Patient Engagement: Finding the Winning Formula

Patient engagement is essential in every aspect of optometric care, from the purchasing and wearing of spectacles and contact lenses, through to the management of chronic diseases and eye conditions.

Research¹ in healthcare shows that when patients take an active role in making decisions, they form a greater understanding and have stronger commitment to the process of their care. They are then able to make informed decisions based on understanding their eye condition and options, and are more likely to take greater responsibility for their health.

In 2018, Optometry Australia researched the likely future for the optometric profession. In its resultant report, Optometry 2040 taking control of our future,2 the Association acknowledged that, “Health care is becoming more consumer centric” and “Consumers must be important partners in this journey”.²

In setting out the path forward, the Association said that to reach its preferred future it is necessary for the profession to, “ensure effective partnerships with consumers and patients that facilitate their empowerment as the leader in their eye health care journey”.

TRUST, COMMUNICATION, PARTNERSHIP

Being recognised as a partner and the leader in a patient’s eye health care journey requires trust.

Indeed, trust is the foundation for any partnership – whether personal or professional – and building trust requires good communication.

In other words, to develop trust optometrists need to demonstrate more than excellent clinical skills – they also need excellent interpersonal and communication skills, also known as soft skills.

The Optometry Board of Australia (OBA) reinforces this sentiment, stating in its Code of Conduct for Optometrists,³ that, “Making decisions about health care is the shared responsibility of the optometrist and the patient (or representative). Relationships based on openness, trust and good communication will enable optometrists to work in partnership with their patients. An important part of the optometrist-patient relationship is effective communication”.

The OBA’s document includes reference to strategies for effective communication between the patient and optometrist.

HOW YOU CAN ENGAGE WITH YOUR PATIENTS

Face-to-face contact with your patient is the most powerful way to interact and build your partnership journey. Effective communication skills, particularly good listening, are the most important skills required.⁵

To solve their individual problems and provide feedback and advice in real-time, you need to make enough time to discuss findings, listen, invite questions and clarify any information. You can support and build on your discussions with digital technology, printed or online resources, trained staff and follow-ups if required.

Compassion and empathy from the optometrist and their staff have been found to be critical to good patient relationships. When you genuinely care and have an interest in your patient as a person, it is easier to be curious and learn more about them. Asking questions about their lifestyle and visual requirements is important and helps you to understand their values. Each point of contact within your practice provides an opportunity for you to deepen that knowledge and for them to learn more about their eye health.

EFFECTIVE COMMUNICATION STRATEGIES

1. Verbal Communication 

To ensure your patient understands your message, it is important to avoid jargon, and instead use simple terms and clear language. Your aim is for them to understand their eye condition and eye health so be sure to meet them at their level. A study on Patient’s Perceptions and Expectations of Professionalism in Optometry⁷ found that, “even patients with a higher level of education expressed preference for the use of simple terms by the optometrist, demonstrating the need for optometrists to be able to communicate at the level of the patient’s preference or understanding”.

Adopt a mindset of curiosity – ask questions and invite theirs to ensure your patient is following the clinical aspects of the conversation and to determine whether you need to go over anything. It is important to ensure they understand their condition before they leave your consulting room. To help with this process, relatable analogies and visual demonstrations that support your verbal and written communication can be useful in the consulting room when explaining eye conditions. Remember that each person processes information differently and has a different learning style. Providing written resources, websites and online information that your patient can access at home will support the conversation, enable them to share with others, and allow some time to process details.

If necessary, schedule a follow-up consultation to investigate options for conditions such as dry eye treatment, myopia management, vision therapy and contact lenses. If suitably trained, your staff can play a role in supporting your information and instructions too. It may also be appropriate to schedule check-in phone calls or emails.

2. Non-verbal Communication 

Non-verbal communication includes behaviours such as your mannerism when you greet patients and introduce yourself. Smiling, making eye contact, paying attention and showing empathy, will make the patient feel comfortable and demonstrate cultural competence and your understanding of their psychosocial and social needs.

Studies⁵ of healthcare practitioners in the consulting room, have found that it is difficult to be warm and engaging when you’re looking away from the patient and typing into a computer. To counteract this negative effect, look at the patient while you speak to them or ask a question – your eye contact will reassure them that you are paying full attention to their concerns and needs. While you enter the information being provided, reassure them that you are still listening, either verbally or with a nod.

3. C.L.E.A.R Protocol 

The C.L.E.A.R protocol is a tool that was developed to guide healthcare practitioners on professional standards of communication:

Connect

Listen

Explain

Ask

Re-Connect

Connect

• Acknowledge your patients, even if it’s non-verbal initially,
• Use eye contact and smile, • Introduce yourself, and
• Keep your voice warm and friendly.

Listen 

• Maintain eye contact and a pleasant expression,
• Use head nods to indicate you’re paying attention,
• Employ ‘active’ listening techniques, and
• Repeat information for accuracy.

Explain 

• Tell your patient what you’re doing,
• Use simple language, and
• Tell them what’s going to happen.

Ask 

• Ask the patient if they have any questions.

Re-Connect 

• Acknowledge them as they leave, and
• Remind them when you will schedule their next recall.

STAFF EDUCATION AND TRAINING

Your staff are integral to building trust and good relationships with your patients. To ensure they are equipped with the knowledge and skills to do this, each of your team members needs to have an ongoing learning and development plan. Their training should be a mix of didactic and hands-on teaching. For example, to upskill them on contact lens management, consider creating a presentation on contact lens wear that includes instructions on insertion, removal care and maintenance. From there, you could place lenses onto the eyes of staff members and teach them how to insert and remove lenses. Doing so will help your staff to have empathy and relate more easily to a patient who has a question about contact lenses.

Similarly, new staff members should be invited to undergo a full eye examination so that they understand the process and what the patient experiences. As part of further training they can have additional tests such as optical coherence tomography, visual field tests and dry eye treatment… For that matter, it is helpful to periodically have the tests yourself so that you can remember what the patient is going through.

The use of role-plays is another excellent way to train staff in various scenarios that commonly occur in practice. Being able to observe how others communicate is a valuable form of learning. Knowing the right phrases and language to use enables staff to approach specific situations with confidence.

NOT ENOUGH TIME?

Making adequate time for your consultations is essential to build patient engagement – it is difficult to provide quality care when you are under pressure and feeling rushed. We all know what it feels like to have a full appointment book with back-to-back appointments, patients running late, emergency squeeze-ins and simply inadequate time to treat multiple conditions and provide all options.

When you’re busy, it’s tempting to save time by reducing communication. However, I recommend that you put yourself in your patient’s shoes and consider how you would feel. For example, although you deal with presbyopia or myopia every day, you need to remember that your patient may be entirely new to the condition. They deserve to have it explained fully, including what the future holds and their treatment options. Additionally, they need to process the information and have time to ask questions. If handled well, there is potential for any first consultation to be the beginning of a long relationship built on trust.

Spending more time with each patient may mean you can’t see as many patients in one day as you once did. While this risks earning less income, it needn’t be the way… true patient engagement in healthcare actually increases income and saves time. Indeed, research shows, “As patients become more engaged with their care, we see higher levels of preventive health behaviours, as well as increased self-management of health conditions”.⁶ 

BENEFITS OF PATIENT ENGAGEMENT

There can be no doubt that patient engagement improves the quality of care you provide and can improve patient compliance.⁴

A better health outcome from increased compliance creates more satisfied and loyal patients. Happy patients are more likely to refer others, thus building your business.

Developing long-term relationships with your patients adds a dimension to practice life that breaks the monotony of “which is better, one or two?”. In doing so, you will find meaning and purpose in your work, which will in turn enhance your personal wellbeing.

This means that patient engagement is good for you, your patient and the healthcare system. The ultimate outcome is a win-win-win.

Lisa Jansen has practised as an optometrist in Western Australia for over 30 years and is now Director of Infinite Clarity Coaching. She held professional positions with Optometry Australia (WA) and the Optometrist’s Registration Board. Most recently she has been appointed in a parttime teaching role at the University of Western Australia in their first ever Doctor of Optometry postgraduate program. 

As a professional coach, Ms Jansen consults with individuals and businesses. She is a speaker, presenter, facilitator and mentor, and her interests are in the areas of communication, leadership and wellbeing. She is fascinated by neuroplasticity and the neuroscience of behaviour, change, and performance. 

Her business, Infinite Clarity Coaching, helps business owners get to the next level of success by evaluating current performance and identifying areas for improvement. Her coaching methods use best practice strategies to assist optometrists to manage and grow their practices. 

Ms Jansen has a unique blend of skills allowing her to bridge the gap between practice management “concepts” and actual implementation of tips and strategies for immediate results. 

References 

1. What Is Patient Engagement in Healthcare and Why Is It Important? tigerconnect.com/blog/what-is-patientengagement- in-healthcare-and-why-is-it-important/ 
2. Optometry 2040. www.optometry.org.au/about-us/ our-organisation/optometry-australia/our-current-focus/ optometry-2040 
3. Optometry Board of Australia Code of Conduct. www. optometryboard.gov.au/policies-codes-guidelines.aspx 
4. Jin J, Sklar GE, Oh VMS, and Li SC. Factors affecting therapeutic compliance: A review from the patient’s perspective. www.ncbi.nlm.nih.gov/pmc/articles/ PMC2503662/pdf/tcrm-0401-269.pdf 
5. Bethke W. The Secret to a Satisfied Patient. www. reviewofophthalmology.com/article/the-secret-to-a– satisfied-patient 
6. Hibbard J H and Cunningham PJ. How Engaged Are Consumers in Their Health and Health Care, and Why Does It Matter? www.issuelab.org/resources/9734/9734.pdf
7. Madadi C, Perumal T, Sibiya CH, Dubazana NR. What Do Patients Expect of Health Care Providers? Patient Perceptions and Expectations of Professionalism in Optometry Practice in KwaZulu-Natal, South Africa. November 2019 Global Journal of Health Science 11(13):135 DOI: 10.5539/gjhs.v11n13p135