In an earlier blog, I wrote about my interest in how stories, through health care and news organizations, can contribute to better health and health care. Research is showing that patient engagement, a key determinant of patient-centered care, improves health outcomes, patient safety and health care costs. In its landmark 2001 report, Crossing the Quality Chasm, the Institute of Medicine urged adoption of patient-centered care by health care providers. Providers now commonly state patient-centered care as a main goal. In this post, I provide a framework of how stories can be targeted to enhance it.

Patient-centered care is a partnership between the patient, family and health care providers that result in decisions that respond to patient needs, wants and preferences.  Two other terms often used in discussions of patient-centered care are patient engagement and patient activation. Patient engagement is the patient’s and family’s involvement in enacting patient-centered care; patient activation is about the patient’s knowledge, abilities and confidence in managing their health and health care, in active partnership with their providers. 

These definitions conceptualize:

• Patient-centered care as the desired outcome.
• Patient engagement as one of two key process inputs to achieving patient-centered care (the other being the provider’s inclination and ability to partner).
• Patient activation as the capacity of patients to effectively engage in their care.

In this framework, process (patient engagement), enabled by capacity (patient activation), determines outcome (patient-centered care). This clarifies where and how stories should be focused to facilitate patient-centered care: encouraging patient engagement and equipping (activating) patients for it. Providers must similarly be motivated and able to play their part. 

Stories focused on encouraging direct care engagement would include that of a patient and his or her physician’s partnership in effective management of the patient’s diabetes in individualized ways that work for the patient. In addition to encouraging engagement, such stories would better enable patient activation to the extent they show patients how to effectively engage in their care and inform the patient about their disease and ways to manage it.  Evidence of activation includes greater confidence and health literacy.

Health care providers are pursuing patient-centered care. This should yield positive results. Stories are a powerful way, for both patients and providers, to learn about and facilitate patient-centered care. The framework I’ve provided points to the best targets of these stories: patient engagement or involvement in the process of care, and patient activation or capacity in effective engagement. Stories that encourage and enhance patient engagement will yield the improvements associated with patient-centered care.