A whistle stop tour of .. Motivational interviewing Problem solving Dr Alison Salvadori, Clinical Psychologist Claire Scott, Care planning lead

Organisational processes informed patient Engaged, HCP committed to partnership working Collaborative care planning consultation If we remember this is the Year of Care house So far we have focussed upon on the 1:1 consultation But clearly there is more to this than that. First step is what this might mean for the whole team… Then systems that help patients and have some examples to discuss shortly There are other key things such as the clinic experience to think about There is a lot of thinking and work going on about the way we record individual choices for commissioning, and potentially about the IT systems we have in place to assist this. There is also a need to evaluate the whole programme and the care we provide, which will need measures beyond those in practice already. These are being finalised, but will include patient questionnaires about the consultations and also the overall care processes. Not in lots of detail, but happy to discuss if wish. Commissioning - The foundation

Supporting Self Management Care Planning Goal Setting Action Planning Engaged and informed patient.

Motivational interviewing An effective way of talking to people about change People find change hard Lack of information? Laziness? Denial? Oppositional personality?

Ambivalence Resolves ambivalence by eliciting a person’s own motivation to change

Spirit of MI Resist the ‘Righting Reflex’ Understand the patient’s motivations Listen to the patient Empower the patient Natural human tendency to resist persuasion MI seeks to evoke something already in the patient rather than add something If very short of time just ask patient why they want to change – rather than telling them why they should!

Using our OARS! Open questions Affirmations Reflections Summaries

Help the patient to argue for change Engage the patient and then listen for change talk Desire ‘I wish, I want, I like…’ Ability ‘I could, I can’ Reasons ‘I would…’ Need ‘I ought to, I have to, I should’

Change then triggered Desire Ability Reasons Need Commitment Taking Steps (SMART) Behaviour change

Am I doing it right? You hear change talk You elicit arguments

A demonstration

How NOT to do motivational interviewing: https://www. youtube …and how you SHOULD do it: https://www.youtube.com/watch?v=67I6g1I7Zao

Meet Bob… 66 years old Type 2 Diabetes (diagnosed 2004) Metformin 2g, gliclazide 80mgs BP 130/80 - BMI 42 – lipids 5.4 Hba1c 62mmols Received results summary in post, now attending for Care Planning with you.

Feedback: One comment or observation Patient HCP Observer

Problem solving - POST Problem Options Solutions Test it out

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