My friend Connie always gripes that her doctor tells her more about what ails her than she wants to know. "All I need are a couple of bullet points: "What is it? How do I fix it?" She feels the same way when she takes her car to the mechanic.

Health care providers are in a tricky situation these days. Everybody's urging them to engage more with patients and their families, to actively involve them in their own health care decisions, to communicate. But health care is complex and emotionally charged. And historically, it's been autocratic: Providers order and patients follow — or fail to follow — orders. Some people, like Connie, prefer it that way.

Now that dynamic is supposed to change. Why? Creating tighter relationships boosts loyalty just as consumers become more responsible for their health care spending. Today, they're more aware of their choices, have access to health care rating sites and increasingly "shop around" among providers. The patient experience also has become a bigger factor in the bottom line as HCAHPS scores gain heft in Medicare reimbursement formulas. Moreover, engaging patients is a key requirement for HITECH meaningful use, patient-centered medical homes and accountable care organizations.

Most significantly, when patients are involved in their health care decisions, they often choose less complex and less costly options than medical professionals might recommend — and because they understand and sign off on the choices, their adherence and outcomes are better.

The concept of patient engagement sounds terrific, but executing it means reformulating how hospital leaders and everybody from physicians and nurses to the financial and housekeeping staff prioritize their jobs. "Every single part of the organization has to be patient-centered," stresses Maureen Gaffney, R.N., of Winthrop-University Hospital in Mineola, N.Y. That means every part — from the obvious, like clinical areas, to the not-so-obvious, like billing, where communication between patient and provider is often most fraught.

"We have to move away from models where we're in charge of everything and start taking some risk in letting the patient get involved in the process," says Don Paulson of University Hospitals in Cleveland.

And providers will have to let patients decide just how engaged they want to be. For example, when it comes to end-of-life discussions, "even some families and patients don't want to talk about it," Gaffney says. "And again, that's true patient-centeredness. They shouldn't have to, if that's what they want."

Adds Deborah Dahl of Banner Health in Phoenix, "We need to be cautious to not make health care a full-time job for patients."

Dahl, Gaffney and Paulson participated in a panel of thought leaders we convened recently to sort out what patient engagement means, exactly, and what hospital leaders need to do to make it happen. You can read more of their enlightening conversation beginning on Page 53.

Information technology, of course, is a vital tool to more fully engage patients, and hospitals are doing so through such things as personal health records and social media. Matthew Weinstock reports on those and other findings from H&HN's 2013 Most Wired Survey in our cover story on Page 26.

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