Transcript Patient - HealthChange Home

The Secret to Successful Care Planning for
Practice Nurses: How to get better satisfaction and
patient outcomes without adding time to consults
for
Presented by HealthChange Australia
www.healthchange.com
Please switch your mobile phone to silent
© 2016 HealthChange Australia
Slide 1
Workshop essentials
• Who is HealthChange Australia?
• Housekeeping, OH&S and timings
• HealthChange® Handouts
• Terminology & Glossary
• Interaction, questions, comments
• PowerPoint and learning styles
• Introductions
© 2016 HealthChange Australia
Slide 2
What topics will we cover?
1. Best practice care planning and the problem of poor
adherence to health, medical, social and other
recommendations for better health and quality of life
2. What patients need to follow health, medical, social
or other recommendations
3. What practice nurses can do to increase readiness,
willingness and confidence in following care plan
recommendations using HealthChange®
Methodology
© 2016 HealthChange Australia
Slide 3
Activity: Discuss with your neighbour/s
• What types of patients do you
consult with?
• What do you want your patients
to do that they are not doing?
• What are your patients doing that
you want them not to do?
© 2016 HealthChange Australia
Slide 4
HealthChange® Methodology
A health service delivery methodology
used to provide person-centred care
and promote health literacy, shared
decision making, behaviour change and
self-management to support adherence
to evidence-based recommendations
for improved health and quality of life
outcomes
Visit healthchange.com for short videos
on HealthChange® Methodology and to
download other resources
© 2016 HealthChange Australia
[Mini Guide p. 1]
Slide 5
Layers of HealthChange® Methodology: An integrated suite of tools
PSMP*
Decision
Framework
Essential Behaviour
Change Techniques
BEST Barriers & Facilitators
Behaviours
Emotions
Situations
Thinking
Person-Centred Practice Principles
HealthChange® Behaviour Change Pathway
*PSMP: Personal Self-Management Plan
© 2016 HealthChange Australia
[Mini Guide p. 2]
Slide 6
HealthChange® Methodology is like an ice
cream cone!
© 2016 HealthChange Australia
Slide 7
Topic
1:
Best
practice
care
planning
and
the
Click to edit master title style
problem of patient adherence to
recommendations
© 2016 HealthChange Australia
Slide 8
Activity:
What is the purpose of care planning?
What are the benefits for health services?
What are the benefits for patients?
Tidying up Messy Head Syndrome
© 2016 HealthChange Australia
Slide 9
Purpose and benefits of care planning:
• To make sure that patient care is well coordinated
• To make sure that patients have the full picture
• To tidy up ‘messy head syndrome’ (for both clinicians
and patients!)
To ensure that patients know and understand:
• What their health issues are, and
• What they can do about them,
• So that they can make fully informed decisions
and get the best possible results given their own
individual circumstances and needs
© 2016 HealthChange Australia
Slide 10
How big a problem is adherence?
31%
Patients who fail to fill initial prescriptions
50%
Overall adherence to chronic conditions treatment
50%
Patients who act on physician referrals to other
practitioners and services
50%
Maintenance of new exercise behaviours following
cardiac rehabilitation
The stats haven’t improved - only 1 in 2 people can
usually be expected to take action!
(Barclay 2014; Family practice clinic audit 2010; WHO 2003; Oldridge 1991)
© 2016 HealthChange Australia
Slide 11
Why is person-centred service delivery important?
‘Don’t tell me
what to do!’
‘Yes, Yes, tell me
what to do’
…because it engages patients to do what they need to do
© 2016 HealthChange Australia
Slide 12
Patient-centred or
Patient-centric?
Support
Coordination
Care
Coordinator
The missing Links!
Information
Assessment
Pathology
Observations
Education
Medications
Referrals
Nurse
Psych
Treatment
GP
Mental
Health
Health
Service
Patient
Allied
Health
Assessment
Treatment
Advice
Patient
Advocates
Health &
Legal Advice
Emotional
buy-in &
Persuasion
© 2016 HealthChange Australia
Family &
Friends
Advice &
Financial
Decisions
Rehab
Program
Education
Assessment
Advice
SelfManagement
Program
Health
System
Navigation
Education
Advice
Attendance
Medical
Specialists
Treatment
& Procedures
Education
Tests
& Skills
Appointments Development
Procedures
Slide 13
Topic 2: What patients need in order to act
Click toon
edit
master
title
style
care plan recommendations
© 2016 HealthChange Australia
Slide 14
People’s needs are sequential:
They follow a behaviour change pathway
Knowledge & Understanding
Health Literacy
See healthchange.com
to view video
Motivation & Expectations
Decision & Commitment
Decision Line
Macro view
Ready to take action
Micro view
Planning & Problem Solving
Action
Self-regulation
Build Importance
Build Confidence
© 2016 HealthChange Australia
[Mini Guide p. 3]
Slide 15
Questions patients need to be able to answer in order
to take action
Patient behaviour change pathway
Knowledge & Understanding
Motivation & Expectations
Decision & Commitment
Decision Line
What do I know about my health
and what can I do about it?
What can I do first to get the
most benefit?
Am I ready, willing and able to
do this?
Macro view
Ready to take action
Micro view
Planning & Problem Solving
Action
Self-regulation
© 2016 HealthChange Australia
What options do I have?
What exactly will I do?
Can I do this and what might get
in the way?
What support do I need?
Slide 16
Three essential tasks for nurses to align conversations
with their patients’ needs
Knowledge & Understanding
1. Set up a healthy working
alliance (build trust)
Motivation & Expectations
Decision & Commitment
Decision Line
2. Identify and address
motivational barriers to
action (build importance)
Ready to take action
Planning & Problem Solving
Action
3. Identify and address
practical barriers to action
and self-regulation (build
confidence)
Self-regulation
From: Gale & Skouteris (2013)
© 2016 HealthChange Australia
[Mini Guide p. 4]
Slide 17
What nurses need to ask themselves to be able to help patients
Does the patient know and understand their health issues and clinical targets?
Do they know and understand the broad treatment, lifestyle and referral
categories applicable to these?
Have they been assisted to collaboratively prioritise these categories?
Are they ready, willing, able and committed to taking action?
Decision Line
Macro view
Ready to take action
Micro view
What options do they have for taking action in particular categories?
What are their personalised goals/plans for achieving category goals?
Are they confident they can do these things? What might stop them?
Will I review the patient? What other support might they need?
Build Importance
© 2016 HealthChange Australia
Build Confidence
[Mini Guide p. 5]
Slide 18
HealthChange® Person-Centred Practice Principles
(How patients need to be treated to avoid adding to the problem)
RICk = Readiness, Importance, Confidence, knowledge
© 2016 HealthChange Australia
[Mini Guide p. 6]
Slide 19
HealthChange® Methodology requires health service providers to
balance their duty of care with their patient’s right to make fully
informed, conscious decisions about what they will do.
If you feel like all your
consultations sound the same, you
are probably not being personcentred
© 2016 HealthChange Australia
[Mini Guide p. 7]
Slide 20
How to turn patients into elks or polar bears…..
• ‘Tell’ people what to do
• Argue the point
• Use scare tactics with people who are low in confidence
• Using judgmental language
• Overwhelm people by expecting them to do too much
• Overwhelm them with too much information/education
Service providers need alternative
strategies to be built into their
consultations and service delivery
© 2016 HealthChange Australia
Slide 21
Use honest and open dialogue to avoid
playing the ‘practitioner-patient’ game!
Acknowledge the
elephant in the room
© 2016 HealthChange Australia
[Mini Guide p. 8]
Slide 22
This is a principle,
not a rule!
© 2016 HealthChange Australia
[Mini Guide p. 11]
Slide 23
Readiness
Importance
Confidence
knowledge
}
Action
Listen to your
intuition, but when in
doubt, ask the patient!
© 2016 HealthChange Australia
[Mini Guide p. 12]
Slide 24
Beware the Motivation Trap!
Motivation to
reduce pain,
lose weight,
retain independence
etc.
© 2016 HealthChange Australia
≠
Motivation to engage in
actions or tasks
required to reduce pain,
lose weight, retain
independence etc.
Slide 25
Elicit information from the patient prior to offering your
own information, education or suggestions to find out:
Prior knowledge,
knowledge gaps,
misinformation
1. What do they already know?
2. What don’t they know?
3. What misinformation do they have?
4. What are they already doing?
© 2016 HealthChange Australia
[Mini Guide p. 13]
Slide 26
WAIT for a response
8 seconds is a
common
response time
Why
Why
Am
Am
I
I
Talking? Taking Notes?
© 2016 HealthChange Australia
[Mini Guide p. 14]
Slide 27
Provide pens and paper and invite every
patient to write themselves some notes
during your conversation if they wish to
It’s a very practical
way to help patients
and clients!
© 2016 HealthChange Australia
[Mini Guide p. 15]
Slide 28
When you don’t succeed…
...try a different strategy!
Discuss trial and error
and reduce the
number of your ‘no
show’ patients
© 2016 HealthChange Australia
[Mini Guide p. 16]
Slide 29
Macro-level
Performance
Indicators

Clinical
Targets
(Physiological)
Macro-level
Areas for
Action
Micro-level
actions or
strategies

Motivational
Drivers


Treatment,
Lifestyle &
Referral
Categories
© 2016 HealthChange Australia
Specific
Personalised
Health Goals
[Mini Guide p. 9]
Slide 30
Patient experience of micro advice from multiple sources
Manage Chronic
Health Condition/s
Hospital-based
Procedure
Know and
understand own
medications
Use accurate
dose and timing
Clinical Targets
Receive home
nursing visits
Have pathology
and other tests as
required
Visit General
Practitioner
Recognise and
act on signs of
Speak with Care
improvement
Coordinator
Recognise and
act on signs of
deterioration
Identify and
manage triggers
Manage alcohol
consumption
Do specific
rehabilitation
activities
Manage nutrition
and eating
Avoid infections
and illnesses
Visit medical
Recognise and
specialist/s
act on side effects
Use bracing,
supports and aids
Monitor and
effectively
manage pain
Take care of
Know and use
equipment
emergency action
plan/s
Manage wounds
and dressings
effectively
Use nutritional
supplements
effectively
Seek a
medications
review
© 2016 HealthChange Australia
Manage weight
Other...
and waist
Manage physical circumference
Address
activity
recreational drug
use
See Diabetes
Manage stress
Educator
and mood
Manage fatigue
effectively
and energy
Engage social
support
Go to physio clinic
Reduce or quit
smoking
Monitor and
Receive Social
manage other
Services
symptoms
Attend education
Arrange transport
or assistance
and other access
program/s
to services
Slide 31
HealthChange® self-management menu of options:
to support health literacy, engagement and action
Manage Health
Condition/s
Manage
Medications
Effectively
Engage in
Specific
Treatment
Activities
Monitor and
Act on
Symptoms
Attend
Services and
Appointments
Clinical
Targets
Manage
Triggers and
Risk Factors
Manage
Healthy
Lifestyle
Factors
Group your patients’ tasks into overarching behavioural
categories (self-management objectives) in order to
create a person-centred self-management plan
© 2016 HealthChange Australia
[Mini Guide p. 10]
Slide 32
HealthChange®
Generic Menu of Options
Manage
Medications
Effectively
Engage in Specific
Treatment
Activities
Manage return to
Prevent
Falls
previous
functioning
ManageOsteoarthritis
Heart
Disease
Manage
Manage
Cancer
Manage
ManageHealth
COPD
Condition/s
Monitor and Act
on Symptoms
Clinical Targets
Attend Services
and
Appointments
Manage Triggers
and Risk Factors
Manage Healthy
Lifestyle Factors
Know and
understand own
medications
Do specific
rehabilitation
activities
Know and use
emergency action
plan/s
Have pathology
and other tests as
required
Identify and
manage triggers
Manage nutrition
and eating
Use accurate
dose and timing
Avoid infections
and illnesses
Recognise and
act on signs of
improvement
Visit General
Practitioner
Manage alcohol
consumption
Manage physical
activity
Recognise and
act on side effects
Manage wounds
and dressings
effectively
Recognise and
act on signs of
deterioration
Visit medical
specialist/s
Address
recreational drug
use
Manage stress
and mood
effectively
Take care of
equipment
Use bracing,
supports and aids
effectively
Monitor and
manage pain
Attend education
or assistance
program/s
Reduce or quit
smoking
Manage fatigue
and energy
Seek a
medications
review
Use nutritional
supplements
effectively
Monitor and
manage other
symptoms
Arrange transport
and other access
to services
Manage weight
and waist
circumference
Engage social
support
Other...
Other...
Other...
Other...
Other...
Other...
©2016 HealthChange Australia
www.healthchange.com
HealthChange®
Manage Diabetes
Menu of Options
Manage
Medications
Effectively
Engage in Diabetes
Treatment
Activities
Manage Diabetes
Monitor and Act on
Diabetes
Symptoms
Clinical Targets
HbA1c, BP, Chol, Eye
health, Kidney function
etc.
Attend Services
and Appointments
Manage Symptom
Triggers and Risk
Factors
Manage Healthy
Lifestyle Factors
Know and understand
your medications
Know and understand
about diabetes
Monitor blood sugar
levels consistently
Have regular
pathology tests and
checks
Identify what affects
your blood sugars
Manage nutrition and
eating to control
blood sugars
Use accurate dose
and timing
Record blood sugar
levels regularly
Adjust medications in
response to blood
sugar levels
Visit your General
Practitioner regularly
Manage alcohol intake
Manage physical
activity to control
blood sugars
Recognise and act on
side effects
Avoid infections and
illnesses
Know and use your
emergency action plan
Visit your diabetes
team for regular
check-ups
Manage caffeine
intake
Manage stress and
mood to control blood
sugars
Take care of
monitoring and
injecting equipment
Manage wounds and
dressings effectively
Recognise and act on
signs of improvement
Attend a diabetes
education program
Reduce or quit
smoking
Manage fatigue and
energy
Seek a medications
review
Check feet and legs
daily, manage blisters
or other problems
Recognise and act on
signs of deterioration
Compile and maintain
personal medical
records
Manage weight and
waist circumference
Engage social support
Other...
Manage other health
conditions effectively
Other...
Other...
Other...
Other...
©2016 HealthChange Australia
www.healthchange.com
HealthChange® healthy lifestyle self-management
menu of options
Manage Healthy
Lifestyle Factors
Manage
Nutrition and
Eating
Manage
Physical
Activity
Manage
Stress and
Mood
Manage
Fatigue and
Energy
Health Targets
Manage
Triggers and
Risk Factors
Engage Social
Support
Group tasks into overarching behavioural categories
(health self-management objectives) in order to create a
person-centred health self-management plan
© 2016 HealthChange Australia
Slide 35
HealthChange®
Menu of Options
Manage Nutrition
and Eating
Manage Healthy
Lifestyle Factors
Manage Physical
Activity
Manage Stress
and Mood
Manage Fatigue
and Energy
Manage Triggers
and Risk Factors
Engage Social
Support
Understand fats,
fibre, salt, protein,
carbohydrates
Improve
cardiovascular
fitness
Manage time
better
Understand
symptoms and
causes
Identify and
manage triggers
Engage in
enjoyable hobbies
or leisure activities
Make healthy
food and drink
choices
Improve physical
strength
Relax more
Plan and pace
activities
Manage alcohol
consumption
Become actively
involved in a
community group
Use portion
control
Improve flexibility
& balance
Manage mood and
emotional
reactions
Manage sleep
quality and
quantity
Address
recreational drug
use
Join a patient
support group or
online forum
Avoid non-hungry
eating™
Increase incidental
activity
Seek professional
assistance
Adjust home
environment to
assist daily living
Reduce or quit
smoking
Re-engage with
friends or family
Manage eating
patterns
Decrease
sedentary
activities
Manage other
lifestyle factors
Engage support to
reduce the burden
Manage weight
and waist
circumference
Seek support from
friends, family,
other sources
Other...
Other...
Other...
Other...
Other...
Other...
©2016 HealthChange Australia
Non-hungry eating™ is a trademark of Dr Rick Kausman
www.healthchange.com
How do the four aspects of goal setting relate to
the HealthChange® behaviour change pathway?

Clinical
Targets

2
Decision
Line

Motivational
Drivers
Lifestyle &
Treatment,
Treatment
Lifestyle
&
Categories
Referral
Categories
Macro view

Micro view
Specific
Personalised
Health Goals
© 2016 HealthChange Australia
Slide 37
Different people will have different motivators
What might commonly motivate the following groups
of patients?
• Children or teens?
• Working age adults?
• Seniors?
• People with disabilities?
• People with mental health issues?
• Homeless people?
• Aboriginal and Torres Strait Islander groups?
• Other cultural and/or language groups?
© 2016 HealthChange Australia
Slide 38
Activity:
Do you have problems with….
• Patients who avoid talking about their health?
• Conversations that go around in circles?
• Difficulty bringing patients back on track?
• Patients who won’t do simple things for their health?
• Consultation times blowing out?
PP: a-j
© 2016 HealthChange Australia
Slide 39
BEST barriers to action and facilitators for change
Behaviours
Social circle
dynamics
Emotions
Situations
Thinking
Personal
Medical & Factors
rehab
system
dynamics
Physical
and other
external
factors
If you take barriers at face value, you may go looking
for the wrong solutions
© 2016 HealthChange Australia
Slide 40
BEST barriers to action and facilitators for change
Behaviours
• Actions, everyday habits, planning or lack of
planning
Emotions
• Emotional reactions to things that happen to
us, mood states
Situations
• Medical, physical, cognitive, social, cultural,
access, $, changes in circumstance, clinicians
Thinking
• Beliefs, attitudes, expectations & habitual
thinking patterns, readiness, importance,
confidence, knowledge (RICk)
© 2016 HealthChange Australia
[Mini Guide p. 17]
Slide 41
Common everyday thinking barriers…
© 2016 HealthChange Australia
Slide 42
What gets in the way for you?
What are the recommended activity levels for adults?
Does your own activity level meet the guidelines?
If No: What stops you from achieving this?
If Yes: How do you manage to achieve this?
What gets in the way for your patients?
© 2016 HealthChange Australia
Slide 43
What causes people to go into denial?
High emotion + low confidence → denial or avoidance
© 2016 HealthChange Australia
Slide 44
HealthChange® Essential Behaviour Change Techniques
© 2016 HealthChange Australia
[Mini Guide p. 18]
Slide 45
Topic 3:
What Practice
do to
increase patient
Click
to edit Nurses
mastercantitle
style
motivation and confidence to follow care plan
recommendations using HealthChange®
Methodology
© 2016 HealthChange Australia
Slide 46
HealthChange® 10 Step Decision Framework
Above the line processes
Set the scene & explain your role
 Identify, discuss & summarise clinical issues
 Identify & discuss all treatment, lifestyle & referral categories
 Prioritise & choose categories to work on in this consultation
 Check RICk & make a decision
Decision Line
Macro view
Ready to take action
Micro view
Build Importance
RICk: Readiness, Importance, Confidence, knowledge
[Mini Guide p. 19]
Slide 47
Set the scene and explain your role:
Create a comfortable environment and
Set up positive and accurate expectations
© 2016 HealthChange Australia
Slide 48
Activity: Explain your role
1. Check knowledge and understanding of the care planning
process and explain what your role is in the patient’s care
2. Outline their role in their care and/or recovery process and
explain how you will work in collaboration with them
3. Address any common negative expectations by reassuring
the patient or carer what you won’t do
4. Create positive expectations of your care planning
consultations by helping the patient to understand what
personal benefits they may gain through actively engaging
in the process with you
© 2016 HealthChange Australia
[Mini Guide p. 20]
Slide 49
Step 1: Identify, discuss & summarise clinical issues
• Gather clinical data and/or conduct clinical or other
objective assessment
• What are the relevant clinical issues?
• Summarise these issues for the patient or client
• Check their knowledge and understanding
• Why are these clinical issues a potential problem for
them?
First ask, then offer!
© 2016 HealthChange Australia
[Mini Guide p. 21]
Slide 50
Elicit information from the person prior to
offering your own information and suggestions:
Prior knowledge,
knowledge gaps,
misinformation
• What do they already know?
• What are they already doing?
• What would help them?
• What could they do to address a
particular problem?
© 2016 HealthChange Australia
[Mini Guide p. 22]
Slide 51
Activity Step 1:
How do you ‘first ask’ to gauge a patient’s
knowledge and understanding of their clinical
condition/s, before offering information to fill in
the gaps?
• What is your understanding of (your condition/s)?
• Are you comfortable that you know enough about
how (your condition/s) impacts on a person’s body
and quality of life? Would it be useful to spend a
little time talking about this?
© 2016 HealthChange Australia
[Mini Guide p. 23]
Slide 52
What is the critical information for people to know
so that they understand enough about their
clinical condition/s to be motivated to take action?
1. Usual course of the condition over time and how it
can impact on people
2. What will make the symptoms or prognosis better
or worse
3. Common misconceptions about either of the above
© 2016 HealthChange Australia
Slide 53
Step 2: Identify & discuss all relevant treatment,
lifestyle & referral categories
• What does anyone with these particular clinical or other
issues need to do over time to get the best results?
• Summarise the general recommendations for the patient
• Check their broad knowledge and understanding of each
general recommendation
• Establish why taking action on these recommendations
might be beneficial for this patient
• Acknowledge current actions (what they are already doing)
First ask, then offer!
© 2016 HealthChange Australia
[Mini Guide p. 24]
Hierarchy
Slide 54
Activity Step 2:
How do you first ask, then offer advice about
referral, treatment and lifestyle categories?
• Can you tell me what you already know about managing
(your condition/s) so that it has the minimum effect on your
health and quality of life?
• What are you already doing to manage (your condition/s)?
• There are some other things that people with (your
condition/s) really need to do over time to get the best
outcomes and avoid complications. Do you mind if we discuss
these as well?
© 2016 HealthChange Australia
[Mini Guide p. 25]
Slide 55
Step 3: Prioritise and choose categories to work on in
this consultation
•
•
•
•
•
Prevent the patient from becoming overwhelmed
Prioritise broad lifestyle and treatment categories
Balance duty of care with patient fully-informed choice
Clarify what the patient is already doing to manage their health
Set the agenda for the current consultation
Messy Head Syndrome
© 2016 HealthChange Australia
[Mini Guide p. 27]
Relief
DF-e
Slide 56
Patient case demonstration
Video – Darren low back pain
Promoting health literacy and prioritising long
and short-term areas for patient action
© 2016 HealthChange Australia
Slide 57
Do the first few steps right and the rest will follow!
© 2016 HealthChange Australia
Slide 58
Step 4: Check RICk & make a decision
Readiness, Importance, Confidence, knowledge
Client decision:
a) ‘yes’
b) ‘no’
c) ‘maybe’
Service provider decision:
a) Client ‘yes’
Proceed below the decision line
b) Client ‘no’
Revisit Step 3 or invite the patient to opt out
c) Client ‘maybe’
Use RICk-focused decisional balance, and/or
Determine if the patient needs more
information to make a decision
© 2016 HealthChange Australia
[Mini Guide p. 28]
Slide 59
Use your intuition to Observe body
language, tone of voice and other verbal
and non-verbal cues to detect low RICk
or ambivalence
Don’t fall into the
Motivation Trap!
© 2016 HealthChange Australia
When in doubt ask the
patient! But, be careful
how you ask your
questions
[Mini Guide p. 29]
Slide 60
Be person-centred in your use of RICk questions!
How important is it to you personally to work on this issue
(given all the other priorities currently in your life)?
How confident are you that you will make some manageable
and sustainable behaviour changes in relation to this issue?
Other words related to Importance:
• Value, priority, desire, motivated, committed, reasons, outcomes, benefits
you hope to achieve, personally important, want to do, feel you need to
do, happy to do...
Other words related to Confidence:
• Ability, able, capable, manageable, comfortable, comfort zone, likelihood
of being able to, think you can do, will do successfully...
© 2016 HealthChange Australia
[Mini Guide p. 30]
Slide 61
Activity:
How many different ways can you
think of to ask about importance
and confidence without actually
using these words?
© 2016 HealthChange Australia
Slide 62
Decision Making Assistance
Alternative A
Alternative B
Pros
1.
Acknowledge
reasons for current
behaviours
(barriers)
Cons
2.
Identify possible
negative
consequences of
inaction
3.
Identify possible
benefits to be gained
from taking action
4.
Acknowledge
undesirable
aspects of taking
action (barriers)
Is anything mentioned important enough for the patient to want to work on this?
© 2016 HealthChange Australia
[Mini Guide p. 31]
Slide 63
RICk-focused decisional balance sample questions
• What are the benefits of what you are currently doing?
• What’s the downside of what you are currently doing? What are the
possible long-term consequences for you and the things/people that
are important to you? *
• Why might you consider doing things differently? What benefits
could you expect from this? *
• What is unappealing about doing things differently? What might stop
you from taking action?
• From what you have said, the reasons why you have not taken action
before are [mention barriers], but if you did take action then you
may be able to avoid [negative consequences] and gain [benefits]. *
• Is anything that you have mentioned important enough to make you
want to work on this issue?
* Questions and reflections that may increase Importance
© 2016 HealthChange Australia
[Mini Guide p. 32]
Slide 64
Patient case demonstration
Video - Terry
•
•
•
•
•
CAD, heart attack
Hypertension
Diabetes T2
Obesity, Lap banding
Gall bladder removed
© 2016 HealthChange Australia
Slide 65
The HealthChange®
Click to edit master title
Carestyle
Planning Tool
© 2016 HealthChange Australia
Slide 66
HealthChange® 10 Step Decision Framework
Below the line processes
Decision Line
Macro view
Ready to take action
Micro view
 Generate personalised goal options within categories
 Choose & refine option/s  Discuss an action plan
 Identify & address barriers  Check RICk
 Consider review, referral & support
Build Confidence
RICk: Readiness, Importance, Confidence, knowledge
© 2016 HealthChange Australia
[Mini Guide p. 33]
Slide 67
Step 5: Generate personalised goal options
within categories
Ways to generate options:
Treatment or lifestyle
category
• Discuss common treatment
strategies within a category
• First ask, then offer
information or suggestions
Options
• Provide a menu of options
Personalised goal/s
& action plan
© 2016 HealthChange Australia
[Mini Guide p. 34]
Slide 68
Sample phrasing for offering a menu of options
It often helps to have a number of different ideas of how you
can tackle an issue, so that if one strategy doesn’t work, you
can try one of the others. I can offer some suggestions if you
like, based on what has worked for other people.
However, ultimately you will be the best judge of what will
work for you and what won’t. Would you like to hear my
ideas or are you confident that you already have your own
solutions?
© 2016 HealthChange Australia
[Mini Guide p. 35]
Slide 69
Step 6: Choose & refine personalised goal option/s
Help the patient to choose and personalise specific short
term goals for achieving longer-term broad category goals.
State personalised goals in one or two sentences:
• What action will they take?
• How much?
• How often?
• When will they start?
• When will they complete or review?
© 2016 HealthChange Australia
[Mini Guide p. 36]
Slide 70
Step 7: Discuss an action plan
Discuss as much detail as necessary
for the patient to feel confident.
Invite the patient to write down their
plan if necessary:
• Actions or tasks
• Memory prompts
• Support mechanisms
• Thinking strategies to support actions
• Emotion management strategies
• Backup plans
• Tracking and monitoring strategies
• Time frames for completing sub-tasks
© 2016 HealthChange Australia
[Mini Guide p. 37]
Slide 71
Track actions and
monitor outcomes
•
•
•
•
•
•
Pen and paper methods
Visual, graphical or mapping methods
Electronic diaries and smart phones
Accumulating objects
Subjective scales
• Record physical measurements
Reward systems
• Record symptoms
• Use pedometers, accelerometers or GPS
• Use the HealthChange® Habit Change Diary
• Others?
[Mini Guide p. 38]
Slide 72
Step 8: Identify & address barriers
Engage in problem solving to identify and address BEST
barriers to action and facilitators for change
Behaviours
Social circle
dynamics
Emotions
Situations
Thinking
Personal
Medical & Factors
rehab
system
dynamics
Physical
and other
external
factors
If you take barriers at face value, you may go
looking for the wrong solutions!
© 2016 HealthChange Australia
[Mini Guide p. 39]
Slide 73
Sample phrasing for discussing thinking strategies
1. Do you ever procrastinate or talk yourself out of doing things
you had planned to do?
2. What excuses do you usually give yourself for not taking
action?
3. What do you need to say to motivate yourself instead, to
make sure you do what you are planning to do?
4. How will you practise these thoughts so that you can say
them to yourself when you need them?
© 2016 HealthChange Australia
[Mini Guide p. 40]
Slide 74
Patient case demonstration
Video – Terry
Identifying and addressing thinking barriers
© 2016 HealthChange Australia
Slide 75
Step 9: Check RICk again
To check whether the patient’s personalised goals are
workable and that the patient is likely to succeed
RICk tips:
Don’t fall into the
Motivation Trap!
Motivation to get outcomes ≠
motivation to act
If importance is low:
Check knowledge, build motivation,
raise priority
If confidence is low:
Identify and address BEST barriers
Adjust personalised goals and/or add
necessary strategies to action plans
© 2016 HealthChange Australia
[Mini Guide p. 41]
Slide 76
Step 10: Consider review, referral and support
• Review consultation scheduling: the lower the
patient’s overall confidence, the sooner the next
consult should be
• Discuss other supports for the patient
• Check RICk for attending referral appointments
• Track patient actions and clinical or other objective
measures to review progress over time
• Encourage a trial and error approach
© 2016 HealthChange Australia
[Mini Guide p. 42]
Slide 77
Sample phrasing for encouraging Trial and Error
• We have discussed a number of things today that
you can do to manage your health and we have
agreed on what you will begin with.
• If for some reason you are unable to do these things
in the timeframe that we discussed, don’t worry.
• Take note of the things that got in the way for you.
We can discuss these at our next appointment and
potentially come up with some solutions for you.
• How does that sound?
© 2016 HealthChange Australia
[Mini Guide p. 43]
Slide 78
What nurses need to ask themselves above the decision line to
facilitate patient action on recommendations
Does the patient know and understand their health issues and clinical targets?
Do they know and understand the broad treatment, lifestyle and referral
categories applicable to these?
Have they been assisted to collaboratively prioritise these categories?
Are they ready, willing, able and committed to taking action?
Decision Line
Macro view
Ready to take action
Micro view
Build Importance
© 2016 HealthChange Australia
[Mini Guide p. 5]
Slide 79
What nurses need to ask themselves below the decision line to
facilitate patient action on recommendations
Decision Line
Macro view
Ready to take action
Micro view
What options do they have for taking action in particular categories?
What are their personalised goals/plans for achieving category goals?
Are they confident they can do these things? What might stop them?
Will I review the patient? What other support might they need?
Build Confidence
© 2016 HealthChange Australia
[Mini Guide p. 5]
Slide 80
The HealthChange®
Click to edit master title
Carestyle
Planning Tool
© 2016 HealthChange Australia
Slide 81
Use your HealthChange® Mini Guide to improve patient adherence
PSMP
Decision
Framework
Essential Behaviour
Change Techniques
BEST Barriers & Facilitators
Behaviours
Emotions
Situations
Thinking
Client-Centred Practice Principles
Behaviour Change Pathway – Client Needs
*PSMP: Personal Self-Management Plan
© 2016 HealthChange Australia
[Mini Guide p. 2]
Slide 82
Using care plans to inform behaviour change
Patient problems, needs
& relevant conditions
Clinical goals
Required
treatment &
services
Provider for
treatment & services
Type 2 Diabetes
HbA1c < 7%
3 monthly checks
Diabetes Education
Exercise Program
Foot care
Physician/Nurse
D. Educator/Dietitian
Ex. Physiologist
Podiatrist
Hypercholesterolaemia
TC: < 4mmol/L
LDL < 2.5mmol/L
HDL> 1.0mmol/L
TG < 2.0 mmol/L
Cholesterol meds
10mg
Low saturated fat
diet
Physician/Nurse
Dietitian
Obesity
BMI < 25
Maintain a healthy
diet
Physician/Nurse
Dietitian
Back pain
Reduce pain &
improve mobility
Physiotherapy
Bone density scan
Physiotherapist
Nuclear imaging
© 2016 HealthChange Australia
Slide 83
HealthChange®
Patient’s Plan to
complement
Care Plans and
Treatment Plans

Clinical
Targets
(Physiological)

Motivational
Drivers

Referral,
Lifestyle &
Treatment
Categories
© 2016 HealthChange Australia

Specific
Personalised
Health Goals
Slide 84
HealthChange® Personal Self-Management Plan
The patient’s personal plan
Recommendations
Priority
Decision Action time
frame
Agreed actions
Comments
Agree
Disagree
Unsure
NA
Agree
Disagree
Unsure
NA
Agree
Disagree
Unsure
NA
Agree
Disagree
Unsure
NA
Step 2
Step 3
© 2016 HealthChange Australia
Step 4
[Mini Guide p. 44]
Steps 5-10
Slide 85
Using the Personal Self-Management Plan:
To document agreed patient actions and priorities
• I have a form here that we can use to write down the broad
areas that you can take action in to get better results for
yourself, and then together we can prioritise them in a way
that suits you, your body and your situation.
• You can take a copy of the form as a reminder and I can keep a
copy for my records and to share with your (other care team
member/s). Is that okay with you?
© 2016 HealthChange Australia
[Mini Guide p. 26]
Slide 86
Patient case demonstration
Video – Darren low back pain
Identifying and addressing potential barriers
and documenting patient self-management
information and intended actions
© 2016 HealthChange Australia
Slide 87
Conducting follow-up consultations
Options:
a)
Continue with the
same personalised
goals
b)
Move to new
personalised goals in
same category
c)
Move on to the next
lifestyle or treatment
category and add
personalised goals for
that category
© 2016 HealthChange Australia
Develop
personal
goal/s and
action plan/s
Extend goals
& add new
categories &
goals when
ready
Track your
progress &
review goals
regularly
Give it a Go!
Keep using
the strategies
that work and
change the
ones that
don't
Slide 88
HealthChange® Methodology within care
planning consultations:
• Integrates person-centred information exchange and
behaviour change support into a decision framework
that guides health service providers
• Actively promotes patient health literacy, shared
decision making, motivation and confidence
• Makes care planning more time efficient and
clinically effective
© 2016 HealthChange Australia
Slide 89
How HealthChange® Methodology saves time
1. Clean, targeted assessment
2. Targeted and individualised education
3. Targeted questions
4. Quickly identifying and addressing barriers to adherence to
referral, treatment and lifestyle recommendations
Quickly builds
rapport and trust
Avoids discussing things that other
clinicians have already covered
Avoids irrelevant and nonproductive conversations
Avoids discussing things the
patient does not want to do
Avoids discussing things
the patient is already doing
Keeps the conversation
focused & on track
© 2016 HealthChange Australia
Slide 90
HealthChange® Methodology uses a
conversational style
‘like a duck gliding on the water…’
© 2016 HealthChange Australia
Slide 91
Activity:
What are you going to do to refine
your care planning as a result of
this workshop?
© 2016 HealthChange Australia
Slide 92
Thank you for your participation!
Find videos, case studies and practice tools at
www.healthchange.com
HealthChange® tools can be used freely in clinical practice
and programs as long as HealthChange® Australia intellectual property
is visibly acknowledged by displaying the HealthChange® Inspired logo
Contact us for more information
Use of any of the content contained in this workbook for training
purposes outside of HealthChange® workshops and without written
permission from HealthChange® Australia is a breach of Copyright and
Intellectual Property Laws and legal action may be taken against
persons or organisations that engage in this activity
© 2016 HealthChange Australia
Slide 93
© 2016 HealthChange Australia
Slide 94
Getting to know you
1. Your name
2. Your role
3. The biggest challenges that you face in
care planning with your patients, clients
or service users
• Managers or administrators may like to consider the service
users associated with their organisation and/or their other
stakeholders (staff, management, colleagues etc.)
© 2016 HealthChange Australia
Return
Slide 95
Booklet
Handout Contents
1. Title page
2. Permission to use materials for clinical practice
3. Contents
4. Glossary
5. Copies of slides – exact match to presentation
6. Practical exercises – dispersed within the slides so that the position of
each exercise matches the workshop flow (see next slide for details with
reference to Core Training Workbook exercises and see mock up booklet)
7. Manage Diabetes Goal Hierarchy (grey scale)
8. PSMP (patient/client pre-populated version)
9. PPET form – grey scale
10. Lined pages
Loose Leaf
1. Care planning task list (purple & green flow chart)
2. A5 card with clinical condition and healthy lifestyle hierarchies
3. Evaluation (not generic)
4. Mini Guide
5. PN workshop brochure
© 2016 HealthChange Australia
Slide 96
Exercises to include in booklet
1.
2.
S49 – Explain your role – space to write some sentences - as per p. 10
CT1 Day 2 workbook
S62 – Different ways to ask about Importance and Confidence and space
to write other ideas - as per p. 44 CT1 Day 1 workbook
© 2016 HealthChange Australia
Slide 97
Notes for facs to emphasise:
• Don’t panic about messy head in the morning with PP and other
information. We will bring it all together in the afternoon
• What’s in it for me?
• What will you get most BENEFIT from?
• NOT health coaching!
• This is not about how to complete a care plan but how to refine this to
make it more effective and time efficient
• Steps 1 & 2 and the 4 aspects of goal setting are all about health literacy.
• The duty of care aim is to help patients to make fully informed conscious
decisions
• Invite participants to write Steps 1 and 2 onto their generic goal hierarchy,
as well as the decision line, if they want to
© 2016 HealthChange Australia
Slide 98
© 2016 HealthChange Australia
Slide 99
Client Reflections
Audio - Dorothy
• Health Professional
• Cancer treatment
© 2016 HealthChange® Australia
Return
Slide 100