The Science of Connection and Why Relational Health Is the Missing Metric in Patient Outcomes
- 19 hours ago
- 5 min read
Dr. Florence Lewis is a licensed Marriage and Family Therapist and the founder of the Upside Health Research Network (UPHRN), where she helps healthcare providers integrate evidence-based tools to measure and support relational health outcomes.
Imagine a cardiac patient leaving the hospital against medical advice. Their vitals are stable. Their medications are optimized. Every clinical metric says they're ready for discharge. But when asked why they're leaving early, they reveal something profound: "Nobody here knows what I'm living for. If they don't know why I want to stay alive, how can they help me heal?"
This scenario, which plays out in hospitals every day, reveals what I've spent my career at Upside Health Research Network trying to prove: We're measuring everything about health except what might matter most, the quality of human connection itself.
The invisible vital sign we're not tracking
Healthcare systems today are drowning in data. We track blood pressure, glucose levels, medication adherence, wait times, satisfaction scores, and hundreds of other metrics. We can predict who's likely to be readmitted, who might skip appointments, and who's at risk for complications.
But here's what we don't measure: Does this patient trust their doctor enough to share what's really wrong? Does the nursing team communicate in ways that make families feel heard and valued? Are patients connected to people who help them want to get better?
I call this "relational health," the measurable quality of connections between people in healthcare settings. After a decade's worth of research and clinical work, I'm convinced that it's the missing vital sign that could transform how we deliver care.
What the research tells us about connection
The science is actually screaming at us to pay attention, but we keep looking at spreadsheets instead of faces. Let me share what the evidence shows in plain language.
Research in primary care found that patients reporting high levels of concordance with their physician were one-third more likely to be compliant with their medication regimen, NCBI. That's not a small bump, that's the difference between managing diabetes successfully or ending up in the emergency room.
A comprehensive scoping review identified that information and knowledge of diseases and their treatment, communication, trust in patient-provider relationships, support, and access to adequate resources appeared to be the critical facilitators of medication adherence from the patient's perspective.[1] When patients feel genuinely connected to their care team, their relationship with treatment undergoes a fundamental change.
Studies of heart attack survivors found that low emotional support was associated with increased mortality. In contrast, social support from significant others was significantly associated with a lower risk of readmissions, including both all-cause and cardiac readmissions.[2] Connection isn't just nice to have, it's lifesaving.
Research shows that social support has been shown to decrease hospital readmissions, improve mortality, and lower reported levels of depression in cardiac patients. One study even equates the mortality risk associated with a lack of social support to that of smoking.[3]
Why we're missing what matters
So if relationships are this powerful, why aren't we measuring them like we measure cholesterol? I've identified three big reasons:
First, we've convinced ourselves that what's hard to quantify doesn't count. Blood pressure is a number. Trust feels fuzzy. But here's the thing, we measure customer loyalty, employee engagement, and brand affinity in business all the time. We just haven't applied these tools to healthcare relationships.
Second, we're scared of what we might find. If we actually measured relational health, we'd have to face that our 15-minute appointments and rotating providers are breaking the very connections that help people heal. That's an uncomfortable truth for a system built on efficiency.
Third, Nobody's getting paid for the connection. Insurance reimburses procedures, not presence. Medicare covers medications, not meaningful conversations. Until we value relationships financially, we won't be able to measure them systematically.
How we can start measuring what matters
Through Upside Health Research Network, I'm working with hospitals and clinics to change this. We've developed simple tools that make relational health as measurable as any vital sign.
We use brief surveys that ask questions like: "Does your provider remember important details about your life?" and "How often do you feel truly heard during appointments?" These tasks take 30 seconds to complete but reveal patterns that predict outcomes more accurately than many clinical indicators.
I'm proud that I'm able to teach teams to do "connection rounds," quick daily check-ins where staff rate the quality of their interactions with patients and each other.
We're even using AI not to replace connection, but to strengthen it. Machine learning helps us identify which patients feel disconnected before they disengage from care. Natural language processing analyzes clinical notes to identify providers who excel at building trust, allowing us to learn from their approaches. Technology becomes a tool for more profound humanity, not a barrier to it.
The future of healing we're building
Consider what happens when a care team knows not just a patient's medications but their motivations, when nurses understand what gives someone purpose, when doctors ask about what matters beyond symptoms. When therapists recognize that patients aren't just recovering from procedures, they're preparing for life moments that matter to them.
Research on the therapeutic alliance between cancer patients and their physicians found that patients with higher therapeutic alliance scores had better emotional acceptance of their terminal illness NCBI. When patients feel known and valued, clinical numbers improve, certainly. But more importantly, patients want to be well. That desire born from feeling connected is more potent than any prescription we could write.
This is the future I'm fighting for through Upside Health Research Network: healthcare that measures connection as carefully as it measures blood counts. Systems that track whether patients feel seen, not just whether they've been screened. Organizations that understand the science of connection are also aware of the science of healing.
Recent research emphasizes that higher levels of perceived social support are associated with lower hospital readmission rates, highlighting the necessity of targeted, durable, and trust-based interactions between people with chronic diseases and nurses to support and improve medication adherence.[4]
Because when we finally start measuring relational health, we'll discover what patients have always known: The quality of our connections doesn't just affect our experience of care. It determines whether we heal at all.
What if your next medical appointment asked not just "How are your symptoms?" but "How are your relationships?" That's when we'll know we're finally measuring what matters.
Ready to make relational health measurable in your organization? Connect with Upside Health Research Network to discover how evidence-based tools can transform connection from a feeling to a metric. Because the future of healthcare isn't just about treating disease, it's about strengthening the relationships that help us heal. Learn more about our approach.
Read more from Dr. Florence Lewis, PhD, LMFT
Dr. Florence Lewis, PhD, LMFT, Relationships & Health Researcher, Therapist
Dr. Florence Lewis, PhD, LMFT, is a Medical Family Therapist and founder of the Upside Health Research Network (UPHRN), a nonprofit focused on measuring the impact of relationships on health outcomes. With clinical roots in integrated care, she has worked alongside medical teams to support patients' mental, social, and relational well-being. Dr. Lewis is a published author and dynamic speaker on diversity and holistic health. She hosts "The Relational Health Report" podcast. Her current work helps healthcare providers use evidence-based tools and AI to improve relational health metrics in practice. She also runs a private therapy practice supporting individuals and couples in navigating and building healthy relationships amid past emotional trauma.
Reference:
[1] (PubMed Central)
[2] (ScienceDirect)
[3] (PubMed Central)
[4] (PubMed Central)
