May 2022

Positive Assessment for Better Patient Engagement

by Alan Schlechter, MD, Jennie Byrne, MD, PhD, Natasha VanWright, RN, MBA, MS, Ramon Jacobs-Shaw, MD, MPA 

The past few years have sparked much discussion about what constitutes ‘good science.’ Although scientific research, by nature, builds from past knowledge, surviving a global pandemic in real-time has not afforded us the luxury of historical perspective. As a result, for far too many people, the crucial line between fact and fiction has been blurred on the subjects of healthcare and public health. 

At Belong Health, we constantly challenge the status quo by addressing sobering facts head-on and by focusing our attention on some of the biggest challenges in healthcare. One such challenge involves solving the ongoing puzzle of patient engagement. 

How do we grab and hold the attention of some of the most marginalized and overlooked populations in the American healthcare system? How can we better understand patients’ wants and needs and work with them in ways that leave them feeling fully understood? How can we increase patients’ motivation to engage in their own care by keeping them at the center of their own decision-making?  

Fortunately, Belong Health’s Chief Patient Officer, Dr. Jennie Byrne, has been instrumental in deepening our understanding of how best to work with patients as they chart their respective futures. As a psychiatrist, a researcher, and the founder of a thriving clinical practice in North Carolina, Dr. Byrne routinely creates environments in which patients feel heard and valued. She achieves this outcome by ensuring healthcare employees feel truly supported, too. 

Recognizing that if a practice is to thrive the people who work within it must thrive as well, Dr. Byrne turned to the research of Dr. Alan Schlechter, a Child and Adolescent Psychiatrist at NYU Langone Health, for a deep dive into best practices in patient evaluation. Dr. Schlechter, who teaches an NYU undergraduate class called “The Science of Happiness,” has spent the last 12 years studying how to teach well-being to students and to his patients alike.  

His strategy of choice? A tool called ‘positive assessment.’  

 

What is Positive Assessment? 

Most clinicians begin an intake in a way that seems intuitively correct: by asking what is wrong with the patient. Inherently, this perspective focuses on negative, rather than on positive, feelings. Dr. Schlechter, however, believes such a process is worth upending. After all, there could easily be other, more engaging, and supportive ways of initiating interviews with patients. 

While it is obviously true that positive and negative emotions make us feel certain ways, it is less commonly understood how often they result in us thinking differently, too. For over 30 years, Dr. Barbara Fredrickson a researcher from the University of North Carolina, has studied the value of positive emotions, as well as the actions (or inactions) positive and negative emotions can spark. Dr. Fredrickson found, as just one example, that negative emotions encourage action. Fear causes a person to run away, while anger tells a person they should speak up or — as some parents often find — scream and shout. 

Positive emotions, according to Fredrickson, are routinely less associated with action and are instead connected more deeply to changes in how we think — and ultimately to more accurate and efficient cognitive processes. High school students who have just experienced positive emotions, for example, remember more words in a foreign language, answer more questions correctly on a practice SAT, and are much more likely to verbally parse through a challenging issue. In other words: feeling happy leads to better brainpower. 

To test out this theory, a recent study by Dr. Schlechter examined two groups of doctors: Group A interviewed patients in the ‘traditional’ way (i.e., focusing on what is ‘wrong’ with the patient) while Group B began interviews by discussing the patient’s well-being or asking them about activities that bring them joy. The sorts of questions asked of Group B, Dr. Schlechter surmised, demonstrated to patients that their providers were concerned as much about the patient’s well-being as they were about the patient’s psychiatric condition. 

30% of patients who were engaged through Positive Assessment reported feeling more bonded to their clinician.

The results of Dr. Schlecter’s study were compelling: by a difference of 30%, patients in Group B reported feeling more bonded to the clinician than did those patients in Group A. Additionally, clinicians reported they felt good learning about their patients’ well-being. In other words, the positive assessment process of patient interviewing had a two-fold effect: enhanced bonding from patient to provider and vice-versa. 

Even as we maintain a rigorous and scientifically sound foundation for our work, Belong Health is proud to innovate with a sense of urgency — and we are thrilled to put findings like Dr. Schlecter’s into daily practice. Today, Dr. Schlechter works directly with our Care Management teams to craft patient interview processes that focus not only on eliminating challenges but on celebrating the good stuff, too — getting to know patients as multi-dimensional people with passions and talents. In many cases, doctor-patient conversations start not with hardship but with inquiries about a patient’s love of painting, photography, or sports. They focus not only on nonclinical work but also on clinical and psychosocial concerns. They lead to a fuller assessment of a whole, distinct, and valued person.  

Imagine entering a care physician’s office to be greeted with positive assessment questions such as, “what is the healthiest thing you have done in the past year?” or “what has made you happiest since our last visit?” That is a mindset shift that could truly benefit all of healthcare — and it’s a practice our care management teams are proud to celebrate and explore as we continue to foster remarkable relationships between patients and providers.