It is well established that relationships have a certain healing power. Relationships are often built on trust, and that trust is often built on time. Spend some time in social media land for a bit and you will see that sending tweets to no one reaps very little reward. Spend some time in social media land on Facebook with no friends and see how much fun it is talking to yourself. Or even better, write a blog post to no one. How rewarding is this?

It is not.

Without some form of engagement in social media, there are no relationships that help keep us coming back for more. We want to form relationships, ideally meaningful ones, and then engage.

Now apply this philosophy and approach to healthcare.

The closest thing we can look for around engagement in healthcare is the relationship often formed between providers and patients. These relationships are often formed over time (continuity) and involve trust. According to an excellent article by Bruce Guthrie et al. in BMJ, there are three types of continuity in healthcare:

Informational continuity—Formally recorded information is complemented by tacit knowledge of patient preferences, values, and context that is usually held in the memory of clinicians with whom the patient has an established relationship

Management continuity—Shared management plans or care protocols, and explicit responsibility for follow-up and coordination, provide a sense of predictability and security in future care for both patients and providers

Relationship continuity—Built on accumulated knowledge of patient preferences and circumstances that is rarely recorded in formal records and interpersonal trust based on experience of past care and positive expectations of future competence and care

Clinically, much of the relationship in healthcare takes the form of informational continuity and management continuity. Over time there may be more of relationship continuity that forms, but this takes time as it is much more interpersonal in nature and not solely dependent on notes from a previous visit.

As Barbara Starfield described in BJGP:

“..the underlying rationale of interpersonal relationships is facilitation of information transfer. When people voluntarily associate with each other, communication is generally freer and more complete. ‘Trust’ that the physician will do the right thing is more appropriately conceived as the ability to question and clarify. This rationale for better interpersonal relationships in health services is supported by a wealth of evidence of benefits that stem from better communication. These benefits include better recognition of people’s problems; more accurate diagnosis; better concordance with treatment advice; fewer drug prescriptions; better preventive behaviours; less emergency use, fewer hospitalisations (especially for ambulatory-care sensitive conditions); and lower overall costs.”

You see, when we engage in healthcare not only do we create trust, we begin to establish a relationship where work can be done. This is seen time and time again in healthcare. So how does continuity and engagement relate to changing healthcare?

What happens if through better patient and provider engagement, the collective needs (and failings) of the system begin to be realized. When engaged, and a relationship is formed, both the provider and the patient better see the others needs. They become acutely aware of the issues that impact on health (and also the delivery of service). They start to see that there may be more to the person they see in front of them than just a diagnosis or just a degree. It becomes less about me and more about “we” – the relationship through engagement can become transformative.

Patients may see the demands put on the providers; providers may see how little they are patient-centered in practice.

Different perspectives are taken and new alliances possibly formed.

And it is through these alliances that change can happen. It can not only be seen at the clinical level through improved health outcomes, but can also be seen in working together towards change. When patient and providers align themselves in the direction of change in healthcare and work together, nothing can stop them.

But, of course, there needs to be a relationship first.