What standardised patients tell us about ‘activating’ patients

Abstract

Context and setting Because of their intensive training in assessment standards and first-hand experience with a wide range of practitioners, standardised patients (SPs) provide a unique source of insight into the patient experience of care. Spurred by numerous anecdotes of SPs becoming more actively involved in their own health and critically concerned about quality of care, we sought to determine whether SPs can be viewed as highly activated patients and to explore what doctors might learn from SPs about the process of patient activation. Why the idea was necessary Patients’ degree of activation (having the understanding, skills and motivation to take an active role in managing one’s health) has been linked to better health outcomes. Activating patients to manage their health and care should therefore be a core goal of doctor practice. How to activate patients, however, is not well understood. What was done A group of 31 (out of 69) SPs who participated in an end-of-Year 3 comprehensive clinical skills examination over 3 years (2005–2008) were included. Data were collected through combinations of in-depth interviews (n = 6), online open-ended surveys (two surveys, n = 26 unique respondents) and one focus group (n = 8) in which SPs were asked to describe the effect of being an SP on their real-life patient experiences and to identify what they looked for in a good doctor. All SPs, who were aged 20–75 years, were professional actors; 55% were men; 65% were White, 23% African-American and 13% Asian. Nearly all were in ‘good’ or ‘excellent’ health. The SPs were trained for at least 5 hours and each evaluated a minimum of 50 students annually; many SPs had years of experience. Responses to open-ended questions were transcribed and coded based on Hibbard’s Patient Activation Framework, which emphasises patient self-management, including effective collaboration with providers. Evaluation of results and impact Most SPs reported that being an SP had substantial effects on their conduct and attitudes as actual patients; these reflect three categories of activation: (i) being a consumer (refusing to continue to see a doctor who did not meet expectations); (ii) doing one’s homework (making sure to ask questions; bringing all relevant information to the doctor’s attention), and (iii) collaborating with the doctor (taking a participatory role, using an understanding of the doctor’s perspective to inform actions and responses). These activated patients also reported that, when looking for a good doctor, they want someone who is first competent, capable and thorough and then seek to find patient-centred care, aspects of which include: being respected, being treated as a person and an individual (25%); demonstrated concern, intent to help (23%); active listening, evidence of being heard (22%); and provision of clear explanations, including the patient in decision making, and instilling trust (each 5%). The SPs in this study appear to be highly activated ‘real’ patients and attribute much of that to their experience as SPs. They believe that doctors are effective when they provide patient-centred care, but also view the doctor–patient interaction as truly collaborative. Further studies should explore how SPs can help us not only understand the central role of collaboration in patient activation, but also how best to use that insight to activate real patients.