The Power of Persuasion The gentle art of influencing people to do something that you want them to do because they want to… Ruth Medak, MD, FACP Medical Director of Hospice Care Providence Hospice Tuesday, March 25, :00–12:45 p.m.

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IIS Innovation Project Team 3 Kelleen Bernard Team Lead Leigh Bohannon QI Specialist Dawn Plante Project Assistant

Norms  Please mute your phone during the presentation  Use the chat feature  Tell us what organization you are with and who is in the room with you  There will be questions and discussion at the end of the presentation 4

About the IIS Innovation Project  CMS-funded demonstration project  Goals  Increase the number of medical practices electronically submitting adult immunization data to ALERT IIS  Engage providers in activities to improve immunization delivery and rates in Oregon  Improve quality of care for Oregon Medicare beneficiaries 5

Today’s purpose  learn how to engage staff more actively in preventive care delivery  understand important barriers to providing preventive health services and how to overcome them  learn strategies for persuading patients to follow through on recommended preventive screenings or vaccinations  hear how to incorporate decision tools that facilitate the provider-patient partnership 6

Ruth Medak, MD, FACP Medical Director, Providence Hospice Dr. Medak is the former medical director for Acumentra Health. With more than 20 years as a practicing internist and 15 years in healthcare quality improvement, she represents QIO process improvement teams in the field, including in projects to improve primary care through EHR- assisted and population-based approaches. Dr. Medak is ABIM certified in Internal Medicine and Hospice and Palliative medicine and is interim medical director for Providence Hospice and Home Services. 7

Persuasion The gentle art of influencing people to do something that you want them to do because they want to… 8

What do you want to get out of today’s time together? 9

Participants will be able to describe  important barriers to providing preventive care services  strategies for persuading people to follow through on recommended preventive screenings or vaccinations 10

11 How is persuading a patient to get CRC screening like getting a child to do homework?

Lessons about persuasion from daily life 12

 Appeal to what’s in it for them  Clear expectations (what, when, where, how)  Consistent message  Consequence for failure 13

Why don’t patients follow recommendations? 14

Common attitudes about patients  Noncompliant  Or poor case  Procrastinator  Or significant barriers 15

Reasons for failure to follow recommendations  Beliefs and culture  Past experience  Fears  Logistics Listen to the patient to decide how to make your best “case” 16

Beliefs  Risk  Low for everyone  No family history of cancer  Excellent personal health  Benefit  Little or none for me 17

Beliefs and culture  Source of health  Cultural and religious beliefs  Role in the family and community  Trust or distrust of health care system 18

Fears  Fear of  Pain  Preparation  Complications  Finding cancer 19

Other issues  Logistics  Time off work  Transportation  Cost  Literacy 20

Colorectal cancer screening facts  Lack of insurance  98% less likely to  have a regular PCP  get a CRC screening recommendation  get screened  Low literacy  Low CRC screening (even with insurance coverage) Source: American Cancer Society,

Colonoscopy instructions as seen by someone with low literacy Your naicisyhp has dednemmocer that you have a ypocsonoloc. Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv eocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc. 22

Old words in a new light  How would you respond to  Would you like to have a pneumococcal vaccination today?  You’re 55 now, so you’ll need to get a colonoscopy sometime before you’re 60.  I’d like you to schedule a mammogram. 23

“So, Doc…How long do I have to ignore your advice?” 24

Critical discussion elements  What  Why  When  What if… 25

Other tactics  Be positive  Speak for the PCP Be prepared to cease and desist. Save your energy to try next time. 26

Operationalize advocacy  Identify patients due for tests and services  Remind patients with prior recommendation or order  Administer vaccinations  Schedule mammograms  Educate about CRC screening 27

You’ve identified a target…  Dr. “X” (or NP or PA) wants all of his/her patients to get a  pneumococcal vaccination  colorectal cancer screening  biennial mammogram  or any other service 28

A positive approach  “I’d like to give you your vaccination before your PCP sees you…”  “The referral coordinator will help you schedule a colonoscopy while you’re waiting.”  “Do you have any questions about the test?” 29

A positive approach  “The mammography center can usually schedule tests within 2 weeks. So, we’ll expect to receive your report by the 1st of next month.” 30

How do you respond?  “I’m healthy and I never get sick. Why do I need a pneumococcal vaccination/flu shot?”  “Nobody in my family has ever had breast cancer/colon cancer.”  “I’ve heard that the prep is awful!”  “I’m afraid that they’ll find cancer.” 31

Conclusions  Persuasion is a skill that anyone can learn.  You have the power to save lives and improve health. 32

Questions? 33 Ruth Medak, MD, FACP Medical Director of Hospice Care Providence Hospice

To join the IIS Innovation Project  Contact the IIS team  Kelleen Bernard | Team Lead |  Leigh Bohannon| QI Specialist |  Go to

For additional information about the IIS webinar series  Contact  Leigh Bohannon | QI Specialist |

Your feedback is very important to us. Please complete the evaluation. Our next webinar will be: Tuesday, May 27, 2014 “Running Reports in ALERT IIS” 36 This material was prepared by Acumentra Health, Oregon’s Medicare Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 10SOW-OR-IIS-14-06