Have you ever had a patient seem to be “all-in” with your treatment plan & goals, only to have them drop off the schedule, no-show, or cancel frequently? What happened? The patient said “sounds good” when you unveiled your detailed plan of care and objective, measurable treatment goals. The patient might have even reported that they felt better after the initial treatment. So what caused them to lose steam and fall off the schedule?
More often than not this problem exists, particularly in ancillary healthcare services like therapy & rehabilitation, because the clinic or treating clinician fails to fully engage the patient in the treatment plan. Take for a moment, the fundamental role that behavioral change plays in a patient’s active engagement in treatment. Obviously, if a patient isn’t motivated to change, either by adopting some new lifestyle habit, or completing their home exercise program, then the likelihood of them achieving their stated goals diminishes. Clinicians, and healthcare organizations in general, tend to miss this point, however. Or at least, they tend to act in ways that don’t take this important factor into account.
Typically, organizations & clinics run patients through standardized processes, which are great for efficiency, but fail to build meaningful relationships with them. And then, once a patient travels through the “workflow” that the administrative offices have put in place for efficiency, they meet clinic staff —and then, ultimately, clinicians— who seem more focused on process and procedure than understanding the unique story of the patient in front of them. This situation leads to a productive facility with high utilization rates, but patient engagement rates that leave much to be desired. Organizations and clinicians who score high on measures such as the CARES Survey (discussed on this episode of the podcast) and other patient satisfaction and engagement measurement tools find a way to strike the balance between cold efficiency & productivity and the reality that each patient is a uniquely different individual with differing biopsychosocial factors that don’t always nicely fit into protocols and procedures. The key to this balance lies in actively engaging patients throughout the treatment process.
How do you engage a patient?
Patient engagement gets touted by academics, administrators, healthcare marketers, and consultants all the time. And for good reason. Patient engagement affects everything from clinical outcomes, satisfaction reports, and even a patient’s willingness to participate in electronic health information exchange systems   . That being said, the literature shows that some efforts to boost patient engagement risk becoming tokenistic or simply fluff and fodder that some PR firm whips together to look good on a billboard or advertisement . When thinking about patient engagement, organizations and clinicians need to truly understand what patient engagement really means.
And that leads to the question: what is patient engagement? At its very basic level, and as I’ve written about in a previous article on doing telehealth right, patient engagement should be thought of as active participation on the part of the patient in the assessment, treatment planning, and plan of care. As I mentioned in this video, an engaged patient is one who takes an active role in their care. Our job as clinicians is to help motivate and encourage patients to step into the driver’s seat in their own healthcare. This means focusing on active treatments & interventions over passive techniques, where the patient is a passive recipient as opposed to an active participant.
Now, all of this begins at the first encounter, that first appointment where the patient comes to your clinic for an initial assessment, evaluation, or consultation. This appointment lays the groundwork and establishes the expectations and context for the plan of care that is to follow. And this usually takes place during the initial patient interview.
The First Appointment
So, how do most clinics & clinicians handle that first appointment? Most often, this appointment serves as the time for the “initial clinical assessment”; a time to obtain the patient & payor information, and to establish the plan of care & treatment goals. We take objective measurements, have the patients fill out various outcome measures & self-reported rating scales, even rate their pain. But in the midst of checking off boxes and filling in forms clinicians and organizations may miss the most important opportunity of this visit: to engage the patient in the process.
Communication, answering questions, and taking time to understand a patient’s point of view, or lived experience, is a crucial part of both establishing a trusting clinician-patient relationship and also engaging the patient in their own healthcare. Since there’s no second chance for a first impression, you need to get this right at the first appointment. And that’s why you need to hone in your initial interview skills.
The One Question You Should Be Asking At The Initial Appointment
I’m going to share with you the one question that holds the key to unlocking patient engagement & buy-in to treatment. I originally heard it when I went through a sales training program through Win Without Pitching. Now, how might a sales training help with improving patient engagement? Well, if you take the approach that a good salesperson merely acts as a facilitator, it begins to make more sense. I’m not talking about the grungy used car salesperson that tries to strong-arm you into buying their sub-par bucket of bolts. I’m talking about a trusted advisor who takes the time to understand your desired future state and then offers options that can help you achieve that end. So, for a moment, forget that this question originally stems from sales, and instead think about this initial conversation with a patient as a time for you to fully understand your patient’s desired future state so that you both can co-create a plan of care to help them achieve that goal.
If so, here’s the question:
For the sake of argument, let’s say it’s 3 years from today and you and I are having a cup of coffee together. We are talking about what’s going on in your life and you’re happy. You’re really happy. My question is: what has happened in the last 3 years that has made you so happy?
Now, you can even hone this in a bit more. Maybe try incorporating something that the patient may have disclosed earlier in your conversation; perhaps a personal goals or specific limitation. But the idea behind this questions is that 1) it’s open-ended 2) there’s no right or “correct” answer 3) it totally focuses on the patient and their own goals, desires, and perceptions about their situation, diagnosis, or condition. Those three factors make this questions ideal for establishing rapport and trust, but also for providing you, the clinician, with more context, background, and insight than you simply obtain from a questionnaire or self-reported outcome measure.
After the Question
Now, while this question has the potential to unlock patient engagement, there is one critical step that must be taken: After you ask the question, you must be quiet, shut your mouth, and take notes! While your patient responds, do your best to practice active listening and show that you’re engaged in the conversation and interested in hearing their answer, and write down (or try to remember) anything they say that could hold a clue or open a window into their own expectations, goals, and desires —not just for treatment in your clinics, but for their long-term health and well-being.
The information your patient gives you through their answer to this question should provide you with insights not only into their short-term desires for treatment, but also a window into their longer-term goals and outcomes. It should prompt you to think bigger than just the diagnosis or symptoms for which the patient may have been referred to your clinic.
Your patient’s answer to this question may prompt you to pull in other team members, make referrals to other specialists, or rethink your initial direction for treatment.
Now, I gave a presentation on the biopsychosocial model for a virtual occupational therapy conference a while back, and someone asked a question about a “win” using the BPS approach. I decided to tell this story, which highlighted this question. Now, I’ve used this question for years in the clinic and not every patient comes back later to say that their lives changed in such a big way, but hey, it’s stories like these that keep us showing back up to clinic every day, right?
At the end of the day, your patients won’t remember the treatment techniques you used, the fancy tools you had at your disposal, or even the “clinically significant” outcomes from treatment. Their experience in your clinic or facility hinges on the your ability to engage them throughout their course of care. And that all starts at that first appointment, with the questions you ask, and your reaction to their responses.
 Needham J, Taylor J, Nomikos D. Integrating Patient-Centred Research in the Canadian Cancer Trials Group. Current Oncology. 2021; 28(1):630-639. https://doi.org/10.3390/curroncol28010062
 Esmaeilzadeh, P., Dharanikota, S. and Mirzaei, T. (2021), “The role of patient engagement in patient-centric health information exchange (HIE) initiatives: an empirical study in the United States”, Information Technology & People, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/ITP-05-2020-0316
 Ennis, William. (2020) “Engagement, an old concept, has a big impact on unwarranted variability and healing.” Healogics. https://n2r8m7y5.stackpathcdn.com/wp-content/uploads/2021/01/Engagement-Quit_Cancel_Final-12.7.2020.pdf
How do you engage patients throughout the treatment process. Do you have any “go-to” questions to prompt patients to share? Share any additional resources that you found helpful in the comments below!
For more informational reads, check out our Insights Page to see all the articles we’ve published to date, recent podcast episodes, and links to past webinars. Click here to head over to our resources section and check out our variety of clinical and professional resources aimed at increasing your knowledge and skills. If you’d like to make some changes in your clinic or health center, and would like some help, check out our consulting and advisement services or contact us to see how we can help you break out of the norm and provide a truly impactful patient experience.
Work With Me
If you’re ready to craft a strategy to help your organization bring in more clients, retain them throughout their course of care, and create uniquely impactful patient experiences, then reach out. I’d love to talk with you about how Rehab U Practice Solutions can help.
What we can help you do:
✅ Train your staff and clinicians to be able to confidently communicate the value your organization provides…
✅ Leverage best practices, new technology, and marketing/messaging to maximize patient engagement & retention…
✅ Develop a system that keeps patients & clients happy, engaged, and satisfied throughout the entire process of care…
We help you not only craft marketing messages & campaigns that build that know, like, & trust value you need to convert leads into scheduled clients; but we also work with your clinicians and staff to make sure that, once a patient decides to schedule an appointment, you have a system setup that keeps them happy, engaged, and satisfied throughout the onboarding, treatment, and discharge process.
In short, we help your whole organization become focused on the most important thing in healthcare: people – the people who work for your organization, and the people who your organization treats and serves.
Rafael E. Salazar II, MHS, OTR/L (Rafi) is the Principal Owner of Rehab U Practice Solutions and the host of The Better Outcomes Show. He has experience in a variety of rehab settings, working with patients recovering from a variety of injuries and surgeries. Rafi has worked in a variety of settings, from orthopedic and musculoskeletal rehabilitation, to academia, and even healthcare consulting. He spent the majority of his clinical experience working at Charlie Norwood VA Medical Center, where he was the lead clinician and clinical education coordinator for the outpatient specialty rehab program. In this role, he treated many veterans with chronic pain and helped to establish an interdisciplinary pain management program. He has worked on projects ranging from patient engagement initiatives to marketing communication campaigns to a multi million dollar project assisting the State of Georgia’s Department of Behavioral Health and Developmental Disabilities transition individuals out of state institutions to community residences. He also has experience as a core faculty member at Augusta University’s Occupational Therapy Program, as a Licensed Board Member on the GA State OT Board, and he serves on the Board of Directors for NBCOT. He works to help healthcare clinics and organizations deliver uniquely impactful patient experiences by improving service delivery through training & advisement and through courses & training programs.