In the realm of modern healthcare, patient engagement stands as a cornerstone of effective care management. Engaged patients become active participants in their health journey, collaborating with their care teams to establish personalized goals and devise solutions that align with their unique needs and circumstances. For care managers, fostering this engagement hinges on mastering effective interviewing techniques and leveraging the right technology to support and sustain these crucial partnerships.
This article delves into the transformative power of motivational interviewing as a technique to significantly enhance patient engagement. We will explore how motivational interviewing, especially when augmented with the right health care tools, empowers care managers to partner with patients. This collaboration leads to a deeper understanding of patient needs, goals, and concerns, ultimately fostering better adherence to care plans and driving positive health outcomes.
The Pivotal Role of Patient Engagement in Health Care Management
The growing emphasis on patient-centered care is underscored by landmark initiatives like the Affordable Care Act (ACA) of 2010, which led to the creation of the Patient-Centered Outcomes Research Institute (PCORI). PCORI’s mandate is to fund evidence-based research focusing on patient outcomes and those outcomes that are most meaningful to patients themselves. Research supported by PCORI has consistently demonstrated that robust patient engagement directly correlates with improved adherence to care plans. This, in turn, leads to better health outcomes and a reduction in overall healthcare costs.
In today’s healthcare landscape, patients are rightfully positioned at the center of the care team. This shift necessitates a move away from the historically directive approach where clinicians primarily dictated care with limited patient input. Care managers are now actively seeking and implementing effective strategies to genuinely engage patients, recognizing that patient participation is not just beneficial, but essential for optimal care management.
Empowering Patients to Commit to Health Improvement on Their Terms
The significance of patient engagement starts even before a patient formally enrolls in a care management program. Prospective patients may harbor reservations about enrolling, perhaps believing they can manage their health independently or expressing concerns about the financial implications of care management and its impact on their health insurance.
Therefore, the initial step for care managers is to engage patients in a manner that fosters trust and encourages active participation. This involves communicating that care managers are partners and facilitators, not authority figures dictating care. When patients feel understood and respected, they are more likely to make informed healthcare decisions, set realistic and sustainable health goals, and feel empowered throughout the process.
To fully realize the advantages of patient engagement, care managers require effective interviewing techniques, and increasingly, health care tools that streamline and support these interactions. Motivational interviewing emerges as a powerful approach, enabling clinicians and patients to collaboratively define healthcare goals that genuinely reflect the patient’s personal desires and life circumstances. This collaborative goal-setting process may involve establishing weekly objectives, determined in partnership with the patient, and deciding upon the most effective communication methods to maintain consistent engagement. Communication preferences can vary widely, with some patients favoring text messages or in-app communication, while others respond more positively to phone calls or in-person visits, depending on age, technological comfort, and personal preferences.
Motivational Interviewing: A Tool to Empower Patients in Healthcare
Motivational interviewing provides care managers with a structured yet empathetic method to empower patients in their healthcare journey. Rather than imposing external goals, this approach centers on understanding and nurturing a patient’s intrinsic motivation for positive change. Developed by clinical psychologist William Miller in 1983, initially to address substance abuse disorders, motivational interviewing has proven to be remarkably versatile. Extensive research has validated its effectiveness in mitigating a range of risky behaviors, such as gambling and excessive alcohol consumption, and in promoting healthy behaviors, including dietary improvements, increased physical activity, and medication adherence.
At its core, motivational interviewing emphasizes sustained empathy throughout patient interactions, moving away from a directive, prescriptive style. This empathetic approach allows care managers to discern the type of communication that best resonates with individual patients, encouraging them to actively embrace and adhere to their care plans.
Motivational interviewing identifies different types of patient communication, notably “change talk” and “sustain talk.” Change talk reflects a patient’s movement toward positive change and includes three levels:
- Desire: Expressing a wish for change (“I want to take my medication as prescribed”).
- Ability: Believing in the possibility of change (“I can arrange for a family member to pick up my prescriptions”).
- Need: Recognizing the urgency for change (“If I don’t take my medication, I risk being hospitalized again”).
Conversely, “sustain talk” indicates resistance to change, where patients express doubts about their ability to commit to positive actions (e.g., “I tried quitting smoking before, but started again and don’t think I can quit this time”). In such instances, a skilled care manager can reframe sustain talk by prompting reflection on past successes, for example, “What strategies helped you quit smoking successfully in the past?”
A key objective of motivational interviewing is to guide patients from sustain talk towards change talk, culminating in “commitment talk.” Commitment talk, ideally expressed at the conclusion of a motivational interviewing session, signifies the patient’s dedication to a specific care management goal. An example of commitment talk would be, “I am committed to taking my medication every day as prescribed.”
10 Key Strategies for Motivational Interviewing in Health Care Settings
Care managers who are accustomed to a more didactic approach—educating patients about their care needs and plans in a directive manner—may inadvertently overlook a crucial element: the patient’s individual perspective and inherent motivation to improve their health. By actively listening to and understanding a patient’s underlying concerns, whether they relate to the stress of a new diagnosis, medication management, complex care schedules, or financial anxieties, care managers can more effectively identify barriers to care. This understanding allows for collaborative problem-solving, working with the patient to identify the most suitable and patient-centered solutions.
Care managers can effectively employ 10 core strategies for motivational interviewing. These strategies are instrumental in fostering trust, enhancing patient engagement, and nurturing intrinsic motivation for care plan adherence:
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Strategy #1: Evocative Questions: Pose questions designed to elicit change talk. For example, instead of saying “You need to take your medication regularly,” ask, “What are some practical steps you could take to ensure you take your medication consistently?”
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Strategy #2: Decisional Balance: Explore the pros and cons of both change and maintaining the status quo. For instance, “Let’s consider the benefits of taking your medication to reduce hospital readmission risk, and also, how might another hospital readmission impact your life if you continue missing doses?”
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Strategy #3: Good and Bad: Discuss the positive and negative aspects of the target behavior. “How will consistently taking your medication improve your overall health condition? Conversely, what are some of the downsides or challenges you perceive with taking your medication, such as cost or potential side effects?”
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Strategy #4: Elaborate and Detail: When a patient expresses change talk, encourage them to elaborate. Use prompts like, “In what specific ways would things be better? Can you tell me more about that? When was the last time you experienced that?”
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Strategy #5: Look Back: Prompt reflection on life before care management. “Thinking back to before you started in the care management program, how were things different for you then?”
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Strategy #6: Look Forward: Explore potential future outcomes if the care plan is followed. “If you consistently follow your care management recommendations, what positive changes do you anticipate? How do you envision your health in five years if you stay on this path?”
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Strategy #7: Explore Extremes: Discuss best-case and worst-case scenarios. “What are the most concerning potential consequences if you don’t adhere to your care management plan? Conversely, what are the most positive outcomes you could hope for if you fully embrace the plan?”
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Strategy #8: Scaling Questions: Use scales to measure importance and confidence. “On a scale from one to ten, where one is not at all important and ten is extremely important, how important is it for you to improve your health right now? What steps do you think you could realistically take to move closer to a ten?”
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Strategy #9: Values and Goals: Connect health goals to broader life values. “What are your main health goals? Is it important for you to be healthy enough to travel this summer? Are there any upcoming family events you are looking forward to attending and want to be healthy for?”
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Strategy #10: Reframing: Adopt the patient’s perspective and reframe barriers into positive strategies. “You mentioned that taking your medication every night before bed feels like a hassle. Would it be more convenient for you to take it in the morning instead?”
Technology: Essential Health Care Tools to Optimize Motivational Interviewing
Equipped with these ten motivational interviewing strategies, care managers are well-positioned to guide patients toward discovering their own motivation to actively participate in their care management plans. To further enhance the effectiveness of motivational interviewing, care managers can leverage technology specifically designed to support care management processes. Platforms like the Health Catalyst Care Management Suite offer applications that can significantly aid in the motivational interviewing process and empower care managers to optimize patient engagement.
The customizable nature of Health Catalyst’s care management tools allows healthcare systems to create interactive conversation guides. These guides can lead care managers through structured motivational interviewing sessions, ensuring consistency and comprehensiveness. Furthermore, care managers retain the flexibility to personalize the tool for each patient, adapting questions based on real-time patient feedback and tailoring the language to align with the patient’s individual goals and expressed commitments.
Beyond conversation guides, other integrated care management tools can facilitate patient surveys to capture patient-reported outcome measures. These surveys assess a patient’s perception of their functional well-being and overall health status, prompting self-reflection and encouraging patients to consider their health from new perspectives. Throughout the motivational interviewing journey, care managers can utilize patient channels within care coordination applications to closely monitor patient progress, provide timely positive reinforcement, and deliver relevant educational resources.
Patient engagement is further sustained through care management applications that facilitate real-time communication with their care teams. For instance, the Health Catalyst Care Companion mobile app enables patients to securely message their care team and access personalized health-related content directly from their smartphones. By effectively integrating these technology-driven health care tools, care managers can significantly optimize the motivational interviewing process, fostering stronger patient partnerships and driving positive behavioral changes that lead to improved health outcomes.
Patient Engagement: The Core of Modern Care Management
As healthcare continues its evolution toward patient-centered models, and as innovative technologies enable greater patient involvement, patient engagement will remain a critical determinant of healthcare delivery effectiveness. This is especially true within care management, where enduring partnerships between care managers and patients are fundamental to achieving superior health outcomes while effectively managing costs.
By embracing motivational interviewing strategies and strategically leveraging technology that facilitates and sustains patient engagement, care managers can empower patients to become genuine partners in their own care. This collaborative approach is key to enabling patients to make meaningful changes that lead to lasting improvements in their health and well-being.
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