Education v. engagement v. experience v emotion v enablement v empowerment

What's the difference and correlation between patient and doctor education, engagement, experience, enablement, empowerment, and quality? Here's how the Chief Experience Officer at the Cleveland Clinic sees it:

But, what about clinician engagement and experience?

Here's my view:

1. I agree that patient engagement is?“actions individuals must take to obtain the greatest benefit from the health care services available to them.”
2. However, engagement starts with education and is a means towards an end-behavior change. Without that, it is a cost . There are many stakeholder engagement models to use. Here's one example . The idea is to move people from awareness to intention to decision to action to advocacy.
3. Physician engagement and experience is as important as patient engagement and experience. Happy doctors make happy patients. However, like most employees, most employed physicians are not engaged and some are active sabateurs. The CEO should be the Chief Engagment Officer (that's different from the Chief Experience Officer), but that role is often turfed to someone else because the CEO is too busy financializing the business instead of focusing on the mission.
4. Engagement is ultimately the responsibility of the patient and doctor that can be assisted by those who provide care or influence physician behavior. Experience, rather, is the responsibility of the service provider.
5. Providing a sick care experience that exceeds the expectations of doctors and patients is the responsibility of those people who provide the care , its processes and the environments where it is delivered
6. In most instances, unless there is meaningful behavior change, engagement and experience have little or no correlation with quality of care. Here is the business case for improving the primary care experience entrepreneurship.
7. Experience, engagement and quality of care require separate metrics and KPIs that are separate and distinct from ecommerce or digital marketing metrics . For example, what does the number of monthly, weekly or daily actives users of your mental health app tell you?
8. There is no consistent agreement on how to define and measure the 3 domains . Here are the problems with the present way we define and measure employee engagement.
9. While behavioral economics has provided us with insights into what makes people do what they do and think how they think, there are significant gaps in its application in sick care . The elusive goal is translating engagment into behavior change that adds value.
10. Patient comsumerism is a myth.
11. Patients and doctors value different things.
12. For patients, conveniencecare trumps value based care
13. The sick care defense is rarely mano a mano. Now it is a care team taking care working with a patient care community. What about their experience?
14. Here is the business case for doctor and patient experience innovation
15. Treat doctors like customers and partners
16. Here is how to enable your direct reports
17. Patients, like all of us, buy emotionally and justify rationally. Consequently, your goal should be to create the right emotional frame of mind so they can make the right choices.

Without a plan, a strategy to gain buy-in can be difficult to achieve. The Institute for Healthcare Improvement put together a framework of six elements to encourage physician buy-in for a shared quality agenda. The framework covers the following objectives and explains why they are important:

1. Discover a common purpose. This forces cultural shift where everyone in the organization begins to think as a system instead of in silos. But not all systems are ready for such a significant shift, which is why it’s helpful to first complete an Improvement Readiness Assessment. This is a systematic analysis of an organization’s ability to achieve and sustain performance improvement based on a three-system approach. The results may show there’s a lot of mistrust that needs to be overcome before the entire organization can unite under a common purpose.
2. Adopt an engaging style and talk about rewards. Identify early adopters, the real physician leaders, and present this new leadership role as a career opportunity for them. This makes it easier to talk about other rewarding efforts they could expect to see, such as a clinician or administrator promotion track and the maintenance of certifications. And then communicate candidly and often.
3. Reframe values and beliefs to turn physicians into partners, not customers. Include physicians in the decision-making process. For example, let physicians lead the planning phases and the teams that are responsible for implementing specific quality improvement initiatives. Then charge them with building the quality program and prioritizing improvement efforts. Also, engage their intellect. Children’s Hospital of Wisconsin engaged their physicians by using an analytics application called the Key Process Analysis application . The application enabled the neonatology group to dive deep into their data to isolate certain conditions where there was truly variation in care versus variation inherent in the patients they were taking care of. But the physicians needed to be allowed to participate in that dialogue together and go through the data to validate it themselves.
4. Segment the engagement plan and provide education. Go ahead and identify champions for the quality improvement initiative. Find the frontline folks who are seen as leaders in terms of the care they provide. Then educate them about the goals for the improvement efforts. Also, provide them with the support and training they will need to gain quality improvement skills.
5. Use “engaging” improvement methods by using data. One of the key pieces to increasing physician buy-in is to use data sensibly and focus on system performance objectives first. Then make it easy to try an improvement effort that doesn’t need to be perfected in the beginning. Physicians are perfectionists. But if the health system can show the benefit to making improvements in a safe manner, even if the improvements haven’t been perfect yet, physicians will realize that quality improvement is an iterative process. With this approach, physicians learn it’s okay to fail, but fail quickly, so they can learn and make adjustments to improve. For example, North Memorial Healthcare adopted an enterprise data warehouse (EDW) with visualization capabilities to enable physicians to get near real-time answers to their clinical quality improvement questions. The physicians could then see how their decisions affected length of stay (LOS) and how specific changes in clinical processes would improve LOS. By accessing the data, it was easier to convince the physicians to make the needed changes.The bottom line with this approach: the more physicians can be made to feel that change is their idea, the faster they’ll get on board.
6. Show courage and provide backup all the way to the board. Let physicians know the CEO will take their improvement plan suggestions to the board for approval, and the board and CEO will understand this is a physician-led initiative.
7. Play the ACE : Awareness, Connection/Content, Engagement
8. Use the right platforms: Match the message to the mindset of your target stakeholder on the omnichannel platforms they use the most and are ridiculously east to use
9. Follow the 3Rs: Be sure your content is repetitive, redundant and relational
10. Use analytics to measure your experiments

Customer/patient journey maps are useful place to start understanding how who, what, where, when, how and why they want the jobs they want done.

Education + experience + engagement enables behavior change (E+E+E=E +Q) and quality improvement that translates into financial impact. However, it does not guarantee it. If only it that were so. Patients and doctors are much too messy, emotional and complicated and they don't make it easy.?Some are getting the Blue Button Blues.

Here is another version of the 4Es: Experience, Exchange, Everyplace, Evangelism It's application to patients and doctors is ongoing and it remains to be seen whether this is a scalable and effective model for sick care, because:

1. The patient and sick care professional experience is substandard
2. Patients and physicians are not used to an "exchange relationship"
3. Omnichannel marketing has limitations when it comes to engaging physicians
4. Patients and physicians don't have enough trust or affiliation with a particular doctor or institution to be evangelists.

Value is always user defined. There is a term for features that don't add user defined benefits-COST. The goal is not to make the average care experience better. The goal is to make the high value care experience better. Just OK quality is not OK even if the experience is great.

Patients need education to enablement in several separate domains: operations ( like referral management and post-acute care options), insurance, and disease education that is individually curated. Robotic process automation might relieve the burden on short staffed and already overburdened sickcare workforce.

Enablement is about giving doctors and patients equitable access to tools. Empowerment is the feeling that results from the willingness to change.

Patient activation measures the results of patient enablement.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack and Editor of Digital Health Entrepreneurship