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Putting People and Patients First

Practicing Patient Engagement in a Meaningful Way.

Like most doctors, I can remember the first time when one of my patients walked into my office with a stack of printed papers in her hands and a long list of questions – all derived from the newly emerging world of the internet. Managing these interactions could feel daunting and even a little threatening. But they were the start of something new: Patients and providers were beginning to engage with one another differently.

Since then, the internet and related technologies have fundamentally changed the way we interact with each other. Now instead of looking at print-outs, I simply turn my desk monitor and sit with my patients to search the net or review their health information together. It’s a joint effort.

What’s more interesting still is seeing how patient engagement has moved beyond individual patient-provider interactions on the front lines to the system level, with patient advisory councils within health care organizations and government-based initiatives and plans that prioritize patient voices.

In early February, Dr. Eric Hoskins, Ontario’s Minister of Health and Long-Term Care, launched the next phase of the government’s action plan for health care. He shared the podium with a representative from Patients Canada as he discussed Patients First: Ontario’s Action Plan for Health Care and the government’s intentions to transform the province’s health system into one that focuses on patient experiences by putting patients at its centre. At Health Quality Ontario (HQO), where I work, we now routinely seek patient input and leadership in helping define and advance our work. To find out a few more ways Ontario organizations and others across Canada are working with patients, click here

It goes without saying that patient engagement has great transformative potential. However the concept (and the way we should practice it) is still in its relative infancy. There are a few important questions we need to collectively consider and address.

How do we best prepare providers, patients and the public for patient engagement?

Providers are still learning how to work as inter- and even intra-professional teams to better understand their respective knowledge and skills in relation to patient engagement. As a provider, I know I want to meaningfully engage with patients, family members and even the public more broadly. (I am not alone in this respect.) But simply “commanding” or “expecting” health system providers and leaders to engage with patients is unrealistic. We need to invest in preparing people for this work and giving them the necessary tools for success. This preparation needs to start as early as during the school years (just as we are doing for inter-professional care); and for those already in practice, we must figure out to how play catch up in a realistic and efficient way.

We also can’t expect patients and the public to easily engage in a system, which often appears complicated in structure, culture and language, without offering help. We must explore ways to commit significant resources to making our work and our world accessible so that patients can also participate in a meaningful way.

How do we engage patients more broadly?

The patients we need to hear from the most are often the hardest to reach. Those who face economic, social, language, cultural, physical and psychological challenges to engagement will need thoughtful and respectful partnership efforts. Involve is one Toronto-based project that is currently targeting difficult-to-reach populations in order to help health planners design services that are universally effective. It’s a combined effort on behalf of the University Health Network’s OpenLab and WoodGreen Community Services, sponsored by the Toronto Central Local Health Integration Network (LHIN). By working with diverse, often under-represented populations, this project is one example of how care can be transformed from the patient level up.

How do we make sure that patient engagement is meaningful to patient outcomes?

Just as health information on the internet was a means to improving health outcomes, so too must broader patient engagement lead to better outcomes. We cannot engage for the sake of engagement. We need to engage in a manner that improves the quality of care people receive in a meaningful way.

These are hard questions, and there are many more we must ask of our health system in order to help it evolve. We must continue to look for thoughtful answers as patient engagement becomes engrained in our everyday lives.

I’d love to hear your thoughts on what patient engagement means to you, how we might answer the questions posed here. Please Tweet me @DrJoshuaTepper and or email You can also read more of my work on patient engagement here.

This article first appeared online in the Medical Post @


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