Patient Engagement

Overview of Issue

Patient engagement is an integral part of improving safety, quality and patient outcomes. Patient engagement is promoted through clear communication and active involvement of patients and families with their healthcare providers. Risk management, quality/patient safety professionals and practitioners can advocate for healthcare organizations to remove barriers to patient engagement. This will build trust between the patient and healthcare provider and potentially decrease harm. Patients and families can be engaged in a variety of ways including individual clinical encounters, improving transitions in care, and providing input into incident analysis.

Key Points

• Risk management and quality/patient safety professionals can advocate for healthcare organizations to remove barriers to patient engagement.

Things To Consider

Promoting patient engagement

• Patient engagement can take various forms such as participation in diagnosis through providing a history; shared/informed decision making; participating in the treatment plan; and reviewing patient education materials.
• A number of factors affect patient involvement in safety. These include health literacy; willingness to speak up; ability to recognize error-prone situations; freedom to act; and knowing who, when, and how to call for help.
• Healthcare providers need to take the time to communicate clearly to patients and actively involve patients in their care to promote patient engagement. This can be accomplished through establishing an atmosphere of compassion and mutual trust.
• Individual clinical encounters with patients, quality/ safety committees, executive suites, boards, research teams, and national policy-setting bodies all have a role in promoting patient engagement.

Leadership best practices

• A supportive environment for patient and family engagement can be created by: communicating the healthcare organization’s vision and values related to patient and/or family engagement; leader modeling the behaviour they want to see; providing the necessary infrastructure and resources; involving and supporting healthcare providers in patient and/or family engagement efforts; and integrating patient and/or family engagement into policies and practices.

Barriers to patient engagement

• Removing barriers to patient engagement will increase the opportunities for patients and families to be more involved in their care. Examples of barriers include: restricted access to health records; intimidation; fear of retribution; and lack of easy to understand tools and patient education materials. Health system barriers include: a fragmented health care system; dysfunctional professional cultures; leadership deficits; workflow design flaws; lack of understanding regarding how to engage patients and families and their role; and lack of appropriate tools and training.
• Leaders and board members have a key role in enhancing patient and/or family engagement. This includes supporting culture change and advocating for education for healthcare providers, governing bodies, and volunteers regarding the value of patient and/or family engagement and techniques to do it.

Patient and Family Roles

Deteriorating patient status

• Families have a role in notifying healthcare providers about deteriorating patient status. This can include families activating a rapid response team or escalating concerns to healthcare providers.

Transitions in care

• Patients and families need to be engaged and agree/commit to the care plan relating to transitions in care.
• Healthcare providers should engage patients and/ or families prior to transitions from one part of their care to another, e.g. discharge home, between shifts from one healthcare provider to another, transfer to long-term care. Healthcare providers should discuss with patients and/or families how to prepare for the next stage in their care including discussing which medications the patient will be taking and when to contact their primary healthcare provider after discharge. Patients can also be involved in bedside report at shift change.

Disclosure and learning from incidents

• Patients and families should receive an apology when things go wrong, receive the facts about what happened, and should receive ongoing support.
• Patients and families have an important and unique perspective on the details of an incident and opportunities for improvement. Risk managers, patient safety and healthcare practitioners should advocate for involvement of patients and families in incident analysis. This can occur through interviewing the patient and/or family as part of the incident review process. Generally this will entail a narrative of the incident and suggestions on how care might be improved.

Tips for patients and/or families

• Patients and/or families should be encouraged to ask questions about their plan of care; have a family member or friend accompany them to the healthcare organization; always know why and how they are taking their medications; repeat back to healthcare providers what they think they have heard; and always know who is most responsible for their care.

References

• HIROC. (2015). Critical incidents & multi-patient events. Risk Resource Guide.
•  Agency for Healthcare Research and Quality. (2013). Supporting patient and family engagement: Best practices for hospital leaders. Guide to Patient and Family Engagement in Hospital Quality and Safety – Information to Help Hospitals Get Started.
•  Buetow, S, Davis, R, Callaghan, K, et al. (2013). What attributes of patients affect their involvement in safety? A key opinion leaders’ perspective. BMJ Open, 3(8): 1-6.
• Canadian Medical Protective Association. (2015). Supporting patient engagement: What it means for physicians.
• National Patient Safety Foundation. (2014). Safety is personal: partnering with patients and families for the safest care.