There’s hardly a medical practice today that isn’t acutely aware of the importance of satisfaction scores among its patients. It’s little wonder, since this metric affects so many facets of a healthcare business, from new-patient marketing to referrals and even reimbursement.

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Patient Satisfaction vs. Patient Engagement:
What’s the Difference?

April 6, 2021

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There’s hardly a medical practice today that isn’t acutely aware of the importance of satisfaction scores among its patients. It’s little wonder, since this metric affects so many facets of a healthcare business, from new-patient marketing to referrals and even reimbursement. Now, however, an even more important indicator is emerging: patient engagement. Here’s a look at what it is, how it differs from patient satisfaction and steps you can take to help your patients become more invested in their own care.

Patient engagement

What Is Patient Satisfaction?

According to the AMA Journal of Ethics, the interest in measuring and quantifying patient satisfaction dates back to 1985, with the founding of Press Janey and its development of scientific measurements of patient-satisfaction levels among healthcare organizations. The practice gained traction over the years and in 2002, the federal government became involved in the movement, working to develop the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey.1

 

Today, in essence, patient satisfaction relates to how well an individual patient’s expectations are being met, whether in a hospital, an acute care setting or a healthcare provider’s practice. Many factors play into how satisfied a given patient is with her healthcare provider, from how easy or expensive parking is, to wait times on the phone and in the office, friendliness of the staff, the amount of time spent with the doctor, and how kind, knowledgeable and attentive the practitioner is.

 

Beyond simply being a positive or negative review of your healthcare practice on social media,  patient satisfaction has a larger importance: A 2010 study pointed out that patient satisfaction can affect not only patient retention, but clinical outcomes as well.2

What Is Patient Engagement?

Patient engagement is a newer, perhaps more important, measure and one that is distinct from patient satisfaction. The authors of a 2019 study in Primary Care, in fact, state that it “may be the single biggest lever we have for improving outcomes and decreasing costs in health care today.”3

 

The study authors say that while there is no single, universally accepted definition of patient engagement, it has to do with patients being actively involved, or engaged, in their own care. “Engaged patients strive to be informed about their health, are involved in health care decisions, and participate in self-care,” the authors wrote. “They assume responsibility and accountability for the role their behaviors play in their care outcomes. They self-monitor and provide information; they offer feedback on their experience and outcomes and commit to making long-term lifestyle changes. They take greater responsibility for their health … .”

 

The Healthcare Information and Management Systems Society, meanwhile, says that patient engagement is predicated on healthcare providers and patients working collaboratively to improve patient health. “A patient’s greater engagement in healthcare contributes to improved health outcomes,” HIMSS states.4

Making the Case for Improved Patient Engagement

It makes sense from a healthcare point of view to strive to increase patient engagement, as doing so makes for healthier patients and improved outcomes. But it also makes sense from a business point of view, as patients increasingly want to be involved in their own care and in the decisions surrounding that care.4 And remember, if your patients aren’t satisfied with the type of care they’re receiving (in this case, collaborative care), they’re more likely to either leave your practice or communicate their displeasure online, which is not what you want in today’s viral social media environment.

Here are a few other reasons to focus on patient engagement in your practice:

  • Less-engaged patients are likelier to have unaddressed medical problems

A 2008 Research Brief from the Center for Studying Health Care Change reported on results from the HSC 2007 Health Tracking Household Survey (a sample of approximately 17,800 people with a response rate of 43 percent), which found that among adults with chronic conditions, the least-engaged patients were nearly twice as likely to delay care and almost three times more likely to have unmet medical needs than the most-engaged patients.5

 

  • Patient engagement affects population health.

According to a 2011 study in the New England Journal of Medicine, modifiable behavior causes about 40 percent of deaths. Yet research shows that among people with chronic medical conditions, a full 75 percent fail to keep follow-up appointments and only 50 percent follow up on referrals. They also take just 50 percent of their prescribed medication.6

 

  • Patient engagement can be a triple threat.

A 2013 Health Policy Brief from HealthAffairs reported that patient engagement is so powerful that it can be an effective strategy to accomplish the “triple aim” of better patient care, improved health outcomes and lower healthcare costs.7

 

  • Patient engagement can affect patients’ mental health.

A 2017 study in the Journal of General Internal Medicine found that among patients with diabetes and/or cardiovascular disease, those who were more engaged in their own care were more likely to report fewer symptoms of depression than less-engaged patients. They were also more likely to report better social health.8

video call with doctor on an iPad

How to Increase Patient Engagement in Your Practice

There are many effective, time-efficient ways to help your patients become more engaged in their own care. Here are eight.

  1. Institute shared decision-making where possible.
    Research has shown that shared decision-making, or the lack thereof, can have dramatic effects on patient care. A 2018 study in the American Journal of Surgery found that low levels of shared decision-making was associated with an increased risk of poor physical and mental health scores; lower use of statins and aspirin; and increased emergency department utilization.9 

  2. Develop patient-education materials for common conditions.
    Diabetes, obesity, cardiovascular disease, hypertension, flu and COVID are just some of the topics that might be appropriate for your practice.

  3. Take advantage of social media.
    Research suggests that patient engagement through platforms such as Twitter may help improve some health-related outcomes.10 You might, for instance, choose to post information about new findings related to COVID treatment and prevention. Or if your region is facing the threat of severe winter weather, discuss how to prevent hypothermia and the dangers of carbon monoxide poisoning. 

  4. Establish patient-specific support groups or community forums.
    A 2018 pilot study published in Surgery reported that among 350 unique users of a Facebook support group for liver transplant patients, 95 percent of respondents said joining the group had a beneficial effect on their care.11 

  5. Focus on demonstrating compassion and building trust with your patients.
    Compassionate patient care is associated with better patient engagement and self-care, according to the 2019 Primary Care study. The authors also report on a study that found diabetes patients demonstrated significantly better compliance with medication usage when they had more trust in their healthcare provider.3

  6. Consider instituting the PAM scale to measure patient engagement.
    Endorsed by the National Quality Forum as a patient- and family-centered care measure, the Patient Activation Measure assesses patients based on questions about their healthcare knowledge and commitment to making positive lifestyle changes, among others. The score is then used to assign patients to one of four categories according to how proactive they are likely to be in regard to their healthcare. Those with lower levels of engagement can be given additional supportive resources, such as an invitation to join an online support group.3,12 (For more on the PAM scale, visit https://www.pcpcc.org/sites/default/files/media/Hibbard%20-%20Feb%2028_0_0_0.pdf)

  7. Keep the little things in mind.
    Sit with your patient rather than stand. Turn and face her when she’s talking. Let her guide the patient visit. All of these can help build trust in your patient and help her feel like a partner in her care.3

  8. Consider using these recommended patient-engagement strategies.
    Authors of the 2017 Journal of General Internal Medicine study list several factors that help increase patient engagement, including the following.8

     

    • Motivational interviewing techniques are used when communicating with patients.
    • Patients are encouraged to discuss their home, work and social lives.
    • Certain staff members are trained to act as health coaches for patients.
    • Patients have access to, and can provide information through, a patient portal.
    • Telehealth appointments are available.
    • Patients are encouraged to develop treatment goals in conjunction with their care provider.
    • Family members are included in the care matrix if appropriate.
    • Patients are offered assistance in managing their medications at home.
    • Patients consistently have follow-up discussions with physicians regarding their treatment options and preferences.

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In the modern era of healthcare, with rising costs, reduced reimbursement and ever-faster patient visits, the prospect of instituting patient engagement strategies might seem daunting. But in the end, helping your patients stay engaged in their own healthcare can bring innumerable benefits not only to them, but your practice.

Footnotes:
1 Richard Bolton Siegrist, Jr. “Patient Satisfaction: History, Myths, and Misperceptions.” AMA Journal of Ethics, vol. 15, no. 11, Nov. 2013, pp. 982–87. journalofethics.ama-assn.org, doi:10.1001/virtualmentor.2013.15.11.mhst1-1311.
2 Prakash, Bhanu. “Patient Satisfaction.” Journal of Cutaneous and Aesthetic Surgery, vol. 3, no. 3, 2010, pp. 151–55. PubMed Central, doi:10.4103/0974-2077.74491.
3 Murali, Narayana S., and Craig E. Deao. “Patient Engagement.” Primary Care, vol. 46, no. 4, Dec. 2019, pp. 539–47. PubMed, doi:10.1016/j.pop.2019.07.007.
4 What Is Patient Engagement? HIMSS. 17 Sept. 2013, https://www.himss.org/what-patient-engagement.
5 Hibbard Judith H, et al. “How Engaged Are Consumers in Their Health and Health Care, and Why Does It Matter?” Research brief, Center for Studying Health System Change, Oct. 2008. Accessed Feb. 2021.
6 Parekh, Anand K. “Winning Their Trust.” New England Journal of Medicine, vol. 364, no. 24, June 2011, p. e51. Taylor and Francis+NEJM, doi:10.1056/NEJMp1105645.
7 Patient Engagement. Health Affairs Brief. https://www.healthaffairs.org/do/10.1377/hpb20130214.898775/full/. Accessed Feb. 2021.
8 Shortell, Stephen M., et al. “A Multilevel Analysis of Patient Engagement and Patient-Reported Outcomes in Primary Care Practices of Accountable Care Organizations.” Journal of General Internal Medicine, vol. 32, no. 6, June 2017, pp. 640–47. PubMed Central, doi:10.1007/s11606-016-3980-z.
9 Hughes, Tasha M., et al. “Association of Shared Decision-Making on Patient-Reported Health Outcomes and Healthcare Utilization.” American Journal of Surgery, vol. 216, no. 1, July 2018, pp. 7–12. PubMed, doi:10.1016/j.amjsurg.2018.01.011.
10 Markham, Merry Jennifer, et al. “Social Media for Networking, Professional Development, and Patient Engagement.” American Society of Clinical Oncology Educational Book. American Society of Clinical Oncology. Annual Meeting, vol. 37, 2017, pp. 782–87. PubMed, doi:10.1200/EDBK_180077.
11 Dhar, Vikrom K., et al. “Benefit of Social Media on Patient Engagement and Satisfaction: Results of a 9-Month, Qualitative Pilot Study Using Facebook.” Surgery, vol. 163, no. 3, Mar. 2018, pp. 565–70. PubMed, doi:10.1016/j.surg.2017.09.056.
12 Hibbard, Judith H., et al. “Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers.” Health Services Research, vol. 39, no. 4 Pt 1, Aug. 2004, pp. 1005–26. PubMed Central, doi:10.1111/j.1475-6773.2004.00269.x.

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