From Compliance To Engagement
From compliance to engagement.
This line came up about halfway through the book Drive by Daniel H. Pink.
I’m reading it as an audiobook (which is cool because Pink himself narrates. No, not pop-star P!nk, though she does have asthma), and I was immediately prompted to re-focus more fully, rewind (or hit the “reverse 15 seconds” button) and take notes. I didn’t really expect to find something that I could relate to patient engagement in this book that is primarily filled with business examples.
From compliance to engagement.
In a few different ways, here on Asthma.Net and on other sites, I’ve written about what I’ve referred to as “the slippery slope of compliance”.
Compliance can seem like a bad word—as can adherence, which is a slightly different vibe on the same word, really, but sort of less legal sounding in my opinion, and a heck of a lot more positive air in its definition.
Compliance, per the magical dictionary in my iPhone, means the action or fact of complying with a will or command; where comply means “meet specified standards”. (Even the words specified standards have a negative vibe to me, like anything less is not good enough.)
Adherence, or, the act or state of adhering (where adhering means believe in and follow the practices of), to me, has a better vibe—one that makes me in control.
Sometimes language means everything—but it is also where things get complicated. Compliance and adherence are rarely in the medical world used positively, rather, are noted when they are absent. Essentially, by not taking my medicine on time every single day, or missing a dose, or altering my doses (hi again—your asthma care plan may vary), I can very quickly become viewed as non-compliant by the standards of some, whereas—as a patient—like my asthma care has to adjust to where I’m at, compliance is kind of a moving target.
“The opposite of autonomy,” Pink states, “is control.” In the context he writes in, a controlling manager or work environment decreases or eliminates altogether, autonomy—or choice—in the work environment. Being a patient is much the same. The more choice we have as patients—just like as employees—the more we actually take ownership of our roles. If we do not have autonomy, our doctors—or worse, our disease—has control.
Let’s pause a second for a definition of engagement, then. To be engaged means to participate or become involved in or establish a meaningful connection with.
By having autonomy, in this case, choice in how we manage our asthma, per Pink, we are led to engagement—“Control leads to compliance,” he writes, “autonomy leads to engagement.”
So, rather than our doctors leading all of the charge when it comes to our health, the more choice, or autonomy, we have—the less we are controlled by our doctors—the more engaged, and successful, we will become. "While compliance can be an effective strategy for physical survival, it's a lousy one for personal fulfilment. Living a satisfying life requires more than simply meeting the demands of those in control."
I don’t want to just be compliant. Compliance does is not about choice or really about me—it’s about standards.
And further? Pink writes that “Only engagement can produce mastery.” He defines mastery as “the desire to get better and better at something that matters."
Look, I don’t really want to be good at having asthma. But if I’m going to have asthma, I don’t want to suck at it, either. And, to me, my asthma matters—having autonomy, or ownership over my asthma matters.
So, no, I am not non-compliant in the traditional sense—because that means I am not going to attain mastery, or ownership, over my asthma. However, If something is not working for me, I’m not going to try too hard to force it, though I will try to make something else work. So, I suppose that, even if they are a better world to be in, engagement and autonomy sometimes may lead to non-compliance.
And for the tradeoff? Hey, I’ll redefine that non-compliant label.
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