Patient Engagement: Make It Real

Primary Care Transformation Delivery System Reform Population Health Social Determinants of Health

Knowing your customer is the key to success in all retail enterprises, including health care organizations. Engagement with customers is particularly vital for the competent delivery of high-quality health care. This is all the more critical for a community health center, which typically delivers affordable primary care to a racially and ethnically diverse high-need population confronting numerous social and economic barriers to positive health outcomes.

Ensuring that patients are true partners in determining the priorities of any health center is one key to successful patient engagement, and to improved health outcomes. That statement is easy enough to write—almost no one will disagree. Yet the realities of practicing community medicine, whether in urban or rural America, show that maintaining patient engagement is essential, but not easy.

In Supporting Meaningful Engagement through Community Advisory Councils: Lessons from the Oregon Health Authority, Community Catalyst profiles a broad and largely successful program committed to bringing Medicaid patients into the decision-making process for Oregon’s coordinated care delivery system. Oregon has made patient engagement a central obligation of its coordinated care organizations. It has dedicated meaningful dollars to build an infrastructure to engage Medicaid recipients in the decision-making of the organizations’ policies and practices. It seems to be working.

For those of us at community health centers, zealous efforts to win patient engagement in organizational advising and governance are nothing new. Since 1973, hearkening back to the Nixon administration, federally qualified health centers (FQHC) have been mandated to incorporate an influential patient and community voice in setting organizational direction. Success, across the country, is mixed.

At Community Healthcare Network (CHN), an FQHC that operates 14 health centers and a fleet of mobile vans throughout New York City, efforts to engage patients are both informal and formal. These activities are ongoing but are not sufficient.

Informally, CHN has a series of patient feedback channels to bring issues directly from patients to health center and organizational leadership. There is the simple suggestion box and a hotline for patient recommendations and complaints. The experienced nurse who leads CHN’s quality improvement initiatives manages these messages and reports them to senior management, including the CEO. Routine feedback loops and frequent focus groups characterize our patient engagement with specialized patients, especially those receiving HIV care. Other specific CHN programs, such as one that connects people to primary care as they leave incarceration, aims to directly engage patient input by hiring peers to deliver key services. Similarly, a program aimed at supporting trafficked transgender women hires staff with shared life experiences.

Federal regulations governing FQHCs mandate a degree of consumer involvement. One rule requires that a majority of board members are patients of the organization’s health centers. The creators of community health centers believed that board membership would ensure patient engagement at the highest level of the health center decision-making. In practice it has not been so simple.

In the early years, FQHCs were often small storefronts offering basic medical care in rural and urban America. While their mission has not changed, health centers in many areas are now sophisticated health care delivery systems with annual budgets running into the hundreds of millions of dollars. As a result, these large complex organizations require a governing board with an array of skills: financial, medical, legal, human resources, political, and accounting, to name a few. Creating a board comprising members who have these skills as well as members who can serve as patient representatives requires recruiting people from a variety of socioeconomic backgrounds.

Ensuring that all voices on the board are heard requires, as in Oregon, resources and sensitivity. A concrete example is supporting board members with tools as needed, such as selectively providing phone cards to cover the cost of multiple governance-related phone calls. Consumer board members can also sometimes benefit from governance training.

Our Community Advisory Boards also allow for enhanced patient engagement. These boards, composed of local community leaders and patients, operate at each health center. They bring together up to two dozen members from a wide range of backgrounds for regular meetings with health center leadership and are invaluable in making sure CHN’s strategies align with the needs of the communities we serve. We loop in our community-based organization partners, as they facilitate critical connections with local providers of services that address social determinants of health like housing needs.

Balancing the priorities of the varied Community Advisory Boards members is an art, not a science. To that end, last year CHN invested in working with the Industrial Areas Foundation, training our health center directors to identify grassroots leaders, and seeking out patients best equipped to advise on organization direction and community need.

In Oregon, one of the most important components of achieving genuine patient engagement was bringing together, in person, the various Community Advisory Councils from across the state.  Community Catalyst found that face-to-face meetings make a large difference in the vitality of patient engagement. Together with its patients, and hopefully soon in person, CHN plans to continue to work toward our goal of fully aligning our health center priorities and actions with our communities’ needs.

Robert M. Hayes is president and CEO of Community Healthcare Network, a federally qualified health center.