Mike Hindmarsh Hindsight Healthcare Strategies QIIP Practice Facilitator Training May 1213 2008 Toronto ON Informed Activated Patient Productive Interactions Prepared Proactive Practice Team ID: 1043360
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1. Using Self-Management Support In Your Coaching ApproachMike HindmarshHindsight Healthcare StrategiesQIIP Practice Facilitator TrainingMay 12-13, 2008Toronto, ON
2. Informed,ActivatedPatientProductiveInteractionsPrepared,ProactivePractice TeamDeliverySystemDesignDecisionSupport ClinicalInformationSystemsSelf-Management SupportHealth SystemResources and PoliciesCommunity Health Care OrganizationChronic Care ModelImproved Outcomes
3. Self-Management SupportEmphasize the patient’s central role in managing their illnessUse effective self-management strategies that include assessment, goal-setting, action planning problem-solving and follow-up.Organize internal and community resources to provide ongoing self-management support to patients.
4. What is self-management?“The individual’s ability to manage the symptoms, treatment, physical and social consequences and lifestyle changes inherent in living with a chronic condition.”Barlow et al, Patient Educ Couns 2002;48:177
5. Patient educ. vs. SMSInformation and skills are taughtUsually disease-specificAssumes that knowledge creates behavior changeGoal is complianceHealth care professionals are the teachersSkills to solve pt. Identified problems are taughtSkills are generalizableAssumes that confidence yields better outcomesGoal is increased self-efficacyTeachers can be professionals or peers
6. Self-Management Tasks in Chronic IllnessTo take care of the illnessTo carry out normal activitiesTo manage emotional changesBased on work by Corbin and Straus
7. Collaborative care“If physicians view themselves as experts whose job is to get patients to behave in ways that reflect that expertise, both will continue to be frustrated…Once physicians recognize patients as experts on their own lives, they can add their medical expertise to what patients know about themselves to create a plan that will help patients achieve their goals.”Funnell & Anderson JAMA 2000;284:1709
8. What self-management support isn’t...Didactic interactionSage on the stageYou should…Finger waggingLecturingWaiting for patients to ask for help
9. Self-Management in CCMGlasgow RE, et al (2002) Ann Beh Med 24(2):80-87 Personal Action Plan1. List specific goals in behavioral terms2. List barriers and strategies to address barriers3. Specify Follow-up Plan4. Share plan with practice team and patient’s social supportASSESS :Beliefs, Behavior & KnowledgeADVISE :Provide specificInformation abouthealth risks andbenefits of changeAGREE:Collaboratively set goals based on patient’s interest and confidence in their ability to change the behaviorASSIST :Identify personal barriers, strategies, problem-solvingtechniques and social/environmental supportARRANGE :Specify plan forfollow-up (e.g., visits,phone calls, mailedreminders
10. Using the Five A’s as a Facilitator
11. ASSESSRisk factors, Beliefs, Behavior and Knowledge
12. Tips on assessing your practice teamAsk questions about them….get to “know” themProvide feedback to team when appropriateAssess their view of QI progress and how easy/difficult it is to get things done.
13. ADVISEProvide specific information about the benefits of practice change
14. Tips on providing adviceMake the source of advice clear (medical knowledge or best practice)Personalize advice to the FHT/CHC environmentListen more than you talkHave a key message for each idea you presentDon’t overwhelm them with information
15. AGREEFoster collaboration in selecting ideas for change.
16. Tips to create agreementBase goals and measures and team’s prioritiesLet then start where they wantDo not judge ideas for changeDo not make them agree with youTeam consensus on testing ideas is not critical unless there is obvious opposition or discomfort
17. ASSISTUsing behavior change techniques (problem solving, counseling) to aid the team in acquiring skills, confidence to test ideas quickly.
18. Tips on assisting patientsUse other teams as examplesAddress helplessnessLearn and use a problem-solving approachLink to the assessment of barriers and environmentAvoid telling them what to doAvoid speechesAvoid cheerleading
19. Problem Solving1. Identify the problem.2. List all possible solutions.3. Pick one.4. Try it in the next testing cycle.5. If it doesn’t work, try another.6. If that doesn’t work, find a resource for ideas.7. If that doesn’t work, accept that the problem may not be solvable now.
20. Thoughts on Team QI LiteracyPeople can read and function above their cognitive level on topics that interest themPeople are very sensitive about being talked down to.Be cognizant of power inequities among team members
21. ARRANGESchedule follow-up contacts to provide ongoing assistance and support as needed.
22. Tips for follow-upTry a wide variety of methods, whichever team prefers (in person, phone, email)Make sure follow-up happens, team trust can be destroyed by missed follow-upDetermine follow-up based on team preference
23. Personal Action Plan1. Something you WANT to do2. Describe How Where What Frequency When3. Barriers4. Plans to overcome barriers5. Confidence rating (1-10)6. Follow-Up planSource: Lorig et al, 2001
24. Confidence Ruler 2 3 4 5 6 7 8 9 10Not Unsure Somewhat VeryConfident Confident Confident
25. www.improvingchroniccare.orgFor More Information on Self-management Support thanks