Where medical paternalism ends, patient empowerment begins - but “patient power” only thrives in a healthcare ecosystem where patients are co-producers of health.
Better-informed patients participate and are more involved in their own health. It takes meaningful patient engagement to do that. With healthcare’s power shift to the consumer, Gartner, a global research group, advised healthcare and life science CIOs “to lead digital efforts to improve engagement.”
“Consumer power in healthcare is the ability of consumers, through their individual and collective actions, to control their experiences of health and wellness and, collectively, to exert influence on the behavior of healthcare organizations.” - Gartner, "Healthcare Business Driver: Power Shifting to the Consumer”
As consumers of healthcare, patients have the power of choice - who to trust, what treatment, when, where, and how to take it. Patient participation has already begun at that point of seeking care. The decision to do so is the first step - how that participation proceeds, whether actively or passively, will rely on the patient-provider relationship that ensues.
“A deep understanding [of capacity] is important to our ability to really engage the patient as a mutual partner in their health and health care journey,” says Gary Kaplan, MD, Chairman and CEO of Virginia Mason Health System.
According to the World Health Organization, the development of consumer empowerment and patient involvement and participation helps promote patient safety, and harnessing new technologies is the way forward.
In healthcare, technology is power in the hands of health consumers. It is connectivity in the hands of providers. Technology enables information. Technology enables access. Technology enhances quality of care. Technology provides efficiency. Technology is both a tool and an important solution for patient participation.
When healthcare’s power shifts to the patients, providers need to arm them with the technology that enables them to be active recipients of care, and informed co-producers of health. In the delivery of care, technology as an enabler of patient participation is a platform for engagement, involvement, and shared decision-making.
Patient Engagement
Per WHO, “patient participation starts with the availability of valid, clear and relevant information at various levels.” And this is bridged by meaningful engagement between the health provider and the patient.
In healthcare, engagement is the next step in the communication channel. Communication is dialogue, while engagement is the commitment to that dialogue.
A patient can be communicating, but not really engaged in his healthcare. It’s when the exchange becomes meaningful to the patient that he/she engages. Technology provides a tool for this communication, but the real value is when it is used for patient engagement.
The power shift of healthcare to patients means personalized patient-centered care that provides unique treatment-specific support to a patient from a multi-disciplinary and multi-specialty treatment team. This patient-centered care requires engaging with the patient regularly, and not simply communicating with them, through a combination of automated dialogue and interactive communication with various members of their treatment team. Technology provides that solution.
Transforming communication to engagement needs to be more than just a functionality of technology. A patient engagement platform, such as LifeWIRE, is a communication platform designed to enable personalized and relevant dialogue for the individual and their specific needs. This places the power with the patient when it comes to the choice of when, how, and what device.
Kaplan states, “If health care providers are truly committed to patient health, then they must deepen their commitment to prevention, patient engagement, and care redesign.” He added that patient engagement “...is understanding patient choices and that they do, indeed, have choices. That the doctor is not in charge and that the patient’s in charge . . . if we engage patients that way, we can make better decisions together.”
Shared Decision-Making
In designing care plans, the first step is communicating clearly what the provider and patient need to do as individuals, and what they will do together.
“Shared decision-making is important because many clinical decisions involve value judgements. Health care providers cannot automatically interpret what patients value. Clinical evidence and the patient’s perspective can only be incorporated in decision-making through an explicit interaction between the health professional and the patient in which all relevant information is elicited and evaluated.” - WHO, “Exploring patient participation in reducing health-care-related safety risks.”
Patient participation in decision-making transforms the patient-provider relationship into a partnership. In this respect, shared decision-making is shared responsibility.
It’s when the patient becomes a partner in their healthcare that he is empowered to take responsibility to manage his health, which contributes to patient safety. Additionally, when there is a legal requirement of informed consent, the patient becomes truly informed.
It is important that patients participate in the decision-making - after all, their health is their responsibility. So it is key that patients know the options available to them, to help them arrive at a decision. This is particularly true when it comes to patients understanding the risks and benefits to refuse medical treatment, or to ignore advice given to them.
While the question “How to best achieve shared decision-making - patient pull, or clinician push?” remains, WHO cites that better-informed patients are less likely to be undecided about the best course of action at the end of a consultation. They also seem more likely to adhere to treatment regimens, and less likely to sue their doctor.
There is a caveat, however, which points to the very first step - providing information through meaningful patient engagement/involvement.
Patient Involvement
According to WHO, “good information is a first and very important step towards patient involvement. Content, availability and timing of information are all of crucial importance.”
When providers work with patients, they can get them more involved when it comes to participation. When patients are informed of the goals of the treatment, or given responsibilities and strategies for better health outcomes, it enables real involvement from both sides.
WHO advises that “... patients’ involvement in their own process of care depends on many individual and contextual factors, including age, level of education and pathology. Family history and cultural background, level of health literacy and emotional support are very important in the patient–doctor dialogue.”
Patient involvement in healthcare brings about participation that improves adherence, quality, outcomes, and patient safety. The power shift in healthcare to patients now sees patients increasingly able to question providers - but they are only empowered to do so if they demonstrate involvement in their own health.
The gap between “getting information” and “getting involved” is in the action each one triggers. Access that translates to managing health and participating in treatment decision-making best defines the degree of active patient involvement in care.
Patient participation as co-producers of their own health is the next stage in the power shift in healthcare to patients contributing to better understanding and outcomes .