Motivational Interviewing was originally developed to help clinicians in working with patients and clients. The idea is that the patient has free will, and can choose whether or not to change behavior. The goal of MI is to help the other person clarify their goals and values, and decide if their behavior is in line with those values. They can then make the decisions that work for them.
I’ve recently been asked to provide training for nurse managers and other team leaders in a variety of clinical situations. These managers are being asked to implement “patient-centered care” and “patient medical home”. This means that the focus must be more on what the patient needs than on what works for the provider and the practice. The goal is to improve patient satisfaction scores.
To do this, the practices are being asked to institute a team approach, with providers, front desk staff and managers all working closely together. Each group would “huddle” or meet first thing each day and plan strategies to help provide the best care possible for each patient, and to increase their satisfaction with their visit. This means that team members must be aware of what the others are doing, be willing to share information, and really keep the patient’s welfare front and center.
Unfortunately, in the rush to see as many patients as possible in a given space of time, a lot of this patient centeredness has been dropped. We are really going back to the old-fashioned “rounds” I remember from when I was a new dietitian in the 1970’s.
So, how does MI fit into this? First the interpersonal skills we teach in MI, including listening skills, asking open questions, reflective listening, providing affirmations, and summarizing are very important. Team leaders need to discuss the concepts of patient-centered care with those they supervise, and tell them what changes are being instituted. They need to listen carefully to the feedback they get. What would be good for you and your job about this proposed change? What will make it difficult for you to do this? How can we problem solve to make this happen.
Then key element is allowing the people being supervised, and asked to change, to have input and make their voices heard. There may be many ideas the employees have that administration has not considered. The leaders of these groups need to have very sharp listening skills to help them pick out the “change talk” from the complaint or reasons for no change.
That’s where MI comes in and training in the MI skills will be very helpful to the participants of my upcoming workshop.
