If you’ve been in practice for any amount of time, you’ve surely had at least one less-than-engaged patient—probably more. You know, those patients who aren’t all that enthused about their sessions. It’s not that that they’re not satisfied with your services (although that certainly could contribute to the problem). It’s simply that they’re not connected. They’re showing up because they have to, or because it’s the least they can do—if they’re even showing up at all. But beyond that, they’re pretty much bumps on a log who are just going through the motions to complete their plans of care, and that’s surely going to produce less-than-ideal outcomes. While you may be tempted to put the onus on them—it is their health, and they should care about it—it may not be entirely their fault. Because if you’re not sure how to engage patients in their care, then you may be partially responsible. Plus, subpar outcomes are not only bad for patients; they’re also bad for your business.
So, what can you do to keep your patients engaged in their care? For starters, you can celebrate therapy wins. Here’s why harnessing the power of positive reinforcement is so important:
Positive reinforcement can shape behavior.
If you have children, nieces, or nephews—or, if you’ve ever babysat—then you’ve probably seen the power of positive reinforcement in action. After all, it’s a fairly common strategy for teaching little ones to repeat a desired behavior. In fact, in the 1920s, American psychologist BF Skinner “posited that behavior is determined solely by its consequences—either reinforcements [positive] or punishments [negative].” In other words, Skinner believed that “people can be manipulated to exhibit or inhibit a behavior based on [the nature of the] consequence.” Skinner is actually credited with coining the phrase “positive reinforcement” as a result of his work with pigeons, finding that “reinforced behavior tends to be repeated and strengthened.” Some of his critics found his theory to be too simple—that rewarding a desired behavior with what they saw as “a bribe” would only amount to short-term behavioral change—but many researchers still see the benefit of this strategy today. For example, Dr. Rita Eichenstein, a pediatric psychologist, believes that “positive reinforcement is probably the most effective method of shaping behavior.” According to Alex Lickerman—the author of this article—“Positive reinforcement is generally accepted to be superior to negative reinforcement in changing behavior as it leads to more lasting behavioral modification.”
It’s ideal for patients.
And this strategy is not just for children, which is why numerous articles—including this one—tout the benefits of positive reinforcement in the workplace. With that in mind, it would follow that positive reinforcement can benefit patients as well. After all, when patients feel a sense of accomplishment—and when you praise them for that accomplishment—they are more likely to continue the behavior that led to their success. Interestingly enough, in this article, the author cites an observational study that was conducted by Dr. Darcy Reed and her team at the Mayo Clinic on professionalism and positive reinforcement for physicians-in-training (i.e., residents)—folks who notoriously see little in the way of encouragement. According to Reed, “Negative reinforcement is so defeating. There are far fewer people who need negative reinforcement than those who need the positive.” Unfortunately, for residents, most of their educators aren’t “comfortable with positive reinforcement”—it’s just not a part of their culture—and even the ones who are willing to try out some positive reinforcement aren’t sure which behaviors to encourage.
It’s also ideal for rehab therapists.
Luckily, for rehab therapists, that’s not a problem—because you know exactly which behaviors to reinforce with your patients (namely, the ones that are contributing to their success). And it’s all fair game. Here are a few examples of how you could celebrate a patient’s therapy gains—without confetti:
- If a patient regularly completes her home exercise program, then pat her on the back and share with her the many reasons why continuing to do so will improve her condition.
- If a patient increased the range of motion for his shoulder, then provide him with the actual data, tell him what a great job he’s done, and explain how this will positively contribute to his overall recovery.
- If a patient made it to every one of her scheduled appointments without canceling, share with her why that’s meaningful to you and how much you appreciate her punctuality.
- If a patient improved in functional ability according to the patient-reported outcome measures you’re using to monitor patient progress, then share the good news as well as what this means for his plan of care.
In other words, make it a point to positively reinforce the behaviors that you want to see your patients continue. And be sincere about it, because patients can smell a phony cheerleader from a mile away. Additionally, keep in mind that data matters. Just as a vague “good job” doesn’t make for very meaningful employee feedback, generic praise is not nearly as encouraging to your patients as specific statements that clearly address their accomplishments. And one of the best ways to ensure you always have data to highlight is to establish a comprehensive outcomes tracking program.
It can improve patient engagement.
As if positive behavioral change weren’t enough of a benefit, this type of genuine encouragement—and information sharing—can dramatically improve patient involvement and engagement. In this blog post on patient participation in outcomes tracking, WebPT’s Lauren Milligan cited this passage from a 2008 policy brief from the World Health Organization (WHO): “One of the most common sources of patient dissatisfaction is not feeling properly informed about (and involved in) their treatment.” And there’s good for reason for that, because “as patients become more involved, their knowledge improves, their anxiety lessens and they feel more satisfied.” Milligan also included this statement from a Families USA publication: “patients who are more involved in their health care are happier with their health care decisions and are more likely to follow treatment plans, which can lead to better health outcomes.” According to this Athenahealth page, true patient engagement goes beyond “patient communication or education” and “online patient portals.” Rather, it’s about these three things:
- Patients having “the knowledge, skills, ability, and willingness” to “manage their own health and care.”
- The healthcare organization maintaining a culture that “prioritizes and supports patient engagement.”
- The patient and his or her provider(s) actively collaborating to “design, manage, and achieve positive health outcomes.”
And engaged patients make better patients.
If you’re not already convinced that keeping your patients engaged is important, then consider this: According to WebPT’s Brooke Andrus, patients who are engaged in their care have several important qualities that make them ideal patients. These include:
- They’re proactive (as opposed to reactive).
- They’re invested in their plans of care.
- They know the value of the services they’re receiving and how it impacts their overall health goals.
- They understand that their habits and behaviors outside of your office (hello, HEP compliance!) impact their results.
- They’re committed to working with the “best, most qualified providers available.”
Now, it’s important to note that harnessing the power of positive reinforcement doesn’t mean sugar-coating patient feedback—and it certainly doesn’t mean withholding important information about their progress if it’s not entirely positive. It simply means skewing your focus to the positive, so that you’re able to identify the behaviors you’d like to see consistently—and then celebrating them.
What do you think about celebrating therapy gains? Have you tried positive reinforcement with your patients? If so, tell us how it went in the comment section below.