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Increase Awareness and Utilization of Cardiac Rehab: A view from a Patient who has been there-- Grad

In the 4th of our series on patient ideas, I turn to think about graduation.

Graduation|Experiment(s)|Cognitive Bias(es)

GRADUATION: Ah the memories of accomplishment that graduation brings. Besides the individual feeling of accomplishment, there is also the experience of graduating together with friends and celebrating with family.

How might we work to make graduation from cardiac rehab an integral part of the experience for patients and their friends/family members? What are some ideas to increase the number of us who will graduate from cardiac rehab and complete the full course of treatment?

The research says it will help us to live longer more quality lives, decrease the amount of re-hospitalizations and decrease early mortality.


I was given a certificate of graduation when I left the cardiac rehab program the last day. Though I appreciated the staff thinking about this and providing me a positive "send off" to my new life without monitored exercise, I wondered whether there were other ways to reinforce and think differently about graduation. Here are a few questions to hopefully promote some experimentation and innovation on how to promote graduation as a jumping off point rather than an ending.

What if at graduation, we could do so with those in our class who has met the most to us? As I've said in previous posts, I think having cardiac rehab help to solve one of the nations most challenging "ailments" is called loneliness and social isolation. How might we make graduation more of a community occasion?

In order to think about all of the possibilities, what if you were able to find a group of patients and have them create ideas on how to make graduation "a big deal" in cardiac rehab? What ideas might they be able to bring to the table and co-create with you to make this a meaningful occasion for all, while assuring that patients stay to the end of their prescribed program (something that unfortunately few do)?

Here are a few more questions/ideas/experiments to consider...

What if at the completion of the prescribed program there was a cardiac rehab graduation card given. This card would be shown at participating eating establishments (restaurants, stores) and customers would be given a 5-10 percent discount on any meals that meet "healthy options" on the menu/store? The goal, of course, to nudge patients to make heart healthy decisions when eating out or shopping?

What if at graduation there were opportunities to join other cardiac rehab graduates? What if there was an "alumni network" available where patients could come together in community to celebrate with one another? Might this even offer opportunity for philanthropy and a way for grateful cardiac rehab graduates to give back with their time or money?

Certainly many phase 3 patient groups act in this fashion and more and more programs are starting Facebook groups for this purpose, but the goal would be to leverage what happens to me all of the time when I meet someone who has had a heart attack. The conversation quickly turns to what you did after the event... did you go to rehab, what did you think about it, would you recommend to others, how are you doing now?

How might this be something (like colleges) where community members find each other and talk about what they enjoyed about the experience and what they might suggest changing?

How might signage in your facility help to reinforce that completing the program shows that people do better? How might signs that nudge patients to get to graduation be helpful in maintaining motivation, particularly if you now are starting to "feel fine"?

Being a partner of a veterinarian, and a proud parent of 3 4 legged creatures... I wondered about this idea? What if for those patients who are looking to continue their walking habit they developed, there was a partnership with a local animal shelter to pair up those who need to be walking more with those who love to be walked? :)

Finally, what if at graduation there were opportunities for something Katy Milkman calls "temptation bundling?" A handout was prepared to help people who struggle to change habits to work on ways in which they can continue the good work done in cardiac rehab (e.g. person loves to listen to audiobooks and often does in their favorite chair but after seeing handout, they are only able to do their favorite activity (listening) if they do so while they walk (not their favorite activity). :)

Imagine what your patients might come up with spice up and think about graduation?

COGNITIVE BIAS(es) to overcome/leverage:

As we've done in other blogs, I turn to think about what cognitive biases exist in us humans that might need to be overcome to manage how graduation plays a role in the future of cardiac rehab programs.

Here are two... and a response/question.

Authority bias: The tendency to attribute greater accuracy to an opinion of an authority figure and be more influenced by them. How might having an "cardiac rehab alumni president" be helpful at a group orientation to positively influence the behavior of those just starting rehab?

Bandwagon affect: Doing things just because others are doing it. How might we work to assure that if others are coming to a graduation ceremony, I may as well go as well? Lots of research shows that we are often much happier after experiencing things in community than we believe will be the case before the event.


If you are a cardiac rehab graduate, or you know anyone who has graduated from cardiac rehab, or you work or are a student looking for a career in the field of cardiac rehab, please consider joining a new national Facebook page I have started-- here. I aim to create a community where the knowledge, wisdom and ideas of patients "who have been there" can help to continue to increase awareness and use, while helping to find ways to improve the experience for future patients--- an alumni network, if you will.

Graduation does deserve attention, praise and a sense of accomplishment from cardiac rehab-- and, of course, it is just the beginning-- thriving post-graduation will be the topic of my last blog in this series... and it's the least understood, least studied and likely-- the most important... next time!