Excellent information, thanks for sharing. I agree this is a false dichotomy of productivity vs. patient-centeredness. When I was with Andersen Consulting working in the organization change field we would hear the same from professionals in most every industry faced with change–from financial services, safety and engineering, telecommunications, you name it. This is one “face” of resistance. However, once they are convinced of the urgency for change, they begin to consider how they will need to change to succeed in the new environment.

As Harvard’s John Kotter emphasizes, a sense of urgency is probably the most important predictor of change in small teams and large organizations. Once we get over this hurdle, then we can address what the individual needs to do to succeed in the new environment, in this case, be more patient-centered.

In the past two decades we have found only one approach that can be used in very brief encounters, that works with patients who are typically the most “resistant,” across socioeconomic, cultural and ethnic divisions–and it is motivational interviewing. However, it can take months and years to be proficient at MI and MI proficiency is what is required to deliver the big gains in engagement and health behavior change. However, with very targeted training we have been able to build basic proficiency in MI for physicians, but this requires feedback based on a recording of their work with a patient, evaluated using a validated, standardized measure (we use the Health Coaching Performance Assessment which was is based on the latest health behavior change research and independently validated by Dr. Ariel Linden, health care services evaluator–the HCPA is now being used by organizations from Mayo, Stanford University Health Center, to the VA).

At first MI does take more time, but soon enough physicians learn that it is MUCH more efficient and effective than the usual patient advice and patient education approaches. Research by Terry Moyers at U of NM who works with MI founder Bill Miller, has in fact found that the use of the traditional education and advice can reduce the prospect of patient change–yet that the method of “health coaching” and patient centered communications that is being routinely used by physicians, nurses, pharmacists and many behavioral health providers–and most telephonic wellness, disease management and care management programs. Using the wrong approach will certainly take more time or trying MI after reading about it in an article or attending a workshop.

Without a sense of urgency and a commitment to change, and practical training, feedback and practice in the new skill-set, we can expect the the same mixed findings on the PCMH as we did with the disease management vendors–who also failed in most cases to adequately train and measure the proficiency and performance of their telephonic staff in these brief, highly effective engagement and health coaching approaches. We have embraced evidence-based medicine, now what about evidence-based health behavior change facilitation?

Blake Andersen, PhD
President & CEO
HealthSciences Institute