Over the last decade, engagement has been a consistently evolving strategic management term, first from the perspective of employees and more recently in healthcare with a line of sight on patients and families. In the simplest of terms, I see engagement as the involvement that someone has in a process or effort. Common discourse has had it tend to the positive by asserting employee engagement is a desired state versus just an action or behavior. Recent research (Shuck and Wollard, 2009) on the term employee engagement noted that with its rapid increase in use the definition of engagement has become muddied. Yet across the descriptions of this phenomenon there was consistency in describing engagement as a personal decision (not an organizational one) and one grounded in individual behaviors (as they relate to organizational goals).
This has significant implications for both employee and patient engagement. In the end it is about creating the environment in which individuals can choose to actively engage. Organizations cannot create engagement. Rather they can create the environment and reinforce the behaviors in which engagement can grow and thrive. This has significant implications for our work in healthcare overall.
Some have said that patient engagement is the latest buzzword for how we work to involve patients and families in the overall care experience. As a concept it has ties to safety and quality and links to the discussions on the application of meaningful use. Patient engagement is focused on ensuring patients take actions in order to obtain the greatest benefits of the healthcare services available to them.
The Nursing Alliance for Quality Care (NAQC) has deemed patient engagement “a critical cornerstone of patient safety and quality”. Their efforts have outlined a comprehensive set of nine principles to consider when engaging patients in their care. They stress “the primary importance of relationships” between patients, families and providers of care as key to effective engagement overall. This work stresses the foundation of relationship and partnership as central to the care experience.
These ideas are essential elements in how we identify experience overall at The Beryl Institute. At the very heart of the definition of patient experience is every interaction that occurs between a patient, family and the healthcare system in which they find themselves, from the deepest of relationships to the briefest of encounters. I believe we need to consider engagement more broadly and link its contributing values to the cornerstones of quality, safety and service. Together, quality, safety, engagement and service establish the legs on which the most comprehensive and positive patient experience can be built.
The same perspective can be taken when looking at the employee aspect of engagement. If engaging employees is around the behaviors of individuals that contribute to the goals of an organization, there is truly one means by which we can influence this action – the culture on which we build our very organizational existence. This leads us again to how we define experience at The Beryl Institute.
In reinforcing that the patient experience is “the sum of all interactions”, as we noted above, “based on an organization’s culture”, then healthcare organizations must have a strong commitment to not only create a positive environment for our patients and families, but one that supports the efforts of our staff, employees, and associates as well. In my travels to hospitals on behalf of the Institute both in the U.S. and abroad, I am continuously reminded that there is great power in the culture of an organization to drive excellence in experience. It is the foundation on which care givers and those that support them act and it shapes the environment in which care is delivered.
In considering engagement, I encourage us to move beyond the concept as a “nice to have” in our organizations, to a “must have” if we are to provide the best experience for patients and families alike. Engagement is not what we directly create, it is the result of doing the rest right – of creating vibrant and supportive cultures of service, quality and safety – of care at the highest order at every touch point across the continuum of care. If we do so and do so well we ensure the greatest of perceptions from our patients and the unparalleled experience we would want for our families and ourselves and we know they undoubtedly deserve.
Jason A. Wolf, Ph.D.
The Beryl Institute