Using Change Theory to Increase Patient Adherence. Carol Lee, MSW, LCSW & Julie C. Wood, RN, MSN, CNS, CHFN. Realities in the Healthcare Business.
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Carol Lee, MSW, LCSW
Julie C. Wood, RN, MSN, CNS, CHFN
We may have the best doctors, the newest techniques and equipment, the best staff and a beautiful hospital but all that does not matter if our patients are not medically adherent.
Our hospital ratings and re-imbursement is measured on patient outcomes.
Therefore finding new ways to enable patients to be successful in changing their behaviors to be medically adherent is the basic key to the success of a medical system.
1. Identify the 6 basic principles to influence change
2. Identify the 2 basic questions that patients ask
themselves before adherence is possible
3. Learn how to identify Vital Behaviors for a specific
patient population and to measure these behaviors with
Patient Self-Assessment Surveys
Based on the work of Kerry Patterson, Joseph Grenny, David Maxfield, Ron McMillan and Al Switzler
Books: Change Anything,Influencer: The New Science of Leading Change, and Crucial Conversations
The authors researched what was effective in changing individual and group behaviors. Based on this research, they developed principles and strategies for successful change.
Results of Preventative Health Self Assessment Survey
Change Theory Principle: People choose behaviors on what they think will happen.
Human tendency is to live “in the now”.
We consider only the immediate result – “Will it make me feel good now?”
Equally important, but often overlooked is the eventual result “How will this effect me in the(very distant) future?
Medical Adherence is a practice requiring many decisions through-out the day and people need to stay mindfulof their bodies and their health.
Treatment to a diverse adult patient population
A continuum of care from Heart Failure to LVAD to Heart Transplants
TAVR and Congenital Heart Clinics
In 2012, we implanted 29 LVADs and 12 heart transplants.
Our total numbers are 108 LVADs and 148 heart transplants.
Our heart failure program was the 1st in the nation to be certified CMS.
Identify Vital Behaviors by studying positive deviance
Develop a recovery strategy when people make mistakes (anticipate mistakes and make a plan in advance)
Test your results
Update strategy accordingly, test results and repeat
Contemplation; Preparation; Action; Maintenance; Termination
people in problem-solving these answers
Social Ability – Real change requires help, information
and support from others
Structural Motivation – Environment impacts behavior
Make the healthy choice the easy choice
Structural Ability – Small changes in the environment
can have a big impact that are “forces that either push
with you or against you”
Personal Motivation – An individual’s desires and wants
Personal Ability – An individual’s skill set
Social Motivation – “Bad habits are almost always a social disease – if those around us model and encourage them, then we’ll almost always fall prey. Turn accomplices into friends and you will be two-thirds more likely to succeed.” (Patterson, Change Anything)
Development for specific populations – (apply change theory and identify Vital Behaviors)
Right now my quality of life is:
(Directions: Circle the number)
Assists the patient with the Can I do it question by:
Front pocket of notebook = Labs & Rx “To Do”
Business card holder
Medical Problem List
Contact List (Emergency contacts, family)
Questions for M.D. (Add blank paper)
Front pocket of Notebook = For labs & Rx “to do”
Business card holder
Medical Problem List
Questions for M.D. (with blank paper)
Presented as a gift – each notebook is personalized
Patient instructed by SW or RN on how to use
Patient asked to bring the notebook to all of their medical appointments
Staff assists patient in keeping notebook up-to-date
Staff teaches the patients how to read their labs and follow along with staff & keeps information current
Staff writes or has patient write appointments in the calendar
When an LVAD patient receives a Transplant, staff re-organizes their notebook for them with the new tabs.
When the notebook is thinned, staff asks if the patient wants to keep the outdated information or obtains permission to safely dispose of their confidential information.
Effectiveness was observed by patient, their family and staff behaviors
Physicians, RN Coordinators were involved in the organization of the notebooks
All new LVAD & Transplant patients are presented with their Medical Notebook as part of their pre-discharge teaching by the RN Coordinators
With our patients who were given implants before this tool was developed or with our Heart Failure patients, our policy is that any staff member can offer a notebook to one of our patients.
Patients, patient’s caregivers and staff “love” this tool
At least 90% of the patients bring the notebook to their appointments and use the notebook to show staff their current medication lists, daily recordings, etc.
Staff updates patient’s notebooks with copies of recent labs, diagnostic reports, etc.
American Heart Association. http://www.heart.org
Miller, William, and Stephen Rollnick. Motivational Interviewing: Helping People Change. 3rd ed. New York: Guilford Press, 2012. Print.
Patterson, Kerry, Joseph Grenny, et al. Change Anything: the New Science of Personal Success. New York: Business Plus, 2011. Print.
Patterson, Kerry, Joseph Grenny, et al.Crucial Conversations: Tools for Talking When Stakes Are High. Updated 2nd ed. New York: McGraw-Hill, 2012. Print.
Patterson, Kerry, Joseph Grenny, et al.Influencer: the Power to Change Anything. New York: McGraw-Hill, 2008. Print.
Carol M. Lee