Integrating Empowerment

Contributed by:

Joseph Gattuso, EVP, Chief Strategic Officer, Ogilvy CommonHealth Worldwide

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The healthcare market continues to undergo a dramatic change that has created a storm of intersecting and interacting dynamics, points of view, and stakeholders. In the face of this increasing complexity, what is needed is the identification of foundational dynamics that clarify and unite this multitude of interconnected and interacting changes. One such foundational dynamic is the changing nature of patient and physician “empowerment.” Gaining greater insights into the changing nature of these relative degrees of “empowerment” through new approaches to research can provide a powerful model for understanding the current healthcare environment — and how we in the pharmaceutical industry can participate in positive changes for the future. Patient Empowerment Is Increasing — But it Can Be a Double-Edged Sword Researchers in our industry have innovated a multitude of empowering content and technologies that are available to patients. Many new research methodologies have turned “technology on technology” to track and analyze the online behavior of consumers and patients, and this shift has provided great insights into their information-seeking behavior. This accelerating role of online access to information and social media, combined with the beginning stages of personalized health diagnostics, EMR, and genomics, is all descriptive of an ongoing revolution in patient empowering technology and access. We continue to become more sophisticated in our ability to understand patient attitudes and behaviors on psychological, social, interactional, and cognitive levels. Innovative uses of new research methodologies — online, in facility, in natural environment, and even in the cognitive laboratory — all demonstrate how increased access to more information and social media is being proactively embraced by many patients. However, these same research approaches have also shown that a significant number of patients have responded to these changes with confusion, anxiety, and “information overload.” Often the gap between the acquisition of information and the ability to apply the information in proactive and positive ways is wide. In our ethnographic and linguistic research in the physician’s office, in pharmacies, in hospitals, and in the home, we have found that patients often do not have a strong conceptual grasp of the information they have gained, or are unclear on how to apply this newly acquired information to make informed medical decisions. We have often found that patient use and understanding of new language is incorrect or imprecise and that their questions remain unasked and unaddressed. Essentially, not enough of “the dots have been connected” for optimal medical decision-making and outcomes. This gap represents a significant opportunity for innovative new approaches to market research and marketing. New research methodologies have a great opportunity to address a significant market need by focusing on gaining greater insight into how patients are understanding (or not understanding), integrating (or not integrating) and acting (or not acting) upon the information they are receiving. Physician Empowerment Has ­Decreased Just When It Is Needed Most Unfortunately, these patient needs often come into direct conflict with the time constraints and pressures (and other disempowering factors) experienced by physicians. A great deal of recent research has documented the dramatic changes that have impacted physicians over the past 10 to 20 years. Insurer influence, decision-making algorithms, the growing influence of groups, institutions, and government have all had a dramatic impact on physicians’ autonomy, time, and compensation. These are pervasive and acute issues with pediatricians, primary care physicians, and psychiatrists, and they have become key issues to varying degrees for all medical specialties. For many physicians, these changes have been profoundly “disempowering” and are perceived as a threat to their ability to practice medicine in a way that is consistent with their expectations and standards. In our research, we have consistently found that physicians directly link these “disempowering” factors with their growing concerns about meeting the information and decision-making needs of their patients. An article featuring the changes in the practice of an individual psychiatrist published recently in The New York Times (March 5, 2011) echoed findings consistent with the extraordinary expressions of frustration that we have observed in research with primary care physicians, psychiatrists, cardiologists, and other medical specialties. Dr. Levin said that the quality of treatment he offers now was poorer than when he was younger. “My office is like a bus station now,” he said in the article. Later in the article he expresses the loss he feels in his professional pride, self-esteem, and his concern for the care he is able to offer his patients. “The sad thing is that I’m very important to them [his patients – ed.] but I barely know them,” he said. “I feel shame about that.” This is in contrast to results from a widely quoted 2008 survey, reported in WebMd and many other media, in which more than 1,000 primary care physicians said they believed that “patients value thoroughness over timeliness or friendliness when it comes to evaluating the doctor-patient relationship.” And consider a recent Consumer Reports (March 2011) cover article entitled “What Doctors Wish Their Patients Knew” based on a survey of 660 primary care physicians in which three of the eight “things physicians wished their patients knew” related directly to time, thoroughness, and the quality of the physician-patient relationship: “Physicians take the long view,” “Respect is a two-way street,” and “Doctors are pressed for time.” Importantly, a fourth related to the “double-edged sword” of online information seeking discussed above – “Research online, but carefully.”So, where do we go from here? Market Research Can Play a Key Role in Integrating Empowerment Fortunately, there are industry changes that can be leveraged to address some of these conflicts and needs – and specific ways that researchers and marketers can support and amplify the promise of these changes. New approaches to market research can play a key role in identifying the current gaps between information access and the application of this content by focusing their efforts on several tactics. 1. By better understanding patients’ needs, marketers can provide better support and learn new skills in the application of information allowing patients to make shared medical decisions with their physicians and/or healthcare professionals. Questions they need to address are: What are the mechanics of the decision-making process? What is the relative decision-making “literacy” of patients? Is the “risk/benefit” of treatment options being offered clearly and comprehensively articulated? Are the reasons and rationale for medical decisions understood and accepted by the patient? 2. By better integrating the content of information with the context of information-seeking, market researchers can obtain a more sophisticated understanding of what medical language and information mean to the patient and how this is being integrated into their understanding and behavior. This will also allow us to better understand their information-seeking behavior. 3. By identifying new and better ways to provide the physician and allied healthcare professionals with support, we can make their time more efficient and effective. These insights can guide the creation of programs and skills that make time with the patient and their caregivers more effective and efficient in the office or institution. Additionally, technology can be used to extend access to the healthcare professional in real time. 4. Partnering more effectively with institutions and organizations that are taking increasing — and at times — enlightened new approaches can improve understanding of the various issues and positively impact patient and professional empowerment. This is new and largely uncharted territory for research that holds great promise. The Research Connection to The Patient Protection and Affordable Care Act (PPACA) and Other Emerging Trends in Health Care Delivery The growth of various models of Accountable Care Organizations (ACOs), the proliferation of Patient-Centered Medical Homes (PCMHs), the establishment of Physician Quality Reporting, and many other new and emerging dynamics in healthcare that acknowledge, address, and measure quality and cost outcomes are being directly influenced by the issues of physician, healthcare professional, patient, and caregiver empowerment that we have discussed in this article. The dynamics of change in the healthcare environment have created new opportunities for more innovative approaches to understanding the unmet needs of the patient and the professional. These insights can and must create a “re-integration of empowerment” so that patient and professional choices that define their relationship and the exact nature of shared decision making are honored and accomplished. With a greater integration of empowerment will come greater patient and professional choice, satisfaction, and overall care. New Approaches to Research of Professional and Patient Empowerment Hold the Key to Greater Health Outcomes and Industry Success Integrating Empowerment Ogilvy CommonHealth Worldwide Ogilvy CommonHealth Worldwide, part of the Ogilvy & Mather network and a WPP company, represents the largest assembly of creative talent in the world of healthcare communications with 65 offices across 36 countries. { For more information visit ogilvychww.com.

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