akhisingh: Relationships: The key to successful engagement

Children's Wellness Experience Lab The other day I found out that the Latin origin of the word doctor is doctoris, which means, ?to teach.? This got me thinking? what is currently happening in the education space that the healthcare system can learn from?

Our country?s education system is currently in the middle of a long-overdue disruption, and the role of the teacher and the ways they?re engaging their students is drastically changing. Teachers across the country are experimenting with new ways to run their classrooms ? pushing their methods beyond the traditional lecture style, where instead of feeling talked at, it?s more hands on and interactive, and therefore more engaging. Teachers? role has shifted to be more ?facilitators of learning?, where they are a supporting guide in equipping students with the tools they need to navigate content on their own, encouraging students to become partners with them in their education.?

Now that we are down in Dallas, Texas working with the Children?s Medical Center trying to understand how the primary care experience can be more patient-centered, I can?t help but see the connections between the two social systems. If we were to apply what we?ve learned in the education space to health care, how could we help doctors become more ?facilitators of wellness? ? or teachers of health? Could doctors form partnerships with their patients and make health more tangible and relevant, thus resulting in more positive health outcomes?

When talking with teachers across the country during our Feedback for Teachers project, many of them reported believing that the key to student learning is having a foundation of trust. Over a year span a relationship is built and because of the rapport that is established, the student is able to be transparent and open with their teacher. The teacher understands them and knows how to communicate best with them and, as a result, is able to effectively engage them in learning.

Patient engagement is a topic that has been getting a lot of buzz recently within the healthcare space. Everyone is trying to solve for it, hoping that by understanding how to engage patients, it will result in increased positive health outcomes. An abundance of innovative solutions are rising to the surface, from technological interventions to community-based health workers on the ground. Even though these solutions might be addressing the right problems, one of the biggest issues that needs to be understood revolve around relationships. However, the current healthcare system is not designed for relationship building, which makes it difficult to effectively engage patients. It is a system built on efficiencies and risk management. Doctors? days consist of appointments upon appointments, with barely any time in between. Each appointment is too often limited to a short 15 minutes (far from the whole year that teachers spend with students). This short amount of time is supposed to cover an immense amount of things - including, catch up time on the patient?s situation, discussion, diagnosis, and explanation of treatment. Building a genuine relationship can be time-consuming and therefore take the back burner. But without it, mistrust, miscommunication, and lack of compliance can result.

Clearly, patient engagement is important but how is it achieved? If we look at Common Core Standards in education, which are the standards that students are expected to learn and are then tested on - there has been movement from students having no understanding of the system to teachers now acting as the mediator between students and the system. Teachers now help them understand what the standards are through easy to understand, obtainable chunks.

How can doctors and the other players within healthcare make the system easier to understand? With a huge push towards the use of electronic health records after the HITECH Act was put in place, many new opportunities have opened up in relation to communication, documenting, and sharing health information. The records no longer have to be cryptic dense documents held in filing cabinets behind the doctor?s office reception desk. Instead, they can be digital, shared documents to which patients have access, can use to better understand what the doctor told them, and remember what they need to do. However, patients should not only have access, but also be able to contribute to their own health records, allowing the record to be collaborative and give the ?full picture? of the patient.

In his blog post around patient engagement, Robert Lamberts, MD writes, ?The problem is, documentation has taken over health care [...] We are paid to document, not communicate. Communication takes time and it is not reimbursed. Communication prevents unnecessary care, which is a revenue stream [?] Engagement is about interaction, listening, and learning in relationship to another person. Engagement is not a strategy, it is care.?

During our foundational research for this project, we spoke with a lot of families who are living in isolation from those around them, which in many ways has impacted their health negatively. Families are looking for people who they can trust. They are craving it. Imagine if their doctor was part of a family?s trusted support network, alongside their neighbors, community leaders, and family. Imagine if healthcare was built around relationships - encouraging and supporting one another to be lifelong citizens of wellness. How would this impact how patients engage in their health and wellness?

Stay tuned for our findings as we explore the future of primary care for children and families in Dallas in the next several months. You can find our foundational research around health and wellness for children and their families in Dallas here.