1. Positively Influencing Provider Behavior Julie McBride, PSI Presented at The First Global Conference on Social Franchising 11 November 2011

2. page 2 Session Objectives  To create a common understanding of what behaviors we are seeking to influence and why  To present a framework for conducting the work that needs to be done to effectively influence provider behavior  To practice using some provider behavior change communications techniques

3. 1 1 2 0 1 9 T H S T R E E T, N W | S U I T E 6 0 0 W A S H I N G T O N, D C 2 0 0 3 6 P S I. O R G | T W I T T E R : @ P S I H E A LT H Y L I V E S | B L O G : P S I H E A LT H Y L I V E S. C O M What behaviors? PSI

4. What types of “behaviors” are you trying to influence?  Broadening of service offerings  Increasing volume of services  Identifying appropriate candidates for services  Adherence to clinical guidelines  Use of proper counseling techniques  Recordkeeping  Referrals  Correct dosage of drugs  Reporting adverse events  Compliance with franchise standards  Etc. page 4

5. 1 1 2 0 1 9 T H S T R E E T, N W | S U I T E 6 0 0 W A S H I N G T O N, D C 2 0 0 3 6 P S I. O R G | T W I T T E R : @ P S I H E A LT H Y L I V E S | B L O G : P S I H E A LT H Y L I V E S. C O M Why does it matter? PSI

6. Franchise Provider Franchisee behaviors affect franchise success Delivers on franchise brand promise? YESNO

7. 1 1 2 0 1 9 T H S T R E E T, N W | S U I T E 6 0 0 W A S H I N G T O N, D C 2 0 0 3 6 P S I. O R G | T W I T T E R : @ P S I H E A LT H Y L I V E S | B L O G : P S I H E A LT H Y L I V E S. C O M How can behavior be influenced? PSI

8. 10 Strategic Framework for Influencing Provider Behavior 1 Goal 3 Process 2 Outcome

9. 11 What behavioral goals are you trying to achieve? Increase volume of services delivered Compliance with franchise standards -Quality -Customer experience -Equity -Tracking and reporting 1 3 2 Goal

10. Awareness “I know about it” OAMOAM Interest “I’m interested in learning more” OAMOAM Trial “I’ve tried it” or “sometimes do it” OAMOAM Adoption “I do it routinely” OAMOAM 14 I ncremental changes in attitudes and behavior need to happen in order for behavioral goals to be achieved. Advocacy “I want to tell others about it!” Need to move providers up adoption stairway 1 32 Outcomes

11. Achieving outcomes requires 3 things: 1)Identifying where an individual provider is on the adoption ladder 2)Identifying what the barriers to progression are at each step of the ladder relative to opportunity, ability, and motivation (OAM) 3)Help providers to overcome barriers by providing relevant solutions 1) Where are they now? 2) barrier to next step? Outcome (Next Step on the ladder) 3) What solution do you have to offer? And so on...

12. 15 A 4-step process is used to achieve outcomes Reinforcing the solution’s value Planning Delivering a solution Uncovering provider needs Step 1 Step 2Step 3Step 4 1 32 Process

13. Planning Step 1  To ensure all providers are reached with regular and sufficient frequency  To maximize return on investment Macro-level planning

14. Planning Step 1 WHY?  To make your visit relevant and productive Micro-level planning HOW? Have a purpose for your visit based on:  Where provider is on the adoption ladder  Barriers to moving up the ladder  Needs (uncovered from previous visits) to address to overcome those barriers Make a plan for each visit  Objective  Strategy for achieving it

15. 15 Uncovering provider needs Step 2 What are that provider’s particular resistance points/ barriers to change and what does he/she need to make a change?

16. 10 What needs? Opportunity Institutional or structural factors that influence the chance to perform a behavior Ability An individual’s skills or proficiencies needed to perform a behavior Motivation An individual’s desire to perform a behavior Easiest to observeHardest to observe Examples Clients Demand Equipment Environment Examples Training Preparation Confidence Examples Personal needs (e.g. financial gain, professional satisfaction, respect among peers, etc.) Altruistic needs (e.g. helping people, contributing to society, etc.)

17. How uncover barriers and needs?  Observation of providers on the job –Clinical skills –Interactions with clients –Record keeping practices –Business management and finance –Etc.  Client interviews and mystery clients  Structured and strategic conversations with providers (using open-ended questions) 17

18. 4 Open-ended and closed-ended questions get different results – and feel different to providers ► Expand the dialogue ► They invite the other person to tell you more ► End the dialogue ► Only get you the specific answer you’re asking for (at best!) Open-ended questions… Closed-ended questions… ► You care about their opinions and feelings ► You care about what they think is important How it feels to providers ► You see them only as a source of information ► You are judging them (answer is right or wrong) How it feels to providers

19. ► How many of your clients … ? ► Are you satisfied with … ? ► Do you… ? 5 Some examples of closed-ended questions… and better open-ended alternatives ► What has been your experience with…? ► How have you…? ► How do you feel about…? ► When do you prefer to use…? ► In what circumstances do you…? Open-ended questions invite explanation. They cannot be answered by a simple “yes” or “no” Open-Ended Closed-Ended

20. 12 Opportunity: Which clients do you think this might help the most? Which clients are telling you that they're interested in trying this? Ability: How comfortable do you feel with starting to do this? What other training or information do you think you need? Motivation: What do you think would happen if you went ahead and tried this with one client? How do you feel about trying it? Interest Trial Adoption Advocacy Awareness If the provider is currently at the “interest” stage… Example questions to ask to uncover needs

21. 5 Which “needs” to address? Provider needs should be prioritized based on: ►Importance – How critical is this need to the provider moving forward on the adoption stairway? ►Relevance – How well do your offerings address the need? Need 1. _______________ 2. ________________ 3. ________________ 4. ________________ 5. ________________ 6. ________________ _______ Importance (High, Medium, Low) Relevance (High, Medium, Low)

22. 15 Delivering a solution Step 3 Demand creation Advocacy IEC Training On the job coaching Equipment and supplies Job aids Tech support (e.g. hotline) Testimonials Trial incentives (e.g. free samples) Communication skills Job aids IEC OpportunityAbilityMotivation

23. 6 Communicating the value of your “solution”

24. 15 Reinforcing the solution’s value Step 4 Examples of reinforcement include: Reminding providers of how the new behavior has benefited them (compare before and after) Acknowledging and thanking providers for their good work Rewarding and recognizing the newly adopted behavior Without Step 4, it’s common for a change to be temporary … and for a provider to go back to their old habits!

25. 8 Tips for reminding providers about benefits ►Focus on motivation Even if the value proposition focused on opportunity or ability, the provider needs to feel good about the change to make it stick ► Keep track of “success stories” with clients (or with other providers & their staff) and tell those stories Why are they successful? What can this provider expect in the future & why? Give credit to the provider for positive outcomes! ► Contrast with “how it used to be” Compare “before” and “after” to help them remember why they made a change

26. Summary 26

27. 10 3 key elements of framework for influencing provider behavior 1 Goal 3 Process 2 Outcome Interest Trial Adoption Advocacy Awareness Reinforcing the solution’s value Territory planning Delivering a solution Uncovering provider needs Coaching and support helps! (from your manager) 1 234 Adoption Ladder

28. 12 Knowing provider needs helps you to offer relevant support to providers Using open-ended questions can help you uncover provider needs Strategic communications can go along way in convincing a provider to accept and adopt the solution you propose to a provider’s “problem” (or to get them to change their behavior?) 1. Offering 2. Impact 3. Proof 4. Cost Effort is required to maintain new behaviors Evidence suggests these techniques work They can be mastered with practice

29. 1 1 2 0 1 9 T H S T R E E T, N W | S U I T E 6 0 0 W A S H I N G T O N, D C 2 0 0 3 6 P S I. O R G | T W I T T E R : @ P S I H E A LT H Y L I V E S | B L O G : P S I H E A LT H Y L I V E S. C O M Questions? PSI