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

2. 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

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

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

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

7. 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!

8. Using our OARS!
Open questions
Affirmations
Reflections
Summaries

9. 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’

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

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

12. A demonstration

13. How NOT to do motivational interviewing: https://www. youtube
…and how you SHOULD do it:

14. 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.

15. Feedback: One comment or observation
Patient
HCP
Observer

17. Problem solving - POST
Problem
Options
Solutions
Test it out

19. Referral forms and further info: