Working in health care these days is like cooking a big dinner on eight burners with two ovens going. Most professionals want to spend their time improving patient health and well-being. The brief time available with patients is often dominated by an avalanche of required tasks. Data collection with a computer between health care workers and the patient make meaningful interactions difficult.
Competing priorities and demands on workers: outcome, performance criteria, complex presentation, financial reality, and a need for more responsibility and accountability from patients themselves create pressure in the thing that has the most efficacy when managed well- the conversation.
The strategies of Motivational Interviewing (MI) offer solutions for prioritizing and organizing tasks that matter to complex health related behavior change. Here is the irony: when using MI, it’s not what you do but more how you do it that gets results.
A well-timed motivational interviewing conversation can save time.
The well-trained healthcare worker can use their practice wisdom, combined with the strategies of reflecting and evocation in new collaborations between care providers and patients. The well executed (MI) conversation is the medicine for those stuck places patients get into.
Using and integrating MI, in systems of care will evoke and enhance motivation and action for change, but often adds another pressure on the worker who sees MI as another task to accomplish rather than a set of techniques and a new way of thinking that gives patients more of what they need (their own thoughts out loud in a distinct and vivid conversation) and less of what they don’t need (reinforcing that stuckness and offering unworkable goals).
Time is of the essence for most workers and the stakes are high both for the patient who suffers, and the worker whose professional judgment has-been devalued and short-circuited by the bottom line and the need to constantly justify through completion of tasks and documentation designed for the system not the relationship.
With all complex behavior change, the well-timed pertinent conversation is the medicine.
A skilled healthcare worker using MI creates opportunities in brief time frames that invites the patient to think out loud in new ways about old problems. In addition a skilled MI practitioner strategizes longer conversations when readiness and motivation are mobilized. Creating this kind of medicine is simple but not always easy and takes a little investment in learning the style and recipe for each individual patient.
Knowing which pot to bring forward and stir and which cake to let bake until awareness or external motivators shift is the art and the skill of MI in medical settings. Like anything worthwhile, It takes time and practice to learn and some time to practice. All worth it when you remember that the conversation itself is the medicine.
TIP OF THE WEEK: If you find yourself planning the answer or what you want to say to the patient before they are finished speaking, or you find yourself interrupting their thoughts with your questions, take a breath and practice a complex reflection to their ideas. Then see what happens next…