ContinuumCloud’s 2024 Behavioral Health Industry Trends Report was just released. The top priority this year was – no surprise – recruitment and retention, while the second was client and patient engagement, followed by employee development and engagement. The first priority is one that is facing every sector of healthcare and has been the focus of previous columns; given workforce shortages, it is one that will linger for some time, requiring organizations to be creative and far more training opportunities to create workforce before it can be remedied. Engagement, for both client and staff, has direct ties to successful retention, but also poses issues of its own. Staff are best retained if they are aligned with the organization’s culture and that culture focuses on actively involving them in the organization’s mission – as well as providing mentoring and development opportunities.
Defining Patient Engagement
Client/patient engagement are terms heard frequently in today’s healthcare discussions. But what is it? A 2017 study in Patient Education and Counseling (Volume 100, Issue 1, pages 30-36) reviewed the literature on these concepts. They concluded that there are four “defining attributes of patient engagement: personalization, access, commitment and therapeutic alliance.” From these they propose a definition: “the desire and capability to actively choose to participate in care in a way uniquely appropriate to the individual, in cooperation with a healthcare provider or institution, for the purpose of maximizing outcomes or improving experiences of care” (p.30).
These clearly indicate that there are patient, therapist, and organizational factors that contribute to patient engagement. In other words, client engagement results from a combination of effective recruitment and retention and an organizational culture that is patient centric. The latter in turn leads to policies and practices that support a high degree of rapid access, treatment individuation, shared decision making, and ease of communication.
Moving to a Patient-Centric Approach
Behavioral health organizations often struggle to move from a program-centric focus (offering what they get paid to offer, which is limited by what payers consider reimbursable services) to patient/client centric – a highly individualized approach focused on the client’s goals, preferences, and values, supported by the therapist or treatment team’s expertise. This year’s survey results indicate that organizational strategies being considered by respondents to address patient engagement include hiring more clinicians (likely to continue to be a challenge), collecting client feedback to improve services, and providing more patient education materials. These activities, while certainly important organizational tasks, do not sufficiently address a key factor in engagement (and in maximizing treatment outcomes) – the therapeutic alliance. That requires individuation of the treatment experience and commitment to the effort needed for treatment to be effective.
Access to care is certainly driven by sufficient numbers of staff. But the staffing crunch can be alleviated if treatment is engaging. Engaged clients keep appointments and reduce the significant impact that no-shows have on effective use of therapists’ time. Client commitment is often facilitated by transparency. Open notes and other shared decision-making models ensure that patients are aware of the treatment team’s assessments and provide additional opportunities for the client to actively participate in their own care.
Technology can support these efforts. Having information readily available for potential patients to review and consider can provide an engagement opportunity at the outset of treatment. Access and timely enrollment can be supported via a robust patient portal. Telehealth can be used to provide services and supports, as can ready access to materials that support the specific treatment being provided. Contact can be maintained via apps and messaging between sessions in ways that support the treatment process. Care coordination and case management platforms can help coordinate services. Health information exchanges can facilitate communication between the patient and other providers – caretakers, healthcare, and social service providers – involved in the patient’s life.
Creating a Culture that Supports Patient Engagement
In sum, creating a culture that supports patient engagement certainly requires all the proposed strategies – having adequate staffing, obtaining client/patient input, and educational supports. But it also requires an earnest and patient-focused review of corporate culture to ensure that practices align with a model that is patient/client centric; one that supports personalization, access, commitment, and the therapeutic alliance throughout the treatment and aftercare process.
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