Case study: Failure to communicate 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, therefore, he advised her to talk to the staff. However, the staff was busy with other patients. They told her to call them later. However, 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.” This reduces the sensitivity of the study for the detection of cancer. The radiologist did not recommend an ultrasound and described the mammogram as “normal” in the report to the gynecologist. Therefore, a follow-up appointment was not 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 unfortunately diagnosed with breast cancer and scheduled for surgery. Missed opportunities to engage the patient What were the missed opportunities to help engage this patient in her healthcare? If the doctor or his staff took a little more time, would the patient have asked her questions and provided additional information? This possibly could have resulted 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. Further, 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. Patient engagement is a quality measure 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.” Opportunities to engage patients begins when they first contact your practice. And, it’s not just the physician who is responsible for fostering patient engagement. It is, in fact, a critical strategy that must be incorporated into all levels of your practice. That includes the receptionist answering the phone, the physician doing check-ups in the exam room, and everyone else in between. 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 enhance patient safety by reducing the likelihood of adverse outcomes. This also reduces the likelihood of a malpractice claim. 4 things you can do to improve patient engagement To achieve engagement, physicians must be aware of the patient experience within their practices. Consider the following tips: 1. Learn what your patients are experiencing Doctors should conduct regular tests on their systems and processes to see what patients experience in each of the following scenarios: 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. Be sure to use this as an opportunity to open the door to additional communication. In addition, 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 process weaknesses, conduct trainings to educate your staff on patient engagement and its importance at all levels within your practice. Source
