Healthskills Leadership Academy e-letter #48 written by Lesley Cave, a Healthskills Academy member
… is being championed by me to encourage the use of this evidence based coaching techniques in more clinical settings and across a wider range of health and other managerial situations where a change in behaviour, performance or culture is needed to bring about real benefits.
It is a technique to engage in a collaborative and evocative discussion between coach and coachee, doctor and patient, boardroom and shop floor; to identify, motivate and commit to a specific change in behaviour to achieve a coachee, patient or client’s desired outcome. Motivational Interviewing is not coercive, threatening or imposing. It is person-centred and goal-oriented. It is trust built on rapport.
In health terms, motivational interviewing is a discussion between health professional and patient to ‘draw out’ those values or incentives that will motivate a patient to make different lifestyle choices to improve their health condition. There are many books written on the subject for example Motivational Interviewing in Health Care by Stephen Rollnick et. al. (2008) Guilford Press, New York.
William R. Miller first described motivational interviewing in 1983 as a result of his clinical experience treating alcohol abuse. The four basic principles of motivational interviewing are
- Express empathy – building rapport so that the coachee experiences the coach ‘seeing’ the world as they do
- Support self-efficacy – supporting the coachee to believe that the ability to change is within them by focusing on previous success
- Roll with resistance – in order not to stop the flow of the process with arguments and challenges. The benefit of motivational interviewing rests on having the coachee identify the problem [causing the avoidance of or reluctance to change behaviour] and develop solutions that suite them, and therefore offer no resistance
- Develop discrepancy – a ‘gap analysis’ between where a coachee is now (career, health etc.) and where they want to be. The motivational interviewer will help a coachee to identify the discrepancy between their current circumstances or behaviour and their values or future goals
The success of motivational interviewing is delivered through asking open-ended questions, affirmation, reflection and summary.
My challenge to doctors, nurses and managers alike, is to try this evidenced-based technique, moving it from patient-centred change talk to leadership-centred change talk in Clinical Commission Groups. It is my belief that this small yet significant move would produce a major cultural shift in the NHS.
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