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My Rules of [Patient] Engagement

Patient engagement is a big topic and, for most people, confusing.  We are all striving to do it better, but what exactly is patient engagement? Let’s break it down.

Engagement is an experience that captures our attention and invites a reciprocal response.  A couple who is “engaged” has undergone 1) a proposal by one and 2) an acceptance of the proposal by the other.  When this interaction happens, the couple is “engaged.”  Then, of course there is a big engagement party to celebrate!

At what point is your patient engaged?

There are many forms of patient engagement.  I propose that the basic formula is the same, with some significant strategies and tactics to succeed at the different phases of patient engagement.

  • Technical Engagement

When you put something out there in the form of an email, social media post or a web page, you are reaching out to connect.  When people acknowledge and respond in some manner, this is engagement. There are many important facets to this form of engagement.  The most important element is that the images and voice accurately represent the experience the customer can expect in your clinic.

  • Environmental Engagement

Engagement is an experience with your brand. What’s important is that you are consistent with your brand promise and that your engagement generate the experience you desire for your customer. I have a business partner who has a fabulous practice in Anchorage, Alaska with a predominately chronic pain clientele. I have other colleagues who run sports medicine clinics. Each of these environments and the patients’ experience are different. That’s the way it should be.

The physical environment matters.  What does the patient experience when she walks in the door?  Are they engaging with each other in a pleasant and purposeful manner?  What are they focusing on, the phone, their computer, other?

  • Interpersonal Engagement

Although the patient has likely engaged with your brand through a phone call, website chat or other means of real-time interpersonal engagement, I am going to focus on the first contact between the people in your clinic and the patient.  I have studied this extensively and have seen the results of clinics that are aware of this initial interpersonal engagement and those that are not.

The patient walking in your door for the first time is primed to make initial judgments about your clinic, and they do. Their brains will pick up on everything. Their level of conscious awareness will depend on many variables.  As a business owner or leader who is committed to success, I am eager to control each of those variables.

I recently had a patient who said that she knew the minute she walked in, that she was in the right place.  I thanked her for the feedback with a bit of pride and asked her to share with me what exactly helped her come to that conclusion.

She said that when she walked in, she noticed an atmosphere of calm, professionalism and “energy.”  I said “huh?”  She told me it was indescribable, but it was everywhere.

Although this patient of mine was fairly present and articulate in her appreciation of her experience, everyone has a sense of “this feels right” or “I’m not sure about this.”

The “sense” mechanism

Malcom Gladwell provided a very digestible explanation of this experience in his book Blink.  He testified that we all have a built in mechanism to “sense” our environment for the purpose of determining where it falls on a continuum of safe or not safe.  When people feel safe they have the best possible nervous system for a healing response. As a business owner and physical therapist, my aim is to optimize every part of the environment to create this “sense” of belonging. From there, I can achieve the best clinical and business results.

Keys to optimizing patient engagement

I believe that your initial engagement with the patient is part of the treatment process.  At the moment that you engage the patient, he or she is forming the foundation of either a successful therapeutic relationship or one that could easily go off course.

Here are some steps to put in motion to optimize patient engagement that I’ve found can help improve clinical and business outcomes.

  • Create identity with your greeting team:  Ensure that your front office team is clear on their role. They must know that they are part of the clinical team, and that they can have a healing effect on the patient.  When you have the right people who are trained properly, they will “prime” the patient’s nervous system and set up the rest of the clinical team for success.  Simply teaching employees techniques is not good enough.  They need to identify themselves as part of the treatment process.
  • Take the extra steps:  The first encounter with the therapist varies between organizations.  I have worked with some clients who have the PT Technician greet and guide the patient into the treatment space to meet the PT.  Whereby, others have the PT as the first contact.  I encourage clients to make sure the PT is the first to greet the customer on the first visit.  Who greets patients on subsequent visits depends upon the level of training on proper patient engagement completed by the clinical team.
  • Establish rapport rapidly:  Remember, the patient will form or alter their opinion of you within the first 30 seconds.  They will have a sense of your body language, your tone of voice, the pace of your speech, your handshake (if appropriate), and of course the words you use.  They will be aware at some level about whether or not you are truly present during the appointment, and it will impact the remainder of the visit.  Training your providers in these subtleties can greatly influence the degree to which they establish a therapeutic alliance with the patient, which in turn can impact clinical outcomes.
  • Optimize your words: A subset of rapport is motivational language.  The power of words is gaining appreciation by those studying engagement and experience.  I had the good fortune of treating a psychologist who is a nationally recognized expert in Motivational Interview. He strongly suggested that we avoid the phrase “How are you today?” at our first encounter with the patient that day. That phase is often overused and can unintentionally invite the patient down the path of experiencing feelings or to a “state” that may not optimize your treatment objectives. It turns your initial contact into one that is not optimized toward a “feel good” state. To avoid this situation, use some version of the phrase, “Great to see you today”, “I like your necklace” or some other initial greeting that allows the initial phase of the contact to be a feel good one. There will be time after this initial contact to get quality information about their current condition.

Engagement is a two way street

In the health care experience, patients want connection and engagement from their providers. As business owners and leaders, we want patients “feeling” the connection to our brand at every level. In addition to the technical ways they engage with your brand, emphasis must be placed on interpersonal engagement in the clinic. It is a skill that should receive the same priority as teaching the proper exercise prescription. Without this connection with the patient, we run the risk of failing to establish a therapeutic alliance which could result in poor patient outcomes.

About John Woolf

John Woolf, PT, trains individuals and organizations in the successful implementation of Relationship Centered Care™ and the use of Interpersonal Engagement strategies as part of a two day course entitled Strategic Communications as a Clinical Tool for the International Academy of Orthopedic Medicine – US. You can reach John at johnw@patientsuccesssystem.com or jwoolf@iaom-us.com. Follow him on Twitter at @juanlobopt.

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