Motivational Interviewing Improves Patient Engagement, Quality of Care

What is motivational interviewing?

Motivational interviewing (MI) is a counseling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick. The concept of motivational interviewing evolved from experience in the treatment of problem drinkers, and was first described by Miller (1983) in an article published in Behavioural Psychotherapy. Miller and Rollnick later elaborated on these fundamental concepts and approaches in 1991, in a more detailed description of clinical procedures. Motivational interviewing is a directive, client-centered counselling style for eliciting behavior change by helping clients to explore and resolve ambivalence. It is most centrally defined not by technique but by its spirit as a facilitative style for interpersonal relationship. (Wikipedia:)

Why is it used in a care management setting?

If you’ve ever tried to change your behavior or kick a bad habit, then you know how difficult it can be. Likewise, it’s challenging for providers to get patients to adopt and maintain healthful behavior changes; such as losing weight, starting an exercise program, or keeping up with a medication regimen. Historically, clinicians took a more directive approach to care, giving patients a limited role in the decision-making process. But as healthcare continues to take a more patient-centered approach, care managers will need more effective ways to engage patients.

Recently, tools like motivational interviewing and programs that use them (such as Vigilance Health’s Care Management Program) can help providers influence patients to make changes and support them along the way. With the right technology, care managers can further optimize motivational interviewing and consistently achieve better outcomes, improve care quality, and reduced patient / provider costs.

How does it work?

Motivational interviewing is non-judgmental, non-confrontational and non-adversarial. The approach attempts to increase the patients’s awareness of the potential problems caused, consequences experienced, and risks faced as a result of the behavior in question. Alternatively, or in addition, care managers may help patients envision a better future, and become increasingly more motivated to achieve it. The strategy seeks to help patients think differently about their behavior and ultimately consider what might be gained if the change is made. The focus is on the present, and entails working with a patient to access motivation—to change a particular behavior that is not consistent with a patient’s own values or goals. Warmth, genuine empathy, and acceptance are necessary attributes to foster gains. Another central concept is that ambivalence about decisions is resolved by conscious and unconscious weighing of pros and cons of change vs. not changing.

The main goals of motivational interviewing are to engage patients, elicit change talk, and evoke patient motivation to make positive changes. Change talk can be elicited by asking the client questions, such as

“How would you like things to be different?” or “How does ______ interfere with things that you would like to do?”

Change may occur quickly or may take considerable time, depending on the patient. Knowledge alone is usually not sufficient to motivate change, and challenges in maintaining change should be thought of as the rule, not the exception.

For a care manager to succeed at motivational interviewing, they should first establish four basic interaction skills. These skills include:

• The ability to ask open-ended questions
• The ability to provide affirmations
• The capacity for reflective listening
• The ability to periodically provide summary statements to the client.

These skills are used strategically, while focusing on a variety of topics, such as looking back, reflecting on a typical day, the importance of change, looking forward, and examining one’s confidence about behavior changes.

MI empowers patients to change behavior and commit to better health—on their terms.

Ultimately, care managers must recognize that motivational interviewing involves collaboration not confrontation, evocation not education, autonomy rather than authority, and exploration instead of explanation. Effective processes for positive change focus on goals that are small, important to the patient, specific, realistic, and oriented in the present and/or future.

While there are as many variations in technique as there are clinical encounters, the spirit of the method, however, is more enduring and can be characterized in a few key points:

1. Motivation to change is elicited from the patient, and is not imposed from outside forces.
2. It is the patient’s task, not the care manager’s, to articulate and resolve the client’s ambivalence.
3. Direct persuasion is not an effective method for resolving ambivalence.
4. The counseling style is generally quiet and elicits information from the patient.
5. The care manager is directive, in that they help the patient to examine and resolve ambivalence.
6. Readiness to change is not a trait of the patient, but a fluctuating result of interpersonal interaction.
7. The relationship resembles a partnership or companionship.

Patient engagement continues to be critical in modern healthcare delivery. This is especially true in care management, where care managers and patients collaborate to drive better outcomes at reduced costs—particularly when it involves chronic conditions.

By using motivational interviewing / healthcare coaching techniques and leveraging comprehensive care management technologies, Vigilance Health can facilitate and significantly improve patient engagement. Our care managers help patients become true partners in their own care, and empower them to make positive changes to their health.

Click here for information on the Vigilance Health Chronic Care Management program.