Ultimately, we believe that the patient is in the driver’s seat when it comes to enrolling in DSME in order to pursue improved health outcomes. But we play a critical role in encouraging this effort at the outset and throughout the process.
The process of getting patients enrolled into and participating in diabetes self-management education relies on a series of effective communication experiences among physicians, patients, and educators. The key driver to conversion is how the provider approaches the referral with patients—this is where the process starts. If the provider doesn’t make the referral or if the communication is ineffective, the process comes to a halt.
If the patient makes the decision to pursue DSME, then the way that the doctor supports the patient along the behavior change journey can help shape a successful experience. Our communication with patients throughout the process can impact their motivation. We hope that the patient will be engaged and take ownership of the process, but the more support we can give them, the greater the chance for success.
We asked Dr. Moen a series of questions to help provide some insights into how physicians refer their patients to diabetes education, his method for motivating patients to participate in DSME, and how diabetes educators can improve their communication to physicians about patient progress.
Q: Dr. Moen, please share with us your patient engagement philosophy.
A: Pretty simple: Healing begins when people feel heard. Listening allows us to meet people where they are and establishes trust.
Q: How do you typically refer to diabetes education? What do you say to your patients?
A: “I would like to introduce you to a member of our team.” As we expanded the team with educators, coaches, and pharmacists in the Fairview Health System, we learned that the “warm hand off” worked best. People sense the respect we have for one another. If one is trusted and conveys a visible sense of respect to another team member, that team member starts off on the right foot.
Q: What do you say to your patients to motivate them to continue attending diabetes education sessions?
A: It is very tough to motivate people to attend something they don’t enjoy. I focus on honoring those [diabetes educators] that do this difficult and important job. It is their sense of passion and commitment that motivates patients to attend more sessions.
Q: What do your patients typically tell you after they attend the diabetes education session?
A: As one might expect it is extremely variable between educators on the spectrum from “I don’t think she really likes her job” to “he was an absolute Godsend and now like a new friend.”
Q: What can we (diabetes educators) do to better communicate back to you about the progress your patients make?
A: Honest observations about how patients experience our team. I like to know how we can continue to improve what we do. As a doctor, I find patients don’t share lots of important information with me. Sometimes I think people don’t want to disappoint their doctors; so, we don’t get key information that others do.
Q: What do you feel is the future of DSME/S and where does it fit within healthcare delivery?
A: Diabetes education will evolve to disease management of all types. Right now, payers have disease-management programs. While profitable for the payer, most suffer from low engagement and poor performance. Providers are in the most trusted position to provide this service.
Our challenge is to do it effectively and efficiently. This is why I love what Healthy Interactions has done: the company has developed an evidence-based learning methodology that prompts real learning and behavior change across conditions and cultures. The group setting promotes peer support and efficiency—lots of wins here! The shift to pay for outcomes demands better from us all and this is a great way to get there.
Q: How do we measure our success/outcomes?
A: I like using leading and lagging indicators. Good leading metrics would include something like: do people come and keep coming? (People vote with their feet.) Lagging indicators include HbA1c and other long-term outcomes.
About Dr. David Moen
Dr. David Moen is a physician leader with over 20 years of clinical and leadership experience. Dr. Moen has a proven track record of leading teams in the design, testing, and scaling of clinical delivery models that achieve triple aim results in primary care and specialty settings. His teams at Fairview won three innovation awards from health plans in 2012.