Strategies to Boost Patient Engagement in Wound Care

It’s well documented in many medical specialties that patient engagement and visit frequency are directly associated with better outcomes. The same is true in wound care.

Unfortunately, the opposite is also true. Low patient engagement may lead to stalled wounds and, too often, amputation. To heal people’s wounds, we need them to attend appointments, adhere to treatments, and actively participate in recommended lifestyle changes.

The literature also cites countless reasons why patients may not engage in their care. Examples include low health literacy, financial concerns, inadequate social support, problems with transportation, and lack of child care, to name just a few. Although these often are valid challenges, we cannot blame them exclusively. It’s important to look in the mirror and assess how we as healthcare providers can boost or sabotage patient engagement.

Learning how to engage patients

Patient engagement is not a course in medical school, and we are only starting to see limited continuing medical education on the topic. In fact, some may argue that it can’t really be taught. Therefore, this aspect of your practice can start to improve only when you conduct honest self-evaluation and identify ways that you, the healthcare provider, may be contributing to the problem.

It’s worth the effort, not only for our patients but also our own practice outcomes. Better patient engagement saves time and money. It makes us more efficient, helps us control healthcare costs, and prevents costly missed appointments.

Fortunately, there are plenty of patient-engagement techniques we can implement immediately to improve outcomes in wound care. This article offers a sampling of things to consider. For more resources, read “Practicing Excellence: A Physician’s Manual to Exceptional Health Care” by Stephen Beeson, or visit the Agency for Healthcare Research and Quality’s page titled Engaging Patients and Families in Their Health Care.

Make a connection

Healthcare providers have enormous constraints on their time, particularly in the era of electronic health records. It can be difficult to make time to really connect with patients. But it takes only a minute or two, and it can be the difference between good and bad outcomes.

A few easy ways to connect:

• Before you enter the room, take a deep breath. Make sure you have cleared your mind so you can concentrate on this moment and this patient.
• Introduce yourself.
• Sit down, rather than stand.
• Take a moment for small talk, whether it’s about the game last night, the person’s family, or a shared interest.
• Make eye contact early and often. Resist the urge to look mostly at your computer screen. You may even consider not documenting in the room at all. Alternatively, you can sit and really listen, then document immediately after the patient encounter.
• Ask questions to learn what matters to the patient—even if you think you already know the answers. For example, “What brings you in today?” “How is this affecting your life?” “Do you have anyone to help you at home?” “What are your biggest challenges?”

Make the patient part of the team

At the first visit and regularly thereafter, remind the patient that they are an integral part of treatment success. The patient needs to understand that they will have to actively do things to help themself. Consider asking, “This is going to take a commitment from both of us. Are you in?”

Avoid rapid-fire care

Even if you have seen a similar case a thousand times before, remember that this situation is new to this patient. Although you must be decisive and clear, deliver information at a pace that is appropriate to the listener. Consider saving some information for the next visit, if it can wait.

Similarly, when performing a procedure, take care to consider the patient’s point of view. Even if you have debrided hundreds of wounds, perform each one deliberately. Apply topical anesthetic carefully and correctly. Listen and look for cues that indicate that your patient is feeling discomfort, then adjust as needed.

Tell them how it is

It’s important to be empathetic, but you also have to state the medical facts directly and truthfully, even if it may be hard for a patient to hear.

For example, you may need to tell a patient with a nonhealing wound, “This wound isn’t healing because you aren’t controlling your A1C and you don’t adhere to your sleep apnea treatment. I can do a lot to help you, but I can’t change your diet, and I can’t make sure you wear your sleep mask every night.”

You can tell it like it is while still providing hope. For example, a patient might have a very bad wound that isn’t healing, but there are steps they can take that should work. In the absence of true hope, such as a patient who is almost certainly facing amputation, you can provide a soft landing. This might take several visits to set realistic expectations and goals of care.

Stay on schedule, and keep patients informed when you can’t

Appointment delays may be inevitable sometimes. But if your appointments always run late, assess the situation to make this the exception not the rule.

When you can’t help but be behind schedule, simply communicating with patients is essential. Studies show that patients have much shorter perceptions of how long they have waited when they have been kept informed. Therefore, have front office staff keep your patients in the loop, letting them know they are important and not forgotten.

Consult with your colleagues

Physician and nurse colleagues are often in a position to provide very helpful feedback on your approach to patient engagement. And you can do the same for them. Consider asking a trusted colleague to shadow you, or consider sitting in on a few of their encounters.

By William J. Ennis

William J. Ennis, DO, MBA, MMM, CPE, is chief medical officer of Healogics, the nation’s leading provider of advanced wound care. He also serves as the Catherine and Francis Burzik Professor of Wound Healing and Tissue Repair and chief of the Section of Wound Healing at the University of Illinois at Chicago’s Division of Vascular Surgery.