Health care reform, whether governmental, institutional or informal, frequently includes substantial discussion of an increased level of accountability for caregivers. Primary care providers are engaged to serve in a coordinating role for patients – sourcing and compiling specialist providers and diagnoses as warranted by patient needs. States are experimenting with Accountable Care Organizations (ACOs) in various forms to find a method within which improved patient outcomes pair with decreased costs. These changes will eventually result in substantial benefits for patients – and hopefully for providers as well. But often, the idea of patient accountability is missing from the conversation. Even in an accountable care model, the best outcomes will flow to those patients who assume accountability for their own well-being.
In an earlier piece on the Four Stages of Change, also covered in Philips Lifeline’s eBook, Engaging Your Patients in Effective Health Management, we learned how different messaging reaches patients differently depending on their psychological relationship to their condition(s). Here, we’ll look at a few ways to pair this awareness with knowledge about learning styles and accountability triggers. When used together, they provide a powerful tool to boost your patients’ accountability.
The Accountable Patient
Prior to passing the Affordable Care Act in 2010, congress spent years considering ideas on how best to reform the American health care system. Much of the media discourse centered on costs, plans, public options and politics. But in public testimony before committees, experts of every conceivable persuasion proffered their best ideas on how to build the best new plan. Most of the testimony is public record, and much of it is remarkably interesting.
Donald Kemper, MPH, the Chairman and CEO of Healthwise and Founding Chairman, Ix Center Board of Directors, addressed the Joint Economic Committee in May of 2006. His testimony and accompanying written statement is full of great tips for encouraging patient accountability.
After thanking the Committee for hearing his message, Kemper said:
“I have a simple message. The greatest untapped resource in health care is the consumer…The recommendation I would like to make to you today is the most powerful of them all. It is simple — remarkably simple. But it has the power to impact the quality and cost of care like nothing else that has ever come before this Committee. This is it: Prescribe information to every patient. Prescribe information to every patient, at every moment in their care.”
More recently, Kemper has written that three items are critical to “trigger accountability.”
- To know what’s reasonably expected of us.
- To have the information, skills, and tools to do what is reasonably expected.
- To be either economically or socially accountable to do what is expected.
Knowing what’s reasonably expected of us is something many people take for granted. But when you’re trying to get a patient to adopt new behavior and action, it’s important to be explicit. To meet those expectations, the patient may need to learn new skills or avail themselves of community resources that are also new. Especially for seniors, it can be challenging to do new things. Be sure to highlight ways in which action or inaction will have an impact on the patient’s finances, family and friends. Together, an active awareness of these triggers make it more difficult for patients to give up on a plan of action.
Providing this sort of guidance and coaching need not wait until it’s a legislative or insurance requirement. Give your patients extensive information, tailored to their state of change. Make sure to employ each of Kemper’s three factors above. You’ll set your patients up with the best chance to effectively participate in their own care.
Listening and Framing
People generally have a primary sense through which they acquire knowledge. The four most common learning styles are auditory, visual, reading/writing, and kinesthetic. A 2006 American Psychological Society article described a preference for one or another style as, “A learning style or preference is the complex manner in which, and conditions under which, learners most efficiently and most effectively perceive, process, store, and recall what they are attempting to learn.” Well-trained sales professionals often glean this information during their first interactions with a potential customer in order to craft a sales pitch that will resonate especially well. It’s a simple yet powerful tool that can help you frame your conversations for the best chance of achieving patient buy-in.
To get a read on your own learning style, visit VARK and take their free 16-question quiz. Then, listen to the way your patients discuss their conditions and treatment to find out their primary learning style.
If a patient says, “I was looking for information about X” or “I saw a commercial about Y,” it’s likely that the patient is a visual learner. These folks talk in terms of things they “see,” so you should frame your discussions in visual terms (even if you yourself are not oriented visually).
Patients who report “hearing a story about A,” or “a friend telling me that medication B worked well,” are usually auditory learners.
Kinesthetic learners are sometimes difficult to identify. Listen for patients using “feel,” “touch,” and relating situations in which they’re doing the things they’re describing.
Those with reading/writing learning style will describe articles and web resources they’ve read, and may express a desire to email you (write) for further information.
As you might imagine, if you’re primarily visual and your patient is auditory, you’re going to be predisposed to deliver information in terms that won’t optimally resonate with your patient. Practice listening for these learning style hints. Then, work on framing your conversations in the same terms your patients use when describing their own experience.