are already at the core of what nurses do, such as creating a dynamic partnership with patients and their families, respecting privacy and confidentiality, advocating for patients and appreciating patients’ rights.
Cheryl Peterson said the ANA wholeheartedly supports enhancing patient engagement.
“Nursing has always been really good about engaging the patient and families, but we are trying to create a better framework and understanding about what that patient engagement needs to look like,” said Cheryl Peterson, RN, director of nursing practice and policy at the American Nurses Association (ANA) in Silver Spring, Md., a member of NAQC.
“It’s about the relationship between patients and providers,” added Nancy Falk, PhD, MBA, RN, an NAQC team member and an assistant professor at The GW School of Nursing. “Nurses are at the forefront of the dialogue.”
The case for safer quality care
Beverly Malone, PhD, RN, FAAN, chief executive officer of the National League for Nursing in New York, a member of NAQC, called patient engagement an issue of safety and quality of care.
“Where people generally fall down is communication,” Malone said. “The provider must not continue as if it’s their territory and the patient is a visitor, rather than a partner in their care.”
Sometimes when busy, the nurse might focus on the task and not encourage discussions. Patients may be handed discharge instructions, which they do not understand.
Beverly Malone, PhD, RN, FAAN, called patient engagement a safety and quality of care issue.
“Patients are often afraid to question us,” Malone said. “We have a responsibility to engage with our patients. That’s part of the role of being a nurse. It’s what we do, who we are, and we should hold each other accountable for that.”
Engaged patients feel safe questioning a medication that doesn’t look familiar or informing the provider when they cannot afford the medication prescribed.
Kammie Monarch, RN, MSN, JD, chief operating officer at Nurse-Family Partnership in Denver, another NAQC member, added that the principles reinforce the need to change the health care environment from hierarchical and vertical to more collaborative and horizontal. The health care nurse cannot dictate, but must address the patients’ needs.
“At NFP, the principles resonate with us,” Monarch said. “It’s about walking beside the client and not in front of him or her.”
Schumann added, “It’s about getting to a plan of care that actually makes the most sense for the patient. It is not about increasing compliance with what the physician prescribed.”
Many patients don’t want to hear all of the details or resist changing their lifestyle, while others seek information about their health conditions and want to discuss ways to improve their health and well-being. Schumann said the ability of a patient to be engaged varies with time and circumstances. Patients under stress may not be able to ask questions.
Tracey Mayberry, a partner at consulting firm CSC based in Falls Church, Va., expects patients gradually will embrace greater engagement.
“Something that will nudge the needle in that direction is people becoming more responsible for the cost of their care,” Mayberry said. “Staying healthier reduces their cost.”
The financial case for patient engagement
Safer care and keeping people healthy is more cost-effective, and the health system is looking to address continually rising costs.
Tracey Mayberry expects patients will gradually take a greater interest in their health, especially as they pay more out-of-pocket costs.
“The current break-fix model of health care is unsustainable,” Mayberry said. “Given the finite pool of money and the increased complexity of illness, how are we going to do a good job of taking care of these folks?”
When patients become more informed about their health, they may make better decisions, modify their behavior, and require fewer health care services, Mayberry said. He added that technologies, such as in-home monitoring and health-related apps for mobile devices, can help clinicians intervene earlier.
Greater patient engagement also has the potential to reduce readmissions, said Joanne Rohde, CEO of Axial Exchange, a care-transitions software firm in Raleigh, N.C. The Centers for Medicare and Medicaid Services (CMS) plans to begin imposing penalties related to readmission, giving hospitals a financial incentive.
Provisions in the Affordable Care Act, including creation of the Patient Centered Outcomes Research Institute, are moving the industry toward greater patient engagement, Peterson added.
“There’s a real movement toward recognizing if we are going to prevent illness, have better wellness, stronger coordinated care and bend the cost curve, which we need to do; patients are a fundamental piece of that,” Peterson said. “How we successfully engage them, [so they] are part of that dialogue, that’s what the principles are trying to do.”
NAQC hopes organizations begin to educate their members about the principles, Schumann said. With funding from the Agency for Healthcare Research and Quality (AHRQ), the organization is developing a white paper about the roles and responsibilities of nurses in fostering patient engagement and improving attitudes to facilitate that.
“We want to get the nursing community on board with the whole conversation and strategy about how we improve the role of nurses in the process and what it will take,” Schumann said.
The Guiding Principles for Patient Engagement
- There must be a dynamic partnership among patients, their families, and the providers of their health care, which at the same time respects the boundaries of privacy, competent decision-making, and ethical behavior.
- This relationship is grounded in confidentiality, where the patient defines the scope of the confidentiality.
- Patients are the best and ultimate source of information about their health status and retain the right to make their own decisions about care.
- In this relationship, there are mutual responsibilities and accountabilities among the patient, the family, and the provider that make it effective.
- Providers must recognize that the extent to which patients and family members are able to engage or choose to engage may vary greatly based on individual circumstances. Advocacy for patients who are unable to participate fully is a fundamental nursing role.
- All encounters and transactions with the patient and family occur while respecting the boundaries that protect recipients of care as well as providers of that care.
- Patient advocacy is the demonstration of how all of the components of the relationship fit together.
- This relationship is grounded in an appreciation of patient’s rights and expands on the rights to include mutuality.
- Mutuality includes sharing of information, creation of consensus, and shared decision-making.
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