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Is There A Silver Bullet to Fixing Patient Engagement?

Fashion and makeup retailers tell women they are too old and ugly. Beer sellers and truck sellers tell men they aren’t manly enough.

Why? Because it works

We have an obesity crisis, yet doctors are telling patients they are too big to absolutely no effect.  Why?  Because the biggest issue with low rates of behavior change in patients isn’t non-compliance by patients.  It’s the unwillingness of providers to commit to innovating how they engage with patients.

Right now, most hospitals that do “innovation” make a big fuss about how digital health is the future, and maybe throw money at an innovation center or get grants for research. And make big press around the products that come out of these efforts. The problem is that they aren’t prepared to operationalize their successful pilots because their organization has no channels for integrating these innovations into regular practice beyond a one-off basis.

This is because innovation isn’t building workplaces that looks like Twitter headquarters – it isn’t disruption, it isn’t necessarily upheaval and displacement.  It’s very simply taking principles and practices that are commonplace in one context, and applying them in a new context. That might result in disruption, or it might result in a smooth transition.  Or better yet improve the lives of patients.

One big problem is that the bureaucracy in the hospital world is what insulates the day to day business of care practice from innovations introduced by startups, industry outsiders, individual contributors or c-level forward thinkers. Bureaucracies built to handle regulatory compliance, reduce liability risk, and negotiate billing rates with payers are not built for constantly changing business practices.

Another other big problem is elitism – the thinking that medical practice is somehow different as a business than retail or every other industry. That top down interaction between doctors and patients is the only right way to engage, and that patients themselves are not qualified to have a say in how they are diagnosed or treated.  But obviously if “doctor knows best” were true, obesity wouldn’t be so bad that it is considered a national security threat.

The fact is, many of the communities who need the most support in addressing chronic disease also have a historical distrust of the healthcare system due to years of marginalization, experimentation, and downright lack of basic respect.  The doctor-patient relationship is badly broken and needs to be repaired first before anything else.  Bureaucracy and elitism together prevent us from rapidly incorporating lessons from other industries into how this relationship can be more effectively managed.

So how do we change?

1. Two way communication and information sharing

We need to move away from one way communication between doctor and patient.  Simply ignoring input from the patient if you as a doctor don’t trust the info you are getting from patients can be problematic, if understandable at times.  Ignoring it as a health system means you are systematically excluding your patients from their own care, treating them as objects rather than people.  If as a system, you are getting bad data from your patients, you need to innovate in information gathering so that you can improve the quality of the patient-doctor dialogue.

Additionally, providing patients with the means of getting more involved has been shown to reduce passivity in self-management.  It can be as simple as open access scheduling, or establishing channels where patients can within minutes get a human response to questions that they have.

2. Create space for experimenting

Don’t just talk about change.  Put skin in the game and fund a pilot.  If you don’t have the money, find partners, apply for grants.  Nearly 40% of hospitals operated in the red last year, and fee-for-service is dying.  Waiting for the healthcare market at large to figure out processes for you to follow is a dangerous game to play if you are just treading water and are short on ideas.  Invest whatever you able to in trying out new things, and exploring alternative care delivery and business models.  It doesn’t have to be organizational culture change – even just iterating on solving simple problems that create financial pain or impact patient outcomes can lead to positive progress.

It’s looking very likely that the memo for the next four years at least from the Capitol and White House is to accelerate value-based care. Financial risk will be pushed more aggressively onto providers and patients than with the ACA, which means that providers and patients will need to find more effective ways of working together to manage chronic disease.