Patient Engagement: 8 Strategies That Improve Outcomes and Build Loyalty

The moment I truly understood patient engagement happened at a bedside, not in a meeting. A few years ago, I sat in on a discharge conversation for a man in his sixties going home after a heart failure admission. The nurse was excellent. Specifically, she covered his diuretic, his daily weights, his salt limit, and the warning signs that should send him back. He nodded through all of it. However, when she stepped out, I asked him what he planned to do when he got home. He thought for a second and said, “Take it easy, I guess.” Nothing about weighing himself. Nothing about the salt. As a result, he came back eleven days later.

Nobody in that room did anything wrong by the usual standards. In fact, the information was accurate and the delivery was kind. Instead, what was missing was the part where the person actually takes the plan in, believes it applies to him, and has the confidence to carry it out at his kitchen table with nobody watching.

I have spent most of my career working on the patient experience side of healthcare, sitting between clinical teams, front desk staff, and the people we are trying to help. So what I want to share here is not a list of trendy tactics. Rather, it is what I have seen actually work, backed by the research that explains why it works, and honest about where organizations usually go wrong.

What Patient Engagement Really Means

The phrase gets used loosely, so let me be specific. First, patient engagement is not the number of portal logins or how many appointment reminders you send. Those are activities. Engagement, on the other hand, is the result: a patient who understands their condition, participates in decisions about it, and has the knowledge, skill, and confidence to manage their own care between visits.

Researchers usually call that last piece patient activation, and it is measurable. For example, the Patient Activation Measure, developed by Judith Hibbard at the University of Oregon, scores patients on a four level scale. It runs from people who feel overwhelmed and passive about their health to people who are confident and already doing the work. That distinction matters because it reframes the job. In other words, we are not trying to get patients to “comply.” Instead, we are trying to move them up that scale.

It also explains why so many engagement programs disappoint. Typically, they broadcast the same message to everyone and count the clicks. However, a patient at level one does not need a newsletter. Instead, they need someone to help them pick one achievable thing and succeed at it.

Why Patient Engagement Moves Outcomes

When I make the case for this work to a hospital leadership team, I lead with outcomes and cost, because that is where the evidence is strongest.

For instance, in a large study of adult primary care patients published in Health Affairs, higher activation measured in 2010 was linked with better results on nine of thirteen health outcomes. Those included clinical indicators, healthy behaviors, and preventive screening, along with lower costs two years later. Moreover, the cost gap was not small. Patients who stayed at the highest activation level had projected costs 31 percent lower than those who stayed at the lowest level.

Activation Changes, and Outcomes Follow

What convinced me personally was the second half of that study. When a patient’s activation level changed, more than half of the outcomes examined, along with costs, moved in the same direction. Therefore, activation is not a fixed personality trait. Instead, it responds to how we treat people.

Similarly, a separate analysis of more than 25,000 patients at Fairview Health Services found that activation was associated with 12 of 13 patient outcomes in the expected direction. In addition, a longer view from a panel of people living with chronic conditions showed that the benefits of activation lasted. Four years later, they showed up as better self management, improved functioning, and less use of costly services.

So when someone tells me patient engagement is a “soft” initiative, I disagree. After all, it is one of the few levers we have that improves clinical results, reduces spending, and makes patients like us more, all at the same time.

Strategy 1: Measure Patient Engagement Before You Hand Over the Plan

The most common mistake I see is giving every patient the same plan in the same way. For example, a newly diagnosed diabetic who is frightened and confused gets the same binder as the retired engineer who has already read three books on carbohydrate counting.

If you can measure activation, do it. Otherwise, at least ask a few honest questions at intake. How confident do you feel managing this at home? What has been hardest so far? What would make this easier?

Then tailor the coaching. Fortunately, the evidence here is encouraging. A dissertation study from the University of Alabama at Birmingham found that the real value of measuring activation came from using it to offer coaching customized to each patient’s level. As a result, that tailored coaching was tied to better utilization and clinical results, including fewer emergency visits and hospital admissions.

Matching Coaching to Activation Level

In practice, that looks like this:

• Low activation patients get one small, concrete goal. For example, “Weigh yourself every morning before breakfast and write it on this card.” Not five goals. One.
• Middle activation patients get help building routines and solving the problems that keep tripping them up, such as refilling prescriptions on time.
• High activation patients get more information, more control, and fewer reminders they do not need. After all, overmessaging them feels patronizing and can push them away.

Ultimately, the measurement is not the point. What you do differently because of it is the point. For some patients, tools like remote patient monitoring can also make that one small goal easier to keep.

Strategy 2: Make Teach Back a Patient Engagement Habit

If I could get every clinician and staff member to adopt one behavior, it would be teach back. The idea is simple. After explaining something important, you ask the patient to explain it back in their own words. Not “Do you understand?” which almost always gets a yes. Instead, try something like, “I want to make sure I explained this well. When you get home tonight, what are you going to do with this new medication?”

The framing matters. In other words, you are testing your explanation, not their intelligence. That small shift keeps patients from feeling quizzed.

The Agency for Healthcare Research and Quality includes teach back as a core tool in its Health Literacy Universal Precautions Toolkit. In particular, the toolkit is designed to help primary care practices simplify care, improve patient understanding, and support patients at every health literacy level. Similarly, a related approach, often called show me, confirms patients can actually follow specific instructions, such as using an inhaler. So for anything physical, from insulin pens to wound care, have them show you.

Getting Teams to Actually Use It

This is not a time sink. In fact, AHRQ’s shared decision making materials note that teach back can take as little as one to two minutes. Now compare that to the cost of a return visit.

Adoption, however, is the hard part. When a Kentucky health education center trained nearly 280 medical professionals with the AHRQ toolkit, teach back showed the largest improvement of any practice. Specifically, its use roughly tripled, from 23 percent of participants to 73 percent at reassessment. The lesson I take from that is simple: people will use it once they are trained and see it work. Therefore, pair the training with stories from your own staff about the times teach back caught a dangerous misunderstanding. Those stories spread faster than any policy memo.

Remember the man from my opening story. In his case, ninety seconds of teach back would have revealed that “take it easy” was his entire plan.

Strategy 3: Open the Chart to Strengthen Patient Engagement

For years, clinical notes were written for other clinicians and kept away from patients. However, the OpenNotes movement challenged that, and the results have changed how I think about transparency.

In a survey of roughly 20,000 patients across three health systems published in the Annals of Internal Medicine, 64 percent said reading their notes helped them understand why a medication was prescribed. In addition, 62 percent felt more in control of their medications, 57 percent found answers to medication questions, and 61 percent felt more comfortable with their medications.

The Patients Who Benefit Most

The finding I share most often is this one. Patients whose primary language was not English and those with less formal education were more likely to report benefits from reading their notes. Many organizations, of course, worry that open notes will confuse vulnerable patients. Yet the evidence suggests the opposite. Those patients often gain the most, probably because they can reread information at their own pace, translate it, or go over it with a family member. Likewise, for patients with limited English, pairing open notes with medical interpreter services closes the loop.

The physician concern I hear most is that patients will be upset by what they read. In my experience, that is rare, and it usually pushes clinicians to write more respectfully, which is good for everyone. For example, avoid labels like “noncompliant” or “denies,” and write the way you would speak if the patient were sitting next to you. Then tell patients the notes exist in their patient portal. Otherwise, many never look simply because nobody mentioned it.

Strategy 4: Extend Patient Engagement Into the Days After Discharge

Most organizations put their best energy into the inpatient stay and the discharge packet. However, the patient’s real test begins when they get home and the questions start.

Press Ganey’s analysis of 10.5 million patient encounters makes this clear. In fact, their data shows communication after discharge can raise likelihood to recommend scores by more than 20 points. Few other interventions move loyalty that much.

The same report also singled out unplanned admissions as moments that demand clearer communication and more consistent processes. After all, these are people who did not choose to be there, often arrived scared, and left with the most complicated instructions. Consequently, they need the most follow up, not the same follow up everyone else gets.

What Strong Follow Up Looks Like

• A call within 48 to 72 hours from someone who can actually answer questions, ideally a nurse, rather than an automated message.
• A specific reason for the call. For instance, “I’m checking on how your new blood pressure medicine is going” gets a better conversation than “How are you feeling?”
• A clear path for problems. Patients should know exactly who to call and when, so the emergency department is not their only option at 9 p.m. In many cases, a telehealth visit can fill that gap.
• Medication reconciliation at home. First, ask them to read you the labels on the bottles in front of them. Then compare. You will be surprised how often what is in the cabinet differs from what is in the chart.

Strategy 5: Make Decisions With Patients, Not for Them

Shared decision making is one of those ideas everyone agrees with and few practice consistently. Essentially, it means laying out the real options, including doing nothing, explaining the tradeoffs in plain language, and asking what matters to this particular person.

I have watched the same treatment recommendation land completely differently depending on whether the patient helped choose it. When someone has weighed the options and picked one, they own it. By contrast, when it is handed to them, it is just another instruction, and instructions are easy to drop when side effects show up.

Pairing Decision Aids With Teach Back

AHRQ’s SHARE Approach offers a practical framework, and it also pairs naturally with teach back. For example, AHRQ recommends using teach back whenever you explain an important concept, such as treatment options. Furthermore, it stresses that teach back is especially valuable with decision aids like written materials or videos. A decision aid the patient skimmed but did not understand is not shared decision making. Instead, it is paperwork.

A simple question I encourage clinicians to add is this: “Of everything we talked about, what matters most to you?” Surprisingly often, the answer is not what we assumed. For example, a patient might care less about their A1C number than about being able to keep working or walk their granddaughter to school. Connect the plan to that, and engagement follows.

Strategy 6: Personalize Outreach Without Overwhelming People

Digital tools have made it easy to send messages at scale. Unfortunately, that also makes it easy to annoy people at scale. Therefore, the goal is relevance.

There is broad agreement in the field that this matters. For instance, in Simon-Kucher’s Digital Health Trend Study, 62 percent of healthcare professionals said personalized communication is essential for patient outreach today. However, personalized does not mean inserting the patient’s first name into a template. Instead, it means the content reflects their condition, their stage of care, their language, and their preferred channel. Used carefully, AI in healthcare can help sort that out at scale.

Practical Rules for Patient Engagement Outreach

• Ask patients how they want to be contacted and honor it. Some people want texts. Others, however, will never open one.
• Tie every message to an action. For example, a reminder that says “Your colonoscopy prep starts Thursday, here is the shopping list” is useful. “Stay healthy this season!” on the other hand, is noise.
• Write at a plain language level. In short, use short sentences, common words, and one idea at a time.
• Stop messaging people who have already done the thing. After all, few things erode trust faster than being reminded to book an appointment you booked last week.

Convenience is also a loyalty driver in its own right. Indeed, Valtech’s work on consumer healthcare notes that convenience plays a major role in building patient loyalty. As a result, online scheduling, easy prescription refills, and quick answers through a portal are not extras. Patients, after all, compare us to every other service in their lives.

Strategy 7: Give Patients and Families a Real Seat at the Table

Some of the best ideas I have seen in this work came from patients, not committees. Above all, a Patient and Family Advisory Council, when it is taken seriously, keeps an organization honest about how care actually feels from the other side.

As Relias describes it, a PFAC builds collaboration between patients, families, and care teams so that care delivery reflects what patients need and prefer. Still, the key words there are “taken seriously.” For example, I have seen councils that meet quarterly to review finished brochures. That is not engagement. Instead, it is approval theater.

So bring advisors in early. For example, let them test a new discharge process before it launches. Also, have them read your patient letters out loud and mark the sentences that confused them. Then ask them to walk from the parking lot to a clinic and narrate what they notice, including the barriers to accessible healthcare your staff no longer see. When advisors see their input change something, they stay involved. In return, the organization gets free, honest, ongoing feedback that no survey can match.

Strategy 8: Focus on What Patients Actually Value

When leaders try to improve loyalty, they often start with the visible things: lobby renovations, parking, coffee. Those are fine, but they are not what drives recommendations.

For example, a Stanford Health Care review of Press Ganey data identified the main factors behind patients recommending a practice. They were sensitivity to patients’ needs, concern for their worries, coordination of care, time spent with them, and the follow up instructions they received. Notably, none of those are about parking or the building.

In other words, that list is almost entirely about communication and relationship. It also lines up with how many health systems define the patient experience. Mount Sinai, for example, bases its physician star ratings on how well the provider explained the condition, the concern shown for the patient’s questions or worries, and likelihood to recommend. So if you want more ways to improve patient satisfaction, start with those three.

The Moments That Shape Scores

Before spending on furniture, look at these first:

• The first 30 seconds of a visit. For instance, make eye contact, use the patient’s name, and sit down.
• Wait time transparency. Patients tolerate delays far better when someone tells them what is happening.
• Handoffs between teams. After all, nothing makes patients feel unseen like repeating their whole story to every new person.
• The last two minutes. Finally, give a clear summary of next steps, confirmed with teach back.

How to Know Whether Your Patient Engagement Work Is Working

Activity metrics are tempting because they are easy to count. However, they can mislead you. For example, a portal with high login rates and poor medication adherence is not an engaged population. Instead, I recommend tracking a balanced set:

• Activation or confidence scores over time for chronic disease patients, using the Patient Activation Measure or a simple validated confidence question.
• Clinical indicators tied to engagement, such as blood pressure control, A1C, and preventive screening rates.
• Utilization, especially 30 day readmissions and avoidable emergency visits.
• Experience scores, particularly communication items and likelihood to recommend.
• Retention, meaning how many patients stay with your practice year over year.
• Qualitative feedback from advisors, complaints, and compliments, which often explains the numbers.

Then look at these together. For example, if experience scores rise but readmissions do not move, your communication may be pleasant but not effective. Similarly, if activation rises but retention falls, something in access or convenience is pushing people elsewhere.

How Patient Engagement Builds Lasting Loyalty

Patient loyalty in healthcare does not work like a retail rewards program. In fact, people do not stay with a doctor for points. Instead, they stay because they trust that someone there knows them, listens to them, and will help them when something goes wrong.

Similarly, Simon-Kucher notes that every touchpoint, online or in person, shapes loyalty and influences whether a patient stays. Every strategy in this article therefore feeds that same trust. Teach back tells patients we care whether they understood. Likewise, open notes tell them we have nothing to hide. Meanwhile, follow up calls tell them we did not forget them the moment they left. Finally, shared decisions tell them their priorities matter.

Consequently, outcomes and loyalty are not two separate goals that need two separate programs. Rather, they grow from the same root. When patients understand their care, participate in it, and trust the people providing it, they get healthier and they come back. That is the business case and the human case, and in my experience they have never actually been in conflict.

Where to Start With Patient Engagement

If this feels like a lot, start small. First, pick one unit or clinic. Next, train the team on teach back this month. Then add a nurse follow up call for unplanned admissions next month. After that, invite two patient advisors to review your discharge instructions. Finally, measure what changes.

In the end, patient engagement is not a project you finish. Instead, it is a way of working that gets stronger every time a clinician pauses to ask, “What are you going to do when you get home?” and then actually listens to the answer.

Frequently Asked Questions About Patient Engagement

What is patient engagement in healthcare?
Patient engagement is the degree to which patients understand, participate in, and manage their own care. In practice, it is often measured through patient activation, a concept explained in this Health Affairs study on activation and outcomes.

How does patient engagement improve health outcomes?
More engaged patients tend to follow treatment plans, use preventive services, and avoid unnecessary hospital visits. For example, research from Fairview Health Services published in the Journal of General Internal Medicine linked higher activation to better results across nearly every outcome studied.

What is the teach back method?
Teach back is a communication technique where patients explain information in their own words so the clinician can confirm understanding. In addition, AHRQ provides free training and tools through its Health Literacy Universal Precautions Toolkit.

Does letting patients read their medical notes help?
Yes. In fact, patients who read their visit notes report better understanding of their medications and more confidence taking them, according to OpenNotes research on medication management.

How can healthcare organizations build patient loyalty?
Loyalty grows from clear communication, coordinated care, convenience, and consistent follow up. Notably, Press Ganey’s Patient Experience 2025 findings show that communication after discharge has an especially large effect on likelihood to recommend.

References

1. Greene J, Hibbard JH, Sacks R, Overton V, Parrotta CD. When Patient Activation Levels Change, Health Outcomes and Costs Change, Too. Health Affairs, 2015. PubMed.
2. Fierce Healthcare. To Cut Costs and Improve Outcomes, Increase Patient Activation.
3. Greene J, Hibbard JH. Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes. Journal of General Internal Medicine. Summary via The Commonwealth Fund.
4. Hibbard JH, Greene J, Shi Y, Mittler J, Scanlon D. Taking the Long View: How Well Do Patient Activation Scores Predict Outcomes Four Years Later? Medical Care Research and Review, 2015. PubMed.
5. Reistroffer CL. Patient Activation: An Examination of the Relationship Between Care Management With Patient Activation-Customized Coaching and Patient Outcomes. UAB Digital Commons.
6. Agency for Healthcare Research and Quality. AHRQ Health Literacy Universal Precautions Toolkit, Second Edition.
7. Agency for Healthcare Research and Quality. AHRQ’s Health Literacy Universal Precautions Toolkit a Popular Resource Among Medical Professionals in Rural Kentucky.
8. Agency for Healthcare Research and Quality. The SHARE Approach: Using the Teach-Back Technique.
9. Chief Healthcare Executive. Reading Clinician Visit Notes Improves Medication Adherence.
10. UPI HealthDay. Patients Who Read Doctors’ Notes More Likely to Take Meds.
11. Press Ganey. Safety, Teamwork, and Communication Drive Patient Trust and Loyalty. Business Wire.
12. Weinacker A. Strategies for Improving the Patient Experience. Stanford Health Care.
13. Mount Sinai. Patient Experience Star Ratings Explained.
14. Simon-Kucher. Patient Retention in the Digital Age.
15. Valtech. How Consumer Healthcare Is Redefining Loyalty.
16. Relias. 7 Best Patient Engagement Strategies.