Double Shot for Health: Motivating Patient Behavior Change Cindy Bjorkquist/Michelle Fullerton
Your Case Manager is Calling
Lets Try That Again!
Your Case Manager is Calling
NOT YOU!
Patients need to be active participants in their own journey They are the sole drivers of health behavior change
NOT YOU!
Some patients are intrinsically motivated from the get go They deserve our support and affirmation But that isn t who we are focusing on today
First step Recognize noncompliant patients Data can be a tool to assist in identification (gap in care) Second Step - Solid assessment skills are needed History Lifestyle Social Determinants Lack support network Get to the nitty gritty
Now that I found that patient, What do I do?????? Every case manager has been here!!!!!!!!!
Patient Cindy Behavior Change A 53 year old with multiple chronic conditions directly associated with her lifestyle, habits and choices but she can t improve her condition
To you and me Isn t it obvious what the patient should do???
BUT it isn t that obvious? Where is the patient on their journey to change? Why are they reluctant to take the next step?
Motivation is the Key Dynamic Modifiable Behavior Change Influenced by social factors Influenced by a practitioner s style and behavior (YOU)
Who wants it? YOU???? I am a health professional and people should follow my advice It s my job to fix people/i want to help People should listen to reason People shouldn t do things that damage their health Remember my first call? Medical model
Back to Nursing 101 Four behavior change models Health belief model Stages of change Self-efficacy* Motivational Interviewing*
Health Belief Model One of the first models to apply behavioral science to health A patient will take health related actions based on their perception of susceptibility, severity, benefits and barriers
Stages of Change Prochaska, used in smoking cessation Change is a process not an event Precontemplation, contemplation, preparation, action, maintenance, relapse and recycle
Self-efficacy Is the belief that I have the power to produce change by completing a given task or activity to reach a goal Is the most important precondition for behavior change
What is motivational interviewing? It is a method used to change the direction of a conversation that stimulates the patient s desire (American Academy of Family Physicians) This is an engagement strategy to overcome a challenge in patient care..change.
What is motivational interviewing? As a CM do I have that skill set? How do you know? As a CM leader does your staff have this skill set? How do you know? Have you incorporated this into your assessment protocols?
Watch a skillful clinician providing MI, and it looks like a smoothly flowing conversation in which the client happens to become increasingly motivated for change. In actual practice, MI involves quite a complex set of skills that are used flexibly, responding to moment to moment changes in what the client says. Learning MI is rather like learning to play a complex sport or a musical instrument. Miller & Rollnick (2009)
Case Management Training Began Intensive two day training program in health coaching. Delivered on site to teams of 50 or more staff. Action learning based program that included individual and team practice in MI
And The Training Continued Support MI skills & apply to the job Bi -monthly phone based sessions Continue with monthly lesson plans with focus on building skills
This is hard stuff!
Training Continues with Measurement Code Calls recorded and coded Analyze Evaluate data and provide feedback Report Individual and group reports delivered to staff/trainers/leaders Improve Steps prioritized and implemented
Built Train the Trainer Mentors selected based on MI performance 1:10 mentor/staff ratio Monthly mentor team/leadership session Mentors gradually take ownership of case review sessions and individual staff coaching moving forward.
This is hard stuff! Measure!
Measure: Evoking/Exploring the Patient s Motivation for Change Eliciting reasons for change from patients vs. telling them why they should change.
Measure: Motivation to Change Example (Pre): Cindy, it s important for you to avoid those fatty foods. High cholesterol diets increase your chances of having a stroke or heart attack. Example (Post): Sounds like your doctor told you that you have high cholesterol. How do you feel about that?
Measure: Evoking/Exploring the Patient s Motivation for Change Results: Q1 2.3 Q2 2.9 Target Goal: = > 4
Measure: Resisting the Righting Reflex Avoiding the need to jump in and fix the patient s behavior which tends to elicit resistance.
Measure: The Righting Reflex Example (Pre): Cindy, it s important for you to avoid those fatty foods. Have you tried staying away from fast food restaurants and packing your own lunch instead? Example (Post): Sounds like [from what pt just said] that you really see the importance of cutting down some on fatty foods. How do you think you could go about doing that?
Measure: Resisting the Righting Reflex Results: Q1 2.6 Q2 3.3 Target Goal = >4
Measure: MI Adherence Percentage of techniques consistent with MI vs. MI non consistent approaches.
Measure: MI Adherence Example (Pre): Mr. Jones, you need to get those A1Cs under control or you will really start to see some nasty consequences! Example (Post): Mr. Jones, I know you ve had diabetes for a long time and know a lot about it. What do you know about A1C values and what do they tell you about your condition?
Measure: MI Adherence Results: Q1 61% Q2: 71% Target goal = 90%
Nurse Testimonials I have to say I was one of the skeptics and did not think it would work, but I am surprised how well it works. I am an MI convert. When I go back and listen to a call from before the training, I realize how different my approach is now.
Conclusion CM practice has to change in order to elicit patient change MI needs to be incorporated into your process flows as well as training This is a journey This is a skill set that requires time and practice to perfect as well as money Nurses think they are good at it (scores) Need Some Advice? Wellness coaching
As we all know healthcare is dynamic and constantly changing. Motivational Interviewing is only one tool for Behavior change. How many of you have heard the term Well being?.
Once staff is aware of BH and MI then we move into the future dimensions of case management and this is when we have to talk about well being Talk to your friend in Wellness!
MI is one of several techniques used in wellness industry during coaching Transtheoretical M odel M otivational Interviewing Health Belief M odel Setting SM ART Goals Social Cognitive Theory B.J. Fogg Behavior M odel and Tiny Habits
Practicing Mindfulness Practicing Meditation Careful Observation of my mind
Meditation and Mindfulness Meditation and mindfulness originated in religion Lecia Bushak, Medical Daily article - Mindfulness Vs Meditation: The Difference Between These Two Pathways To Well-Being And Peace Of Mind Earliest records of meditation found in the Vedas, the oldest texts of Hinduism, dating from 1700-1100 BCE. Different forms of meditation began developing in Buddhism and Taoism, mainly in India and China Ancient meditation focused on spiritual growth and transcending emotions to live in a calm present state Meditation currently is used as a way to reduce stress and improve healthy living
Mindfulness and Meditation Meditation is the practice of reaching ultimate consciousness and concentration, to acknowledge the mind and self-regulate it Mindfulness is the act of focusing on being in the present removing overpowering emotions from the mind Mindfulness is a form of meditation like being mindful of your breath improves your awareness of being in the present
What does this have to do with coaching for behavior change?
REWIRE THE BRAIN REPROGRAMMING ATTITUDE AND HABITS Rewire the brain and change the default setting Research suggests you can rewire your brain for: Happiness Success Stop bad habits Start new habits
ACHIEVE BALANCE WITHIN YOURSELF TO REPROGRAM YOUR ATTITUDE AND HABITS
REPROGRAM YOUR ATTITUDE FOR HAPPINESS Happiness is linked to higher productivity and job satisfaction The Happiness Advantage by Shawn Achor Use of Positive Psychology Positive people More engaged More creative More energetic More resilient More productive
REPROGRAM YOUR ATTITUDE FOR HAPPINESS DAILY HABITS TO MOVE TOWARD HAPPINESS 1. Look for positive possibilities in daily life (write 3 things down each day) 2. Change your mindset to be positive (meditate daily) 3. Train your brain to think positive 4. Use setbacks to drive you up 5. Set small manageable goals to build momentum 6. Put desired behavior on path to least resistance 7. Build a strong social support system (greatest predictor of happiness)
WHERE IS HAPPINESS FOUND IN THE BRAIN? HOW DOES MEDITATION AFFECT IT? Scientist at Kyoto University in Japan used MRI scans to locate what part of the brain was activated with happiness Precuneus area located in the top of the brain towards the back was larger for people who felt happiness more intensely Meditation increases grey matter in the precuneus area
CREATE A SENSE OF PURPOSE ROOM
Thank You!!!!!