A 42-year-old patient arrived for her annual gynecologist appointment complaining of a self-detected breast lump. She had several questions about her condition and wanted to tell her doctor about a family history of breast cancer. The doctor was in a hurry and advised her to ask the staff, but the staff was busy with other patients and told her to call them later. The patient did not call.
The gynecologist ordered a mammogram but did not include the patient’s complaint of the breast lump on the requisition. The mammogram was read as “normal,” but the report noted a “very dense stromal pattern,” which reduces the sensitivity of the study for detection of cancer. The radiologist did not recommend an ultrasound and described the mammogram as “normal” in the report to the gynecologist. No follow-up appointment was scheduled. Several months later, the patient scheduled another appointment with the gynecologist when she noticed the breast lump had increased in size. Subsequently, she was diagnosed with breast cancer and scheduled for surgery.
What were the missed opportunities to help engage this patient in her health care?
If the doctor or his staff took a little more time, would the patient have asked her questions and provided additional information, possibly resulting in an earlier diagnosis? Cases like this reveal the importance of engaging patients as a strategy to prevent adverse outcomes. When patients do not feel involved in their care, they are less likely to follow through with treatment, keep the physician informed, and follow the treatment plan.
Patient engagement has emerged as a key component of reducing the likelihood of an adverse outcome. When patients are angry, they are more likely to sue. Similarly, patients are more apt to file a claim when they feel like they are not being heard, or their questions are not being answered.
Active patient engagement is a quality measure of the Institute for Healthcare Improvement’s Triple Aim Initiative, a framework targeted at optimizing health systems “to improve care, improve population health, and reduce costs per capita.”
And it’s not just the physician who is responsible for fostering patient engagement — it’s the entire practice. Opportunities to engage patients begin when they first contact your practice. Patient engagement is a critical strategy that must be incorporated into all levels of your practice, from the receptionist answering the phone and doing check-ins to the physician in the exam room. At each level, the question that must be answered is “Does the patient feel his or her needs are being met?” For engagement to occur, everyone has to make the patient feel involved.
Through effectively promoting patient engagement, physicians and practice staff can not only enhance patient safety by reducing the likelihood of adverse outcomes, but also reduce the likelihood of a malpractice claim.
To achieve engagement, physicians should be aware of the patient experience within their practices. Consider the following tips:
1. Test your system. Doctors should conduct regular tests on their systems and processes to see what patients experience when they call for an appointment, walk into the waiting room or talk with office staff. Doctors can even use family members or friends as testers and solicit their feedback on the experience. From there, physicians should identify any system weaknesses and take appropriate measures to improve them.
2. Get feedback through surveys. Ask your patients to provide feedback about their whole experience with your practice and their satisfaction with their treatment. Measure patient engagement through Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys from the Agency for Healthcare Research and Quality (AHRQ).
3. Create an open communication channel. When a patient is first seen at your practice, tell them they will get a survey to provide feedback about their experience with your practice, but also open the door to additional communication. Make sure a patient feels comfortable airing complaints about any aspect of their treatment, your practice, or their relationship with you or your staff.
4. Train your staff. Based on feedback from patients and on identified system weaknesses, conduct trainings to educate your staff on patient engagement and its importance at all levels within your practice.
David B. Troxel is medical director, and Robin Diamond is senior vice president, patient safety and risk management, both at The Doctors Company.