Engagement Begins With Empowerment

I recently attended a lecture by a high school English teacher on the topic of empowerment. She shared the results of an experiment she had done in her classroom where she tried to improve her students’ care and storage of notebook computers used during class.

She described engaging her students by sharing with them how to properly care for and store the notebooks in the classroom. Despite her best efforts, the computers continued to be returned to their storage units haphazardly and sloppily at the end of each class. It drove her crazy. The students, not so much.

The teacher then decided to empower her students to develop acceptable storage solutions for the notebooks and to vote for one that the class would implement. Her results were impressive. The students used their knowledge and skills to develop solutions that were far better than any that the teacher had developed. The solution that won the student vote and was implemented in the classroom kept the computers stored neatly and safety, every day. Problem solved.

As I listened to the teacher tell her story, one sentence stood out to me: “A voice is not power,” she said. The teacher gave her students a voice by engaging them in procedures that she had developed to properly store the notebooks. However, the teacher had not given her students the power to develop the process that they would use every day in the classroom. The classroom experiment demonstrated that when students were empowered to take ownership of the process, they developed an effective procedure (with high compliance) that was not readily apparent to the teacher.

In healthcare, we talk a lot about engagement. Patient and family engagement. Physician engagement. Staff engagement. Much like the teacher who tried to engage her students in established procedures for storing computers, are we in healthcare trying to engage individuals in procedures that we have develop for them, but not with them?

Empowered patients are more motivated to make autonomous, informed decisions. Patients who are not empowered, on the other hand, may only highlight the shortcomings of our cursory engagement efforts, which may be more style than substance.

Empowered physicians may use their unique medical expertise to identify and improve practice conditions in order to provide safe, high-quality patient care. Physicians who are not empowered may not have the authority to influence how patient-centric care is delivered in the hospital setting.

Empowered healthcare staff collaborate at the bedside to identify and meet patient needs on the spot. Staff who are not empowered may only be able adjust to constantly changing “new” strategies developed by senior leadership to adapt to the changing rubrics of a consumer-driven industry.

The World Health Organization (WHO) defines empowerment as “a process through which people gain greater control over decisions and actions affecting their health” and recommends that empowerment be seen as both an individual and as a community process. WHO notes that several components are fundamental to empowerment, including the acquisition of sufficient knowledge and skills.

Working to establish solid health literacy skills for patients, physicians, and staff is a crucial first step in the acquisition of knowledge and skills that are foundational to true empowerment. The Centers for Disease Control and Prevention (CDC) recommends that all organizations involved in health information and services need a health literacy plan. Likewise, the Institute for Health Improvement offers six elements to empower physicians and providers to engage in quality improvement efforts. Staff empowerment is so important that Planetree, a not-for-profit organization that partners with health care establishments to drive adoption of patient-centered care principles and practices, provides a resource that hospitals may use in new employee orientation designed to demonstrate the difference between eliciting employee compliance (engagement) versus one designed to elicit buy-in (empowerment).

Once patients, physicians, and staff have sufficient knowledge and skills and are empowered with a support system in place, the balance of decision making and problem solving (and the consequences of both) become the responsibility of the individual. Empowerment equips people with the knowledge, skills, and confidence to take control over events that influence their lives. It’s this personal accountability that is the critical link between engagement and empowerment.

The teacher’s classroom experiment to improve her students’ care and storage of notebook computers used during class provides an important reminder for those of us in the field of promoting patient-centric care. The true transformation of our health care system must not center on engaging patients, providers, and staff in procedures that have been developed for them without their participation.

It can be challenging to shift and share power, whether in the classroom, the exam room, or the board room. However, it is only by allowing patients, physicians, and staff the ability to mobilize and affect meaningful change will engagement achieve its fullest potential. Utilizing empowerment in the health care setting is a well-designed lesson plan that results in satisfying outcomes for us all.