On 2/29/2012 the discharge notes read, "We will set you up with cardiac rehab as well to help you feel safe re-instituting exercise into your daily life." This (and my appointment card) was all it took for me to enroll into cardiac rehab in April 2012.
Unfortunately, for approximately 70-80% of patients--- yes you read that figure correctly-- 70 to 80% of patients who are referred to cardiac rehab, DO NOT enroll in cardiac rehab.
And remember from the last blog, if you add the percentage to those who are not referred by their doctors (though eligible), the benefits of cardiac rehab help an embarrassingly low number of patients, in spite of all the data to show the positive health outcomes and improvement in the lives of patients.
As I continue the series of how we (as patients) might create innovative ways to improve awareness and utilization of cardiac rehab, we will look at ideas/innovations to boost enrollment rates from my lens as a patient, while also working to counter or leverage our cognitive biases.
ENROLLMENT- According to recent studies, the most optimistic data report rates of enrollment at approximately 1 and 3 patients utilizing cardiac rehab after being referred. As I have now joined as a patient voice the Million Hearts Collaborative, where the goal is to go from 20% to 70% enrollment, I will share some of my "tiny experiments" that facilities could use to increase enrollment.
1. Create a community of patients and enroll them at the same time, on the same date, and in the same class. Currently, the model for enrolling into cardiac rehab is that you have a cardiac event (Phase 1). If fortunate, you are referred to go to an orientation session, where you then choose an open class (Phase 2) that fits your schedule and the one that is available at the facility.
What if... patients were clustered close to when their event took place and offered to join a group of patients who had just experienced a cardiac event? What if we leveraged the power of social media and created an online group to "meet" and then help each other even before rehab began? What if they all came to group orientation together and they used the power of social influence to start at the same time with the goal of "graduating together."
I understand the logistics issues this can cause in facilities where efficiency (almost factory like) is often prioritized for economic reasons, but I'm confident that there are logistics specialists who could maximize the benefits of patient communities that might improve health outcomes, while also maximizing the business models.
2. What if... we placed information/signage about the benefits of cardiac rehab outside of the hospital setting? What if information was known to communities BEFORE they were to have cardiac issues and the community was knowledgeable of the benefits of cardiac rehab while at the YMCA, barber shop, grocery stores, community centers, golf courses, etc.?
3. What if... we added a key message to why someone might want to enroll into cardiac rehab-- it helps with Loneliness! (i.e. it has the potential to help solve one of the nations' most serious cause of bad health). What if we worked with current doctors, nurses and exercise physiologists to train them on ways to build community and foster connections.
What if in addition to understanding how to exercise safely and what to eat post-cardiac event, there were messages about coming to meet "new friends, new business partners, new lunch buddies, etc." as a reason you should enroll in cardiac rehab.
As I have learned from many conversations from patients who have graduated from phase 2 and still go to the cardiac rehab fitness center (phase 3), most see the benefits of continuing to come to the fitness center is as much (or more) about the friends they have met.
COGNITIVE BIAS THESE IDEAS TRY TO OVERCOME OR TO LEVERAGE POSITIVELY
As discussed previously, all of us are affected by cognitive biases, or shortcuts in our thinking, that are often flawed and unconscious.
The experiment of clustering groups of patients together hopes to help overcome the common error in thinking where humans generally over-estimate how challenging things will be and under-estimate the gains and how one will feel after joining a group (projection bias).
The experiments of new messages (loneliness and posting in new environments) about cardiac rehab attempts to overcome cognitive biases from too much information that exists after a traumatic cardiac event. We can use the "anchoring effect" to our favor to have folks who have cardiac event begin the process by seeing the value of going to rehab.
To give more information about the benefits of social connections, more information can be gained from sharing with patients studies showing that even when we believe that we would be happier being alone, when tested, we actually are happy talking with strangers.
What ideas do you have? As patients, what innovations/ideas do you have to increase the number of patients who enroll in this crucial therapy? As staff members, how might you engage patients to extend the experiments you will try at your facility?
ACTION ITEM: Go to your local cardiac rehab facility and give them the one actionable experiment they can implement ASAP to increase the number of patients that enroll in their program.
Remember, rather than use the 10,000 hours model to do something better, try the 10,000 experiments model. Together, we might just stumble upon something that transforms cardiac rehab forever!
Next up.... How might we innovate to assure patients persist to graduation and thriving after cardiac rehab?