Engagement Is In The Eye Of The Beholder

Engagement Is In The Eye Of The Beholder

Engagement Is In The Eye Of The Beholder

What should you do when a company claims “We can help you achieve 100% engagement”?  Should you run? Should you instantly question the authenticity of this claim?  Is someone trying to swindle you?   Well, that all depends.  Business, including health care, is all about “engagement”.  The problem is, what is the definition of said “engagement”?  If you stop and think about it is so easy to promise engagement.  Engagement has no specific definition, it does not mean anything specifically. As per Webster’s dictionary engagement is “an arrangement to meet or be present at a specified time and place”  (Merriam Webster).   If we drill down just a bit into this definition, we see that it has a call to action.  It’s a call to “meet or be present at a specified time and place.”  We want you to go somewhere at a certain time.  We essentially are saying that we want you to “do” something.   So engagement can be seen as doing something that has been asked of you to do.


Now, on to health.  What does engagement mean in a health context?   Adherence to medical regimen, compliance with medication dosing, showing up for preventive screens, participating in physical therapy, doing self wound care, exercising, eating certain food, signing up for insurance, enrolling in a condition management program, login on to a health/wellness portal, setting up an account, reviewing an EOB, completing an education program, using a flexible spending card to pay for approved items, practicing relaxation, having vaccinations completed, getting enough sleep,  answering satisfaction survey questions, making an appointment to see a provider.  These are ALL viable engagement metrics. Every one of them could be defended as being a form of engagement with great conviction.  Is one better or more potent than another?  No.  Is one more relevant than another?  It completely depends on the stated intention of the person, organization etc. wanting “engagement”.


Engagement is defined as people doing what “you” want them to do.  This is where things get fascinating.  When you approach an engagement initiative, the first thing you should be able to articulate is the nature of the engagement.  There is no such thing as generic engagement.  You want people to do certain actions that will: make them healthier, drive revenue, reduce costs, improve evaluation scores, make people satisfied.  If you ask for engagement generically and/or if a vendor claims they can produce engagement generically there is a foundational gap in communication.   No company, organization, service provider should be reporting generic rates of engagement. We engage by doing something.  So, when we are reporting engagement rates, asking for engagement capabilities, touting our engagement producing strength we must define or operationalize the word engagement very specifically.    100% engagement could mean 100% of eligible participants were signed up for a program because it was an opt out program and no one had opted out in the first month and that’s when the reporting took place.  That’s not true engagement is it?  It’s legitimate, but without a clear operationalization, it sounds on the surface far more potent than a company reporting 50% engagement rates, however, their engagement rates were in a 12-week diabetes management program that included pre and post A1c screenings and only individuals who achieved A1c rates within normal limits were considered to be engaged.   This is a huge difference once it is unpacked.    Why does any of this matter?  Because engagement is a term that sounds wonderful, but unless defined, it can result in a waste of time and resources.   If we want individuals with diabetes to take their medication, then engagement rates defined as the number of individuals who log into a health portal has very little meaning.  A company that provides condition management services is not automatically in a position to influence participation in health and wellness screenings or sign ups for flexible spending accounts.


So how can we ever understand “engagement?”  Engagement is in the eye of the beholder so let the buyer beware.  Before taking on an engagement initiative of any kind, a clear definition of engagement must be explicitly established.  This definition must be operational, meaning it has to be quantified; if it can’t be counted, it doesn’t count.   The definition must also be strategically aligned with business, technological, clinical and satisfaction goals.  It can be as simple as stating what engagement will be defined as, how will it be tracked, what will metrics of success (i.e., levels of engagement) be.  As simple as this sounds it is often a missed step in the design of a health engagement effort. Moreover, engagement does not need to be singular in definition. There can be multiple measures of engagement in any program.  Web engagement, account engagement, engagement in exercise, food intake, preventive screens, use of health reimbursement account, medication refills, condition management program sign up, condition management program completion – just to name a few.

Engagement should rarely represent a single metric, as there are very few initiatives to have individuals do only one behavior. In the end, the process should include the following:

  • State the strategic, business, clinical and technological goals for the program
  • Define how each of those goals will be measured/quantified
  • Create a specific measure of engagement for each goal
  • Report on engagement in each goal not as a single metric


What should you do when a company claims “We can help you achieve 100% engagement”- Be scared- be very scared.  Unless engagement is defined and meets your criteria for success.


josh klapow

Joshua C. Klapow is a clinical psychologist and Adjunct Associate Professor in the Department of Health Care Organization and Policy (School of Public Health, University of Alabama at Birmingham). In his capacity as Chief Behavioral Scientist, Dr. Klapow is responsible for the integration of behavioral science methodology into the core technological infrastructure of the ChipRewards enterprise solution. Further, he is responsible for assuring that ChipRewards functionality and products leverage appropriate behavioral science tools, technics and methods. Finally he is responsible for leading professional services efforts to assist clients in the design of strategic engagement programs. Dr. Klapow’s research portfolio includes the examination of delivery system design and its impact on the management of chronic illness, the role of provider behavior in disease prevention and management, and the role of psychosocial and behavioral factors in determining population based health outcomes. He is the author of more than 100 professional articles, abstracts, and book chapters in the area of behavioral medicine and health psychology. He is also the author of “Living SMART: Lifestyle Change Made Simple” a consumer focused book on lifestyle change. Dr. Klapow has served as a chronic conditions and behavioral science consultant for a wide variety of health care organizations including HMOs, third party administrative organizations; prescription benefits management companies, e-health technology companies, quality improvement organizations and the World Health Organization. Dr. Klapow received his Ph.D. in clinical psychology with a specialization in Behavioral Medicine from the University of California, San Diego in 1995.