Individual health status is determined by myriad factors: socioeconomic status, education, lifestyle choices, genetic and environmental influences and others. More often than not, hospitals and health care systems see and treat patients late in the disease state. For health care organizations to become more activist and to move upstream, or intervene earlier in the disease state, they must do more to engage individuals and the communities they serve.

Interaction and engagement with health care users can:

  • improve compliance to treatment and prevention plans
  • result in fewer emergency visits and hospitalizations
  • discourage participation in unhealthy behaviors
  • help hospitals and health care systems work with their patient population to improve care quality and reduce medical errors, hospital-associated infections and readmissions

Patient and family engagement has grown in importance and gained recognition because it can improve quality and outcomes of care. In its framework for health care delivery transformation — Health for Life — the American Hospital Association embraces the core tenets of the Institute for Healthcare Improvement's Triple Aim: optimize health, care and cost. The 2012 AHA Committee on Research focused on understanding the dynamics of engagement and examined ways for hospitals and health care systems to address this issue.

Entry Points for Patient and Family Engagement

The 2012 research committee's report, "Engaging Health Care Users: A Framework for Healthy Individuals and Communities," outlines a continuum for engagement from information sharing to shared decision-making to self-management to partnerships, with entry points occurring at four levels of the health care system — individual, health care team, organization and community.

At the individual level, the aim is to increase the skills and knowledge of patients and families about what to expect when receiving care. Engagement strategies include using online personal health records and seeking health information and knowledge. For example, Howard University Hospital in Washington, D.C., provides its diabetic patients access to personal health records to assist them in monitoring a range of clinical indicators pertaining to their health. Those who participated saw their hemoglobin A1c levels decrease by approximately 13 percent.

At the health care team level, the focus is shared understanding of expectations among patients and providers. Strategies include using bedside change-of-shift reports and involving patients and families in multidisciplinary rounds. At Emory Healthcare in Atlanta, patient and family advisers help develop protocols for conducting bedside change-of-shift reports and serve as instructors in training front-line staff. A survey among nursing staff showed that overall partnership was highest in units that used bedside shift reports. Quality outcomes also improved; for example, hospital-acquired pressure ulcers decreased from 8.15 to 2.5 percent.

At the organizational level, the objective is to encourage partnerships and integrate the patient and family perspective into all aspects of hospital operations. Engagement strategies include allowing patients and families to participate in advisory councils, governing bodies and committees as well as using volunteers or patient advocates to support care.

Bellin Health System in Green Bay, Wis.,developed and established an employee health and wellness pro­gram called the Total Health Model. This program improved the health and well-being of participants by using health risk assessment and analysis, offering resources to help employees make sustainable lifestyle and behavior changes, and providing a comprehensive navigation platform to guide patients and ensure they receive the appropriate level of care. Since 2002, the cost of employee health coverage at Bellin has remained stable. An estimated $10 million savings in employee health costs was projected over a five-year period.

At the community level, the emphasis is to expand the focus beyond the hospital setting and find opportunities to improve overall community health. Engagement strategies include providing health education and health literacy classes and using patient navigators and peers to provide support. The Congregational Health Networks, a partnership between Methodist Le Bonheur Healthcare, church congregations and community health organizations in Memphis, Tenn., improves care transitions from hospital to home. More than 12,000 congregants from approximately 400 churches have signed up for the program. A study showed lower health care charges, lower inpatient utilization and higher patient satisfaction for the participants.

The Future of Health Care User Engagement

Best practices for engaging health care users are found in many health care organizations, and the 2012 AHA COR report highlights several programs and initiatives that have been implemented successfully. While awareness of the issue exists, tremendous work is needed to bridge the gap between health care users, providers and policymakers to improve engagement. Doing so requires collaborative partnership among all stakeholders in the industry.

Hospitals and health care systems can lead the transformative element of system redesign in their own communities and serve as labo­ratories for developing, testing, learning and disseminating new engagement practices to achieve the Triple Aim. Topics that are likely to have some significance but require further research include:

  • consideration and integration of behavioral health and mental health as they relate to engagement at all four levels;
  • health plans and their role as significant stakeholders in the engagement process;
  • role of employers as drivers for creating a culture of health;
  • current and emerging technologies that will facilitate patient, family and provider interactions, health education, treatments, and overall engagement;
  • social media to enhance communication and networking with individuals and communities.

The health care system is adapting to the ever-changing needs and demands of health care users. Patient, family and community engagement has the potential to be a "game changer" in health care delivery.

Benjamin K. Chu, M.D., is the regional president of Southern California for Kaiser Foundation Hospitals. He is also the chair of the AHA board of trustees and co-chair of the 2012 AHA Committee on Research.

You can access "Engaging Health Care Users: A Framework for Healthy Individuals and Communities" at