How to Measure Patient Engagement in Your Practice

By Craig Phifer, PT, MHA

Have you ever been to a new restaurant, eating a very average meal, when the server approaches your table and asks how everything is tasting?

If you’re like most people, the response is something like, “It’s great! Thank you!” The feedback you’ve just given the restaurant is that they’re doing a good job, and you’re enjoying your meal. The action you’ll take is that you probably won’t come back anytime soon.

Unfortunately, this scenario plays out frequently in physical therapy. We ask patients if they are satisfied with the service they received or how likely they are to recommend their therapist to a friend or family member. The feedback we get is largely positive. We pat ourselves on the back and move on. Then, if those patients are like the 90% of physical therapy patients, they do not complete the plan of care.¹ Patients tell us they are satisfied with what we are doing, but their action is that they do not value it enough to continue attending sessions.

We have traditionally measured patient satisfaction in physical therapy, and it provides us information that tells us that people like us, which is positive. Hush et al found that “treatment outcome was infrequently and inconsistently associated with patient satisfaction.”³ Furthermore, customer attitude measures like satisfaction and net promotor score (NPS) do not correlate with customer behavior. As Dana Severson states, “even with the happiest customer experience, one in which the price was reasonable and the service was stellar, satisfaction is still backward looking. It only measures whether someone was happy with your product, service, or interaction. It tells you nothing about their future intent.”²

Therefore, being liked shouldn’t be the goal. The goal is for our services to be valued and consumed. We want people to value physical therapy. We want to be the first option for care in individuals with neuromusculoskeletal issues. We want the 50% of adults in this country who have musculoskeletal disorders (and those with other conditions) to see and receive the benefit of our services.⁴

Because your goal is not to capture whether patients like you and your service, you need to move beyond measuring satisfaction or NPS. If you are trying to capture how patients value your service, their engagement with your company and clinicians, and their likelihood of telling their friends and family members about the wonderful benefits of seeing a physical therapist, then you need to look into measuring what they do and not what they say. Customer engagement measurements vary across different types of companies, but here are a few examples:

• The number of people consuming content on a website
• How many active daily users a product has
• How many likes, comments, and shares social media posts get
• The number of blog views on your website

One element is common for these measures of engagement. They are measures of customer behavior instead of customer attitude. You may or may not have a blog, vlog, or even be active online, but you can absolutely measure engagement in your practice by measuring the behavior of your patients. There is even a simple way to do it: Measure the percentage of patients who complete care versus those who drop-off.

This measure of engagement is outstanding because it captures the behavior of your patients, and you can glean actionable data from it. For example, if your therapist Dara has 50% of her patients completing care, she is really excelling in a vital metric for your practice. She is performing extremely well and is helping a much higher percentage of patients complete care than national average.1 At the same time, if your therapist, James, only has 10% of his patients completing care, you need to do some coaching with him. You may need to sit in on Dara’s sessions to determine why and how she is excelling so much. You can then use what you glean from Dara to provide James the assistance he needs to help more patients achieve their goals.

If all your therapists are performing near the national average of 10%, then there are likely some systematic issues you can improve. Are you giving your team members the ability to connect with patients? Are your patients not getting the opportunity to share their story and goals and play an active role in deciding how to progress care? These simple questions may help identify the source of your problem.

In addition to providing actionable information about how your clinicians are performing, measuring engagement through completing care can help you determine how your practice is being financially affected by the industry trend of patient drop-offs. For example, let’s say your practice has the following engagement, productivity and financial data:

• 20% of your patients complete care (better than national average) and those who do, come for an average of 12 visits
• The 80% of your patients who self-discharge complete an average four visits
• You generate $100 in revenue/visit
• Your practice had 500 new patients in the last year

It isn’t reasonable to assume that any practice can get 100% of patients to complete care. Your patients are human, and disruptions happen. But perhaps creating a metric you feel is representative of your ideal goal is warranted. In this case, consider 80%. Therefore, if your patient engagement was ideal, and 80% of your patients completed care, then you would see an additional 60% of your patients (300 people) for eight more visits (2,400 additional visits). You can multiply those 2,400 visits by the average revenue per visit ($100) to determine the value of patient engagement to your practice. In this case, the value to your practice is $240,000/year.

Patient engagement is certainly worth your investment. It’s good for your patients, your practice, and for the profession. Your first step to investing in patient engagement should be measuring it. 

References:

¹WebPT. The state of rehab therapy in 2018. https://www.webpt.com/resources/download/the-state-of-rehab-therapy-in-2018. Accessed March 2019.

²Severson D. Customer satisfaction vs. customer loyalty (companies can lose millions getting this wrong). Inc website. https://www.inc.com/dana-severson/customer-satisfaction-vs-customer-loyalty-companies-can-lose-millions-getting-th.html. April 19, 2017. Accessed December 2019.

³Hush JM, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy: a systematic review. Phys Ther. 2011 Jan; 91(1):25-36.

⁴United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States (BMUS), Third Edition, 2014. Rosemont, IL. Available at http://www.boneandjointburden.org. Accessed December 2019.

Craig Phifer, PT, MHA is a PPS member and owner of Rehabilitation & Performance Institute which has five offices in the Indiana, Illinois, and Kentucky area. He can be reached at craigphifer@gmail.com and @craigphifer on Twitter.