The term “Patient Engagement” is appearing in pharmacy media at an increasing rate.
But what is meant by this term and is there more than one form of patient engagement?
The quick answer is that the term is not new, but has been expanded to include patient sharing between various health professions.
Patient engagement has always been a feature of community pharmacy, but with commercial pressures (mainly from PBS requirements), some basic elements of patient greeting and courtesy have started to disappear.
So we have decided to review the very basic form of patient engagement in a pharmacy environment.
I mean the opportunity that presents itself every time a patient request is channelled to a pharmacist through a pharmacy assistant or other format such as telephone, email or Internet.
It takes only six seconds for a person to form an impression about someone they are about to engage with, in a personal exchange relating to their health.
It takes practice and concentration to develop the skill of “Patient Engagement” that you may not have thought too much about before.
If you are naturally an outgoing personality and you have the ability to smile, then you have reached first base.
If you can “smile” through the tone in your voice then you are an advanced communicator.
Those of us not so gifted may need to put smile at the top of a checklist.
For example, how do you think you come across when a pharmacy assistant taps you on the shoulder during an intense period of dispensing.
Do you look hesitant, momentarily confused, unsmiling, serious, and avoid engagement by not looking in the patient’s direction?
If so, (and you would be in the majority), you have just made your patient feel as though they were an interruption to your day – not the reason for your actual professional being!
While it is not possible to prepare exhaustively for every type of engagement, you can at least make your initial engagement in the form of a smile and look directly across at your patient, thus making a positive contact.
Smiling confers other benefits to advance an engagement because a smile opens doors by projecting confidence and they make you appear trustworthy.
These are all precursors to create a full and beneficial engagement with a patient.
I once had a conversation with ABC presenter, Virginia Trioli while at a pharmacy conference she was convening.
She told me that her pharmacist had a great manner for patient engagement and she said it had followed on from an enquiry about her medication and a query as to whether she might have had elevated blood pressure.
She was immediately invited to sit down and have a blood pressure reading, with a conversational flow taking place that was regarded as a “knowledge exchange”.
She said that first encounter encouraged her to enter into a self-care mindset and she was very relieved after her third reading showed completely normal and that the daily stresses had just caught up with her for that day.
”On subsequent visits, without any request, my greeting was: ‘Hi Virginia – let’s take a reading. Just take a seat and I’ll be with you in a moment’.
Other staff made sure I was seated comfortably and interacted conversationally.
I was made to feel at home – I would never consider going elsewhere”
The secret to this apparently casual form of engagement is far from its appearance.
And the trust that flows from proper engagement cannot be measured other than in the form of increasing numbers of patient visits.
Much preparation goes into developing strategies for engaging patients and you need a repertoire of these types of “hooks” that will capture a patient immediately and get them to focus on you immediately, which means that you have established a patient engagement.
Of course preparation includes the set up of convenient interview areas (clinical spaces) with varying grades of privacy (see photographs in the article Pharmacy Inertia is Crippling Development – Build Clinical Spaces and Move Into Your Local Area Market Plan and also the article Apple’s Genius Bar – an Opportunity for Pharmacy )
Have files of appropriate information (hard copy or electronic files store on your personal mobile iPad or Smartphone to be able to transfer to a patient if the patient has their own iPad or SmartPhone), a supply of business cards for future contact and have a protocol in place for staff back up (escorting the patient to a seat and ensuring pharmacist phone calls are diverted to a later call back) and a casual replacement to do your original job.
Patient details should be entered into an appointment booking system while the patient is waiting. This process will extend the “allowable” waiting time, because that time commences when an assistant disengages from the patient prior to the pharmacist taking over. That is the “waiting” time.
Do not keep people waiting.
Do your research.
If you know in advance the name of the person you will be talking to, and the subject to be discussed, see if some research is available.
If prescriptions have been dispensed at your pharmacy, the technician ought to be able to run off a drug list quickly.
Even Facebook and LinkedIn these days can contribute to the social history of a patient and provide insights as to what “hooks” can be used to engage that patient.
Use care to not come across as a “stalker”.
Keep a record of your research and your interview and claim any valid intervention fees if they apply.
Manage your interview.
The more you practice patient engagement the more interview requests will evolve and the interviews will eventually be for longer periods.
Here you have to establish parameters in terms of how much free time you will give and at what point do you start charging and what structure is clearly identified to a patient for that charge.
1. Have your price list of fees and charges clearly displayed in the interview area, properly prepared and designed – framed in a photo-frame.
2. Be on time.
If your appointment has been pre-planned through a booking it is very important that you handle this aspect of your patient engagement efficiently. You will be judged professionally on your time management.
If your appointment has arrived casually, you have a window of 2-3 minutes to engage with your patient.
You will be compared to other health professionals, including GP’s in the management of your interviews.
Nothing irritates more (and causes disengagement) if a patient is left in limbo and is not informed or entertained (as a distraction) while waiting.
Proper time management is a measure of responsibility and respect.
This has been reflected in other parts of pharmacy business and illustrated by the ever faster dispensing systems operating through competitive community pharmacies. It is pressure from this factor that has caused patient engagement to lose prominence, because no time or system has been allocated to managing interviews with patients by pharmacists.
“To be early is to be on time; to be on time is to be late; to be late is to be sorry!”
3. Turn off distractions.
There’s nothing more embarrassing than having your phone go off in the middle of an important interview — unless it’s actually checking your phone during the interview and you can include the patient in that process.
The same criteria applies when using an iPad. It acts as a physical divider unless you frequently include the patient in what you are viewing.
Never use lap-tops or PC’s because they create instant patient disengagement.
The best method for computer use is a touch screen embedded in the surface of an interview table where the screen can be rotated by touch so as to involve patients. The advantage of this type of system is a large rotating screen with text of size suitable for elderly patients who may have vision impairment.
This system type does not create interview “blocks” due to size or lack of sharing ability.
The patient is a participant in the touch screen at all times.
Set your phone to silent before you ever arrive for an interview, and, if the vibrations letting you know you’ve been re-tweeted are still too big a temptation, turn the whole thing off.
Phone intrusion is a big flaw for any interview and causes patient immediate disengagement.
Do not allow any overflows from the dispensary to intrude – they are the major “killers” of patient interviews.
If there is a genuinely urgent request always explain this to your patient, ask for permission to attend and give an estimate of the time needed.
4. Record everything through your own portable data storage device, which should contain templates for patient profiles, common information data such as CMI and Self Care files, and other personally developed knowledge files written in lay language.
Without proper patient records you will not be able to extend patient engagement to the shared patient level. Here you must be able to introduce patients formally to other health professionals through a referral note for which you already hold a template file for.
5. Be curious
When it comes to conversation skills, simply being curious will help you truly engage with the person you’re speaking to.
Ask thoughtful questions and really listen to the answer, instead of using the time to plan your response.
Ask people about themselves, even family history if you have any knowledge, to get people to really open up to you and to help them gain a positive impression that you are both interested in them as a whole person, and come across as an experienced, professional and knowledgeable pharmacist practitioner.
Patient engagement can arise from a range of circumstances:
* As a casual request from the front area of a pharmacy
* As a formal request from an existing patient contact
* As a referral from another health practitioner
* As a collaboration with other health practitioners
Patients can be exclusive or shared depending on how and where the contact has been initiated.
If you are working as an independent practitioner, a clear demarcation as to who “owns” the patient needs to be determined through a written agreement.
Always record how your patient found you (by referral from a friend or other health practitioner to you by name, may allow you to claim that patient as “yours” irrespective of what environment the interview took place).
If you are working as a contractor you may be working with say, existing pharmacy patients but providing knowledge services not able to be normally offered by that pharmacy.
Doctors would regard patients taking prescriptions to a pharmacy as “their patient” but few pharmacies would regard that as being the situation if they are providing extensions for that patient in the form of pharmacy care services.
But there are boundaries in shared patient situation and a respectful approach by all parties will lessen tension and possible legal action if things go wrong.
So, sensible patient policies and protocols are essential if “patient engagement” is to be entered into by patients.
They will not support professional relationships where there is tension in any shared arrangements (nor should they have to put up with that situation).
An important part of any patient engagement will be registering a patient on your system and classifying them as yours, shared or belonging to other practitioners.
Having a large database of registered patients will become an important negotiating element when forming future collaborations within pharmacies, GP environments or other health-related environments.
Future events may see medical funds emerge as partners in pharmacy services. Patient databases become the negotiating tool if you are looking to provide a channel for patients to get the most economical service through your practice.
If you do not own and control your own data, you will be made vulnerable – both professionally and financially.