One of the things we love doing most is providing the continuous improvement community with more resources and opportunities to learn. Our webinar series aims to do precisely that by bringing in experts, improvement professionals, and front-line process operators to share their experiences and knowledge.
This post is a recap of one of our most popular webinars ever. Mark Graban, our senior advisor, was delighted to host Mark Valenti. (You can never have too many Marks on a webinar, but you can in a webinar recap. To make it easy to tell who is speaking, and keep the informal tone of the presentation, I'll call them Mark Valenti just Mark, and Mark Graban, Mark G.)
Mark has a background in health systems management, human behavior, and patient activation. Mark focuses on helping others reach their goals by uncovering their intrinsic motivation. He also has a unique teaching framework called "Activate Your Audience" to help speakers better express their messages.
Mark introduced the topic of the webinar, "From Ambivalence to Action: Leadership Lessons from Motivational Interviewing," by explaining that it is really about recognizing that people struggle with changing their behavior. Changes seem overwhelming and unreachable. He asked, as leaders, what is our role to help people change their behavior?
From Ambivalence to Action: Leadership Lessons from Motivational Interviewing
Presented by Mark Valenti
Most people struggle with changing their behavior. Changes seem overwhelming and unreachable. As professionals, we often support, educate, and coach people to continuously improve behavior. You are invited to join your colleagues for a unique webinar that will help you build your change coaching skills and learn new approaches to communication.
In this webinar, you will learn:
- The history and common misperceptions about Motivational Interviewing
- The 3 crucial elements of behavior change
- Successful applications of Motivational Interviewing to real-life workplace situations
- Some tips to start applying the concep
What Motivation Interviewing is NOT
Before getting into the definition of motivational interviewing, Mark gave us some insight into what it isn't. Motivational interviewing is not the same as motivational speaking. It is not someone like Tony Robins trying to motivate a crowd. It also isn't a charismatic doctor or leader trying to inspire an individual to change.
Motivational interviewing is not someone like Matt Foley from Saturday Night Live trying to scare kids into making positive decisions so they don't end up like him living in a van down by the river.
Motivational interviewing is not trying to scare patients by showing them images of bad things that can happen if they don't manage their condition. It's not about manipulating people into doing things they don't want to do.
Motivational interviewing is not therapy - it has its roots in therapy, but it is not client-focused therapy. It is not behavioral-based, like a job interview.
Motivational Interviewing is Simply Helping People Change
The approach gets its name from the book "Motivational Interviewing," by William (Bill) Miller and Stephen Rollnick. The third edition of the book came out in 2013, and it has been continuously updated since its original publication.
Motivational interviewing (MI), Mark explained, focuses on people who are struggling through ambivalence. People who are keeping current sustained behaviors and thinking about changing. It's a guidance style that invites people to examine their own values and behaviors and come up with their own reasons to change.
A person partnering with someone doesn't try to argue or convince them. Instead, using the framework, they draw out the other person's ideas about how to change. The ultimate goal is to promote intrinsic motivation toward behavior change or activation.
The MI approach started in the field of unhealthy substance abuse in the 1980s. At the time, there were a lot of labels put on people who were struggling with alcohol addiction. Bill Miller found that just by listening to people and really trying to understand them as individuals, they became more than their labels. He learned the value of how to connect with people and really understand their perspective.
Activation in Healthcare
Mark defined "Activation" as people doing things without someone looking over their shoulder. It's about people doing something because they are intrinsically motivated to do it. Mark quoted a former colleague, Dr. Bruce Block, who used to say, "Healthcare happens between visits." People make healthcare decisions during the 99.9% of the time they are not in the doctor's office or the hospital. It happens when they are out in the community living their lives. Motivational interviewing is about helping people meet their healthcare goals in a meaningful, self-managing way.
When you think about patients, what exactly are we asking them to do? Mark asked. Guiding people to self-health management includes things like cutting down on cigarettes and other unhealthy substances, taking their medications, choosing a healthy diet, managing chronic conditions, or calling the office when symptoms arise. All of this activation is really about the self-realization of health goals and change without constant supervision.
Most traditional healthcare doesn't focus on activation; it focuses on planning. For example, when someone leaves the hospital or doctor's office, they get discharge instructions or an after-visit summary that includes a lot of information and directives about what to do next. They may also include warnings trying to scare people into doing what's been prescribed. Ultimately, these tactics don't change people's behavior.
Mark reminded the audience that a similar scenario plays out with our teams at work. We present people with a lot of information, we give them documents, policies and procedures and all sorts of great educational material, and we plan out what they should do. But inevitably, people become frustrated, and they don't change their behavior. Front line team members often just don't see the value in change, and if you prod them too much, they end up looking for other jobs.
Motivational interviewing seeks to uncover what is the root cause and what is the current condition through the lens of understanding people and what motivates them. MI starts with engaging, which involves getting to know someone for who they are. What are their fears? What are their values?
Activation starts with motivation. What gets people out of bed in the morning? Mark commented on the book "Drive" by Daniel Pink, noting that Mr. Pink has done a lot of research, interviews, and observations to understand human drive.
The first level of drive is called biological drive. It includes the most basic needs that must be met before any intrinsic motivation is even considered. If you are facing a lack of food or shelter, you aren't likely to be worried about having your cholesterol checked.
The same is true at work. If you are always worried about losing your job, which is your way of obtaining food and shelter, you aren't going to be spending time innovating and coming up with creative new ideas.
If you don't have the tools you need day-to-day, you are stuck in that biological drive because you can't do the job without the tools.
In addition, when signs and instructions are unclear, people start to panic. This can prevent people from graduating past biological needs. When people see missing pieces of the puzzle, we fill in our own ideas about what should go there, and we often fear the worst.
If the basic biological needs are met, the person graduates to the next level, extrinsic motivation. At this level, people are motivated by rewards and punishment. For example, many health insurers send out gift cards to entice people to come into the office for their annual wellness check so they don't lose out on the associated financial rewards they get when patients do so.
At work, managers may offer things like pizza parties to get people to participate in Lean or other programs. These approaches may get people to respond, but it doesn't change their intrinsic motivation because they are doing it to get that reward.
Another part of extrinsic motivation is relationship approval. Leaders who focus on relationship approval can actually prevent intrinsic motivation by putting all of the emphasis on their approval, causing the employee to seek positive feedback continually. A "check the box" mentality can develop if certain behaviors seem to be what's valued in the department.
The third level of motivation is intrinsic motivation. Someone with intrinsic motivation must know that they have autonomy. As human beings, we have choices. The moment we feel like choices aren't there, we regress to extrinsic or even biologic motivation.
Research has found that when people are aware that they have options, they tend to dive into their intrinsic motivation. As a leader, you have a lot of power in promoting autonomy with your employees.
Mark gave an example of mandatory meetings or training, which can decrease the perception of autonomy. Even strongly suggesting attendance to an "optional" meeting, can make employees feel like they don't have a choice. Leaders may fear that no one will show up if the event isn't required, but if that is the case, it invites some reflection on why no one found the event of sufficient value to attend.
Once one understands that they have autonomy, the next step is mastery. Someone who is intrinsically motivated focuses on improving themselves. They do a lot of reading and learning outside of work — people at this stage care about talking about their progress and how they are growing.
The third part of intrinsic motivation is purpose. That comes when people are doing something because they feel like they are part of something bigger. People that are focusing on the community, giving back, and working with a mission are intrinsically motivated people.
The Three Parts of Change
Mark explained that for someone to make a change, they need the required knowledge; they must find the change important and have the confidence to make the change.
Knowledge is necessary because we only retain about 20% of what we are told. In healthcare, there's evidence that 40%-80% of what patients are told is forgotten immediately. On top of that, when asked to recall information later, 50% of that information was recalled incorrectly. Without knowledge, the rest of the change can't happen.
If you have people on your teams that aren't following through with particular procedures or who aren't participating fully, it is essential to know if the barrier knowledge, importance, or confidence. The best way to uncover that is to listen and express empathy. It is easy to fall into the trap of shutting people down by telling them why they should feel grateful or why they should change.
Sustain Talk and Change Talk
The goal of motivational interviewing is recognizing the self-talk that keeps people sustaining the current state but guiding them toward change talk that motivates change. This is important because the more people can verbalize something, the more likely they are to follow through with it. Sustain talk is about the positives of the current undesired behavior and the downsides to change. Conversely, change talk is about the negatives of our current practice and the upside to change.
When it comes to encouraging change talk, it is useful to ask open-ended questions. Mark gave a few examples:
- What are your thoughts on how to improve?
- What would help you the most?
- How can we better meet the needs of our patients (customers)?
We are very grateful that Mark was able and willing to take the time to share this valuable information with our audience. Anyone interested in helping others grow can benefit from the techniques of motivational interviewing and the wisdom that Mark has to offer.
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