One thing is clear in the chorus of words about patient care today, there is no consensus on a definition for patient engagement. I suggest we are missing something very important because we have a historical precedent for patient involvement in their care that led to positive change.
In fact it was patients who became a very powerful force for change because they read, they attended classes and they understood they should be partners in the way they received care. They were engaged.
In the 1970s, childbirth education surfaced to help women learn about the normal processes of labor and birth. Their knowledge led to the recognition that many of the interventions we were using were not necessary when mom and baby were healthy. Our “usual care” approach kept family apart during delivery, and the baby was quickly taken to the nursery after birth. These two practices lacked evidence to their benefit for mom and babe. In fact, separating the mother and child in the first critical hour of life disrupted a normal process, where the babe could begin to recognize his mother. In seeing the mother’s face the newborn could then attach to the voice long heard in-utero.
Clinicians who walked the path through these changes, as I did, learned a great deal from our patients. They really wanted us to listen, small word with a big meaning. They had expectations for how a normal labor could be supported rather than usurped by inappropriate interventions. They were learning to breathe with contractions, did not want a lot of medication, and some even rebelled at our NPO (nothing by mouth) insisting their bodies needed to be treated like an athlete in training. They did not want our IVs; they wanted juice, tea and carbs! And they brought us a Birth Plan because they knew we were not listening.
This was an epiphany for those of us caring for pregnant women. Their expectations were not easily accepted, but their actions were the tipping point for birth in the 20th century. It may have taken a decade, but clinical care for women in labor did change to incorporate evidence as we partnered with our patients to achieve better outcomes and greater satisfaction.
I believe it is essential we draw important clues from the “childbirth revolution” and apply them to our turbulent practices today.
Take Away #1: Lessons from our Patients in the 1970’s
In the 1970s we were not measured on how well we listened as clinicians are today through HCAHPS. Listening has been tossed into the pool of myriad measures about patient care today. But let’s not miss the point by assuming listening is about getting a good score for the organization. As clinicians you know your relationship with your patients is healthcare’s heart.
Tuning in, actively listening, is not easy when the schedule is tight and the demands are high but it is the key to trust. Your relationship with the patient may be sporadic if you are the night nurse or it may be long term if you are the primary “doc”; either way it is the most essential component in healthcare.
The two to three minutes you take to sit next to the patient and look at their face are the most powerful moments in this person’s day. They feel valued, they know you care, and they feel “heard” all because you listened to them.
Take Away #2: Culture Change is Trench Work
Did we recognize the importance of our patients expectation in the 1970s and begin to make the evidence based changes ourselves? In some cases yes, but even in the progressive environment where I practiced the idea that a woman would walk in with a birth plan was not greeted with smiles. It took decades for family-centered care to become the norm.
We don’t have the luxury of that kind of time today. The window will close if clinician-patient partnerships are unable to reach the patient centeredness tipping point as the “childbirth revolution” did. Creative ideas are taking hold in some organizations with bedside reports, team rounds, open ICUs, and more. But it is hard work. Habits, or in the evidence lingo “usual care”, are personal changes for each of us and that is never easy. The alternative to remain unchanged, however, is asking to be driven to the cliff or become irrelevant.
Can we go Back to Future with Engagement?