We all agree on the need for “physician engagement.” I rarely attend a meeting of physicians where someone doesn’t say that the problem with healthcare is that patients are passive, non-compliant and demanding and that a more effective form of “patient engagement” is necessary. Those wails usually sound like an excuse to me for the poor quality and high cost of care that is perpetuated by our collective behavior, but I do agree that effective “patient engagement” is a key strategy in the quest for the Triple Aim or just plain old mundane financial success in a world of value-based reimbursement.
Things change when even a small number of people become engaged around a uniting cause. Lean thinkers like to talk about the power of the square root of “n” (n= the number of people in the group) as being an effective minimum coalition within an organization. That formula probably holds for communities as well. It does not take many people who are dedicated to a cause to make a difference, especially if they are effective with the use of data.
It occurs to me that we treat each part of the Triple Aim as an independently difficult journey. By design all of the goals in the Triple Aim, or if you prefer, the Triple Aim “plus one,” are connected and interdependent. Though each part can be a separate discussion and effort, none of the parts can really succeed without them all succeeding. It surprises me to realize that we are trying to get healthcare professionals to engage collectively but we still talk about patient engagement as a mostly individual activity. We rarely expect much from the community acting in concert.
I must admit that I have frequently assumed that the best way to achieve the goal of improving the health of the community is to ensure the access to quality healthcare of the individuals within that community. I know that the concept of managing a population remains an enigma to most physicians and organizations. Because of patient choice and multiple providers in most communities, it is hard to define populations and geographies that allow anything other than defining virtual populations who must live in a virtual community.
Despite several years of discussing population health, most practitioners show little real interest in thinking about anything other than the care of the individual. The allopathic approach to care, which is to “repair and restore,” still seems like a preference for most doctors. It seems we would rather focus on medicines and interventions for the care of the individual after they are sick or have a defined problem. We have less interest in discovering the complexity of the intermingling of social and physical issues that remain as impediments for creating healthier communities.
We pay lip service to “prevention” but when we talk about prevention it is usually about how to achieve the goal through enlightened individuals. We celebrate efforts at the individual level like exercising more or controlling our weight, but we rarely get into the sort of collective action within a community that improves the environment in such a fashion as to reduce the incidence of problems like drug abuse and obesity. We rarely go up stream to search for the origins of the problems in the community.The environment that ultimately generates the diseases we want to treat is not managed effectively. More than fifty percent of all premature deaths arise from social and behavioral health issues that could be better managed if we were to work together more effectively.
http://www.nejm.org/doi/full/10.1056/NEJMsa073350
For most physicians, patient engagement is the concept of engaging the individual in the treatment of their condition, as described in a recent blog posting by Health and Human Services. The blog post is the testimony of one woman’s journey to developing self management skills for the treatment of her own hypertension and diabetes. Her tale is inspiring and we want to have every patient become as focused on participation in the management of their own care as she is, but we will never achieve the Triple Aim without more coordinated action as a community.
