Successful healthcare needs active rather than passive patients. In creating more active patients it will be necessary to not only work with medical issues but to include functional, social and psychological issues.
To develop active patients, healthcare organizations need to understand the assets that the patients’ family and carer possess that can be mobilized to better manage their healthcare.
The development of new services that invest in the development of skills and capabilities of patients, their carers and communities to support self-management is a challenge for traditional providers and payers. It may involve:
- New skills and job roles such as coaching and motivational interviewing.
- New ways of engaging to identify patients‘ assets and develop the different options available to them.
- Social prescribing – sign-posting patients to non-healthcare services, for example to reduce social isolation.
- Incentives and new interventions to change behaviors including using social proof and insights from behavioral economics.
- Remote monitoring using technology backed up with case managers.
- Intensive intervention to support the vulnerable or chaotic patients.
- Building and supporting peer networks so patients can provide mutual support.
The emphasis in the discussion of this has tended to be about the technical capabilities to support self-care. The change in culture and in the practice of medicine that is implied by this is at least as significant. Simply adding technology to existing delivery models will not succeed.
Both self-care and shared decision making make demands on patients. In particular they require a greater degree of health literacy and to become ‘activated patients’.
Goal orientated healthcare provides the healthcare organization with the capacity to work with patients to achieve their own life goals. This builds on the purely biomedical view of goals and will often gain impetus from the patient’s own greater motivation to achieve something that they want and can recognize.