1. Reid-Ponte, Patricia DNSc, RN, FAAN, NEA-BC


Patient- and family-centered care is a central tenet of nursing practice. This concept has evolved to include patient partnerships, patient engagement, and patient activation. This column differentiates these concepts and describes the core principles embedded in the overriding intention of ensuring that patients (and their families or significant others) are orchestrators of their health and their care plans. In this interview, Karen Drenkard, PhD, RN, FAAN, NEA-BC, CNO, of the GetWellNetwork, discusses work by the O'Neil Center as a leader in this area.


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Dr Reid-Ponte: Dr Drenkard can you tell the readers something about the O'Neil Center within the Get Well Network?

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Dr Drenkard: The Get WellNetwork decided to create the O'Neil Center in 2015 as the research and innovation arm of our enterprise focused on creating, supporting, and advancing the science of patient and family care and engagement. There is both an art and science to engaging patients in their care. We were interested in learning more and creating new knowledge about the relationship between a person owning his/her care journey and the outcomes of care. One of the 1st things we did was embark on a literature review to determine the definition-what is patient engagement, and how does it relate to other concepts that have been in practice for years? We were surprised to learn that there is a plethora of definitions, from individual to system to policy definitions. So we reviewed the literature provided and landed on Coulter's1 definition of patient and family engagement to guide our work. Coulter1 offers that "patient engagement is the relationship between patients and healthcare providers as they work together to promote and support active patient and public involvement in health and healthcare and to strengthen their influence on healthcare decisions, at both the individual and collective levels."


Dr Reid-Ponte: Can you inform readers about some of the other definitions you identified?


Dr Drenkard: Yes, we found 2 definitions that are relevant to current practice, 1 from the Center for Advancing Health, which suggests that engagement includes the actions individuals take to obtain the greatest benefit from the healthcare services available to them. The 2nd captures the notion that patients are involved in their care-actively processing information, deciding how best to fit care into their lives, and acting on decisions.2


Dr Reid-Ponte: What information technologies have evolved in this past decade to make patient and family engagement more accessible?


Dr Drenkard: Technology is at the forefront of patient and family engagement. Healthcare reform has included a set of meaningful use requirements that set forth standards for patients to receive their healthcare data. As a result, multiple strategies involving technology solutions have emerged. One sector is called interactive patient care systems. The concept of leveraging interactive technology is based on the premise that a more engaged patient is a more satisfied patient with better outcomes. This technology has advanced rapidly and is now agnostic, delivered via television, mobile device, laptop, iPad, or app. These technologies include patient reminders, texts, and alerts and can even transform clinical pathways into unique patient pathways-involving and including the patients in their care journey. Everything the patient does can be visible to the clinician in a dashboard that allows insight into a person's capacity to be engaged in his/her care, so the clinician can respond accordingly and live time.


Dr Reid-Ponte: Is there a unique role for nurses in advancing and implementing these innovative technologies?


Dr Drenkard: Nurses are particularly well positioned to transform the healthcare system so that a person can actually own his/her healthcare and wellness journey. Nurses as caregivers now need to add the functions of coach, navigator, educator, and care coordinator to effectively engage people in their care and improve their capacity to engage. The impact of nurses can be enhanced by directly interacting with the overall system assisting the patient in care transitions and working with patients around practical approaches to healthy living, coaching patients around medication adherence, activity level, diet, physiological monitoring such as home blood pressure monitoring, weight management or glucose testing. In this way, the entire team can view the data and coordinate, with the patient and those who are assisting in the patient's care to make collaborative adjustment to the care plan.


Dr Reid-Ponte: What are the trends you are seeing in transforming our care delivery system to actually empower patients to own their care journey?


Dr Drenkard: I have had the opportunity to be in hundreds of hospitals, and I have seen firsthand the efforts being made to more effectively engage patients in their care. The system is not where it needs to be yet. There has been no single aggregate measure to assess a person's capacity to be engaged. Through an interactive process involving consumers, clinicians, and leaders, the O'Neil Center has developed the Person Engagement Index,3 a valid and reliable tool that measures a person's capacity to be engaged in leading his/her care journey. The administration of the tool can be integrated into the care process and then provides understanding a person's capacity to be engaged, allowing the clinical team and the patient to tailor interventions based on where a person is in his/her care journey. By tailoring these interventions, engagement capability can increase, and outcomes can be improved.


Dr Reid-Ponte: What is the call to action for nurse leaders?


Dr Drenkard: Patients don't consistently experience a system that is organized around their needs, values, and preferences. Our systems are still largely organized around the clinical workflow, the electronic health record, and the medical establishment norms and routines. Nurse leaders have a unique role in figuring out how the system needs to change and embracing the role of change agent in designing, developing, implementing, and evaluating system transformation. Leadership characteristics such as being courageous, taking risks, and serving as advocates for patients need to be demonstrated in the important work in transforming the care delivery system. The 1st order of business is to ensure that the voice of the patient is at the bedside, in the boardroom, and everyplace in between. The next is to ensure that nurses have the opportunity to innovate and make change that actually results in improvement. To do this, meaningful information is necessary to manage cohorts of patients so that improving both processes and outcomes is actually feasible. We need to understand that the "healthcare system" is only a piece of the person's puzzle and that it is no longer "our system" that people enter. Rather, we partner with people to engage with us in it. Knowledge, skills, and abilities of nurses and other clinicians will need to include expertise in motivational interviewing and appreciate inquiry skills, coaching and mentoring, and teaching techniques that truly allow people to be engaged in their care as owners of the healthcare journey. We will have to leverage all that the system has to offer in a new way. Nurse leaders have outstanding opportunities to lead the transformation process for patient care based on the patient at the center. Nurse leaders should establish systems where clinicians are not doing things "to" or "for" patients, but cocreating plans of care and setting goals based on a patient's capacity. We should engage patients and their families in that care transformation process and leverage our considerable influence to make changes, monitor and evaluate the impact, and disseminate our work.




1. Coulter A. Measuring what matters to patients. BMJ. 2017;356:j816. [Context Link]


2. Swartwout E, Drenkard K, McGuinn K, Grant S, El-Zein A. Patient and family engagement summit: needed changes in clinical practice. J Nurs Adm. 2016;46(3 suppl):S11-S18. [Context Link]


3. Drenkard K. Are we really patient focused? Time to challenge ourselves. J Nurs Adm. 2016;46(3 suppl):S1-S2. [Context Link]


4. Drenkard K, Swartwout E, Deyo P, O'Neil M Jr. Interactive care model: a framework for more fully engaging people in their healthcare. J Nurs Adm. 2016;46(3 suppl):S3-S10.