In 2016 I led an inquiry for NACHC (National Association of Community Health Centers) into just what defined and explained The Great Community Health Center. One of my findings was that outstanding health centers focus as much on what the patient does as what the health center does to help them. Their premise is that the choices patients make are as consequential to health as are all medical interventions put together. These Centers follow their patients out the door for two reasons: to ensure compliance with medicine and to support the voluntary acts critical to managing chronic conditions such as diabetes and high blood pressure.
In my inquiry I came across Judith Hibbard at the University of Oregon. Dr Hibbard had done the research and development to create PAM—the Patient Activation Measure. Responses to this 13-item instrument define placement among four levels of activation. Increase in level correlates clearly with increased health outcomes. If this interests you take a look at an article, “What the Evidence Shows About Patient Activation: Better Health Outcomes and Care Experiences; Fewer Data on Costs” published in Health Affairs in 2012. If you want more just Google Judith H. Hibbard.
I keep thinking about how much this approach fits many kinds of social and human services, including school. As in health, level of engagement in most programs is a key predictor of participant success. This prompts the shift from the mind-set of social service delivery to equipping participants to take active steps to use what they get. While we hear increasingly more about the customer experience, the connection can be weak between experience and gains which matter more to most participants. They do not just want to feel safe and enriched in a program. They want to get a job, reduce weight, or see their kids succeed in school.
A promising direction in my view comes from the PAM research showing that activation is a mixture of knowledge and skill and of the confidence to use them. A sense of efficacy is hard to find in persons who keep experiencing failure. If you do not think what you do is possible, let alone consequential, why try?
I have vowed to pursue this in Results1st. Keep you posted.