Motivational Interviewing: The Key to Effective Conversations About Change
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Presented by Paola Torres, Sr. Performance Improvement Manager at Healthfirst in NYC Learning objectives: Become familiar with the spirit, theory, and practice of Motivational Interviewing (MI) Identify your customer’s readiness for change based on key communication indicators Learn basic MI communication techniques to help your clients resolve their ambivalence and develop intrinsic motivation to change Paola Torres Paola Torres is a Lean Six Sigma Master Black Belt and continuous improvement professional with 17 years of experience in the Healthcare industry. She is currently a Sr. Performance Improvement Manager at Healthfirst in NYC. Prior to joining Healthfirst, she was the Director of Supply Chain Transformation and Integration at NYU Langone Health. As a Lean Six Sigma practitioner and coach, she has led over 40 cross-functional Kaizen/Rapid Improvement Events (RIE) integrating change management concepts and adult learning theory into applied process improvement science. A native of Colombia, she received her BS in Microbiology from Javeriana University in Bogota and MPA in Health Care Management from New York University.
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Motivational Interviewing: The Key to Effective Conversations About Change
- 1. Motivational Interviewing: The Key to Effective Conversations About Change Hosted by Host: Mark Graban Senior Advisor, KaiNexus Mark@KaiNexus.com Presenter: Paola A Torres, MPA, LSSMBB Sr. Performance Improvement Manager at Healthfirst paolatorres.pena@gmail.com
- 2. About Paola Torres • Works in New York City – HealthFirst – Sr. Performance Improvement Manager – Lean Six Sigma Master Black Belt and continuous improvement professional • 17 years of experience in the Healthcare industry • Led over 40 cross-functional Kaizen/Rapid Improvement Events (RIE) • BS in Microbiology from Javeriana University in Bogota, Columbia • MPA in Health Care Management from New York University
- 3. Learning Objectives Become familiar with the spirit, theory, and practice of Motivational Interviewing (MI) Identify customer’s readiness for change based on key communication indicators Learn basic MI communication techniques to help your clients resolve their ambivalence and develop intrinsic motivation to change
- 4. Take a moment to think about the following and type in the chat: • What motivated you to attend this webinar?
- 5. What is Motivational Interviewing? A collaborative conversation style that seeks to elicit and strengthen a person’s: ü motivation ü commitment to change Miller and Rollnick, 2009
- 6. Does MI Work? • Motivational interviewing: a systematic review and meta-analysis Motivational interviewing in a scientific setting outperforms traditional advice giving in the treatment of a broad range of behavioral problems and diseases. Rubak at all . Br J Gen Pract. 2005 Apr;55(513):305-12. PMID: 15826439; PMCID: PMC1463134. • The Missing Piece in Improvement: Understanding How to Motivate Change “I’m often asked about the best way to motivate people. Learning to unleash intrinsic motivation is a particularly challenging skill. I am a huge proponent of the principles of motivational interviewing. The underlying idea behind motivational interviewing is that you don’t tell people to change; instead, you help them recognize that they want to change. “Julia Moore | Wednesday, March 13, 2019 IHI Blog
- 8. Mechanism for Change Pre contemplation Contemplation Action Maintenance Motivational Enhancement Strategies Relapse Intervention Relapse Management and Prevention Transtheoretical Model (Prochaska & DiClemente, 1986) Graphic credit to Dr. Jonathan Fader, PhD
- 9. “I know what needs to change to optimize their processes, but nobody is listening to me!!” The Righting Reflex
- 12. Take a moment to think about the following: • What did you discuss during your last meetings with a customer/client? • What if your client or customer was “told” to work with you?
- 13. MI Capability Collaboration, Acceptance, Evocation and Compassion Interviewing OARS, Listening Mechanism for Change MI Process, MI Principles Graphic adapted from Lucas, B. (2019), Why we need to stop talking about 21st century skills.
- 14. MI Process What are we here to talk about ? Who is this person? Why is this important to you? Evoking Focusing Engaging How are we going to change? Planning
- 15. Open Ended Affirmations Reflections Summaries Gagneur A. Motivational interviewing: A powerful tool to address vaccine hesitancy. Can Commun Dis Rep. 2020;46(4):93-97. Published 2020 Apr 2. doi:10.14745/ccdr.v46i04a06
- 16. Open Ended Affirmations Reflections Summaries • We had a consultant here last year, nothing changed • We are already working on this!
- 18. MI Process Who is this person? Evoking Focusing Engaging Planning
- 19. Take a moment to think about the following: • Where was the first time you met your in-laws • Did you ask all the questions that you had in your mind?
- 20. Engaging – Case Study The Supply Chain Case Study: • Find “the defects” or reasons why nursing units did not have supplies needed on time • A dateline to identify root causes was given to the process improvement team
- 21. “We already worked with a consultant here last year and nothing changed” • Trust • Partnership Engaging - Questions
- 22. “We already worked with a consultant here last year and nothing changed” • I understand, it most be tremendously frustrating to invest time working with a consultant and not see the benefits, what matters to you is to make sure the clinical care team has what they need to do their job • Your department manage a super complex operation we can run the hospital without your team! Engaging – OARS
- 23. Engaging - Avoid The Premature Focus Trap The Expert Trap The Label Trap
- 24. MI Process Who is this person? Evoking Focusing Engaging Planning What are we here to talk about?
- 25. Take a moment to think about the following: You just got assigned a new project, things are busy at work. You spouse/partner wants you to take time off to go on vacation, what is your response to that request ?
- 26. “The accounts payable department Case Study: • The director of the department is extremely dissatisfied current workflow to process credit memos • He reached out to the company's process improvement team Focusing – Case Study
- 27. Focusing - Questions “We want to ensure our members account balance information is accurate and decrease the time it takes to send a bill and also ensure bills go out without any defects” • Goals • Dancing or wrestling?
- 28. We want to ensure our members account balance information is accurate and decrease the time it takes to send a bill and also ensure bills go out without any defects- I don’t know where to start! • It sounds like there are a lot of opportunities here and improving the member’s experience is a top priority for you • Let’s discuss them more in detail, tell me more about the account balance information… Focus – OARS
- 29. ELICIT-PROVIDE-ELICIT Elicit: Would it be ok if I share with you how this issue was addressed before? Provide: Your processes are all interconnected, we can start by identifying the beginning and end point of some them… Elicit: What are your thoughts about this approach?
- 30. Focusing - Avoid The Righting Reflex Taking Control Task Completion
- 31. MI Process What are we here to talk about ? Who is this person? Why is this important to you? Evoking Focusing Engaging Planning
- 32. Take a moment to think about the following: • Do you believe you can influence your client’s readiness for change?
- 33. Evoking – Case Study The Emergency Department (ED) Call Center Case Study During day 3 of Kaizen event with ED call center, several team members expressed the following statement: ◦ “We would like to call the patients specialist and confirm their appointments, but we don’t have time”.
- 34. We would like to call the patients specialist and confirm their appointments, but we don’t have time”. • Why • Arguing or telling Evoking - Questions
- 35. Evoking - Elicit Change Talk D Desire A Ability R Reason N Needs C Commitment A Activation Ts Taking Steps
- 36. Evoking - Elicit Change Talk D Desire • What services do you envision providing 5 years from now? A Ability • If you were to call a patient’s specialist how much time would it take? R Reason • What are the advantages of speaking with a patient’s specialist? N Needs • How important is it for you as a call center nurse to speak with a patient’s specialist?
- 37. Evoking - Avoid The Wrong Question Taking Sides
- 38. MI Process What are we here to talk about ? Who is this person? Why is this important to you? Evoking Focusing Engaging How are we going to change? Planning
- 39. Planning - Case Study “Director of care management department reached out and indicated that IT system changes implemented through a previous kaizen needed to be included in the new care management system.
- 40. Planning – Questions “We are ready to test these changes in our new care management system.” • Steps • To evoke vs. “to tell”? • Permission
- 41. Evoking - Elicit Change Talk C Commitment • There are good reasons to run a small pilot with our private practice patients A Activation • We are ready to run the pilot Answer: when will you do it? T Taking Steps • I scheduled a meeting to discuss key activities for the pilot
- 42. Engaging Focusing Evoking Planning The MI Process Who Where Why How
- 43. Customer’s Ambivalence Motivational Interviewing Behavioral Change/Action Project Success Takeaways
- 44. Do you want to learn more about Motivational Interviewing? Motivational Interviewing: Helping People Change Miller, William R., and Stephen Rollnick https://motivationalinterviewing.org/tra ining-motivational-interviewing-0 Change management and process improvement resources for practitioners https://www.leanconnectome.com/
- 46. Future Webinars • Training Team Office Hours – August 12th, 1 pm ET – KaiNexus customers only • Next Webinar – “The Wheel of Sustainability” – Adam Lawrence – August 10th, 1 pm ET – Open to everybody! Register: www.KaiNexus.com/webinars
- 48. KaiNexus Podcasts • www.KaiNexus.com/podcasts • Subscribe via: – Apple Podcasts – Google Podcasts – Stitcher – Spotify
- 49. Q&A • Web: – www.kainexus.com – blog.kainexus.com • Webinars on Demand: – www.kainexus.com/webinars • Social Media: – www.twitter.com/kainexus – www.linkedin.com/company/kainexus – www.facebook.com/kainexus Host: Mark Graban Senior Advisor, KaiNexus Mark@KaiNexus.com Presenter: Paola A Torres, MPA, LSSMBB Sr. Performance Improvement Manager at Healthfirst paolatorres.pena@gmail.com