Transcript (How?) Decision Line

Introduction to HealthChange® Methodology:
How to get better satisfaction and patient outcomes
without adding time to consults
for
Presented by HealthChange Australia
Janette Gale
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 and person-centred care
2. What health service clients need to follow health,
medical, social or other recommendations and what
stops them from doing this
3. What health service providers can do to increase
readiness, willingness and confidence in following
these recommendations using HealthChange®
Methodology
© 2016 HealthChange Australia
Slide 3
Topic 1: Best practice and person-centred
care
© 2016 HealthChange Australia
Slide 4
Is this person-centred?
Coordination
Care
Coordinator
Information
Assessment
Pathology
Observations
Education
Medications
Referrals
Nurse
Psych
Treatment
GP
Patient
or Client
Mental
Health
Health
Service
Allied
Health
Assessment
Treatment
Advice
Patient
Advocates
Health &
Legal Advice
Family &
Friends
Emotional
buy-in &
Persuasion
© 2016 HealthChange Australia
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 5
Why is person-centred service delivery important?
‘Don’t tell me
what to do!’
‘Yes, Yes, tell me
what to do’
…because it engages clients to do what they need to do
© 2016 HealthChange Australia
Slide 6
Evidence-based Best Practice
Evidence-based assessment,
diagnosis, treatment, advice and care
Evidence-based
person-centred service delivery
© 2016 HealthChange Australia
Slide 7
Client Reflections
Video - Geoff
• Back injury (medical discharge from Navy)
• Chronic pain
• PTSD, depression & other psychosocial
• Diabetes type 2
• Prostate cancer previously
• High cholesterol
• Weight management issues
• Resistance from previous experiences
© 2016 HealthChange Australia
Slide 8
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
(HCM Mini Guide p. 1)
Slide 9
Australian and Overseas programs and services
Primary Care
•
•
Prevention
•
•
•
•
GP & Allied Health consultations
ACT Health/Medicare Local/Heart Foundation
HeartLink Program
Practice Nurse Care Planning
NSW Get Healthy Telephone Coaching
NSW Live Life Well Diabetes Prevention
VIC WorkSafe WorkHealth Coach
Program
Clinical Research
•
•
•
•
Chronic Condition Management
•
•
•
•
•
•
•
•
•
•
NSW CDM Connecting Care
Home & Community Care (HACC)
VIC Early Intervention (EICD)
VIC HARP programs
Heart failure & Cardiac rehab
Diabetes, HIV, Disability, Aged Care
Mental health
QLD Health Call Centre Cardiac Triage
QLD Disease Management Services
TAS Diabetes services
Deakin University – HIPP/Healthy Pregnancy Study
Melbourne University – Knee Osteoarthritis, Diabetic Retinopathy, Lung Cancer
Wollongong University – Practice Nurse Care Planning Studies
Monash University – Positive Ageing with HIV
Ottawa Regional
Cancer Foundation
•
Survivorship support
coaching
Alberta Health Services
•
Chronic Disease
Management Services
© 2016 HealthChange Australia
Denmark - Copenhagen
•
Metropolitan University College
Slide 10
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
(HCM Mini Guide p. 2)
Slide 11
HealthChange® Methodology is like an ice
cream cone!
© 2016 HealthChange Australia
Slide 12
Topic 2: What people need in order to act on
advice from health service providers
and what stops them
PSMP
Decision
Framework
Essential Behaviour
Change Techniques
BEST Barriers & Facilitators
Behaviours
Emotions
Situations
Thinking
Person-Centred Practice Principles
HealthChange® Behaviour Change Pathway
© 2016 HealthChange Australia
Slide 13
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
(HCM Mini Guide p. 3)
Slide 14
HealthChange Health Literacy
Health
Condition
What can be
done to manage
this condition
What
Why
(Information)
(Motivation)
 
 
Elements required to make a fully informed decision
© 2016 HealthChange Australia
Slide 15
Three essential tasks for health service providers to align
conversations with their clients’ or patients’ needs
Knowledge & Understanding
Motivation & Expectations
Decision & Commitment
Decision Line
1. Set up a healthy
working alliance (build
trust)
2. Identify and address
motivational barriers to
action (build
importance)
Ready to take action
Planning & Problem Solving
Action
Self-regulation
© 2016 HealthChange Australia
3. Identify and address
practical barriers to
action and selfregulation (build
confidence)
From: Gale & Skouteris (2013)
(HCM Mini Guide p. 4)
Slide 16
What service providers need to ask themselves to help clients
Does the client 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 client? What other support might they need?
Build Importance
© 2016 HealthChange Australia
Build Confidence
Build Confidence
(HCM Mini Guide p. 5)
Slide 17
Client case demonstration
Video - Terry
•
•
•
•
•
CAD, heart attack
Hypertension
Diabetes T2
Obesity, Lap banding
Gall bladder removed
© 2016 HealthChange Australia
Slide 18
HealthChange® Person-Centred Practice Principles
(How patients need to be treated to avoid adding to the problem)
PSMP
Decision
Framework
Essential Behaviour
Change Techniques
BEST Barriers & Facilitators
Behaviours
Emotions
Situations
Thinking
Person-Centred Practice Principles
HealthChange® Behaviour Change Pathway
© 2016 HealthChange Australia
[Mini Guide p. 6]
Slide 19
HealthChange® Methodology requires health service providers to
balance their duty of care with their client’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
(HCM Mini Guide p. 7)
Slide 20
How to turn clients 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
(HCM Mini Guide p. 8)
Slide 22
Macro-level
Performance
Indicators

Clinical
Targets
(Physiological)
Reasons for
actions
Macro-level
Areas for
Action

Micro-level
actions or
strategies
Motivational
Drivers

Treatment,
Lifestyle &
Referral
Categories
© 2016 HealthChange Australia

Specific
Specific
Personalised
Tasks
Health Goals
(HCM Mini Guide p. 9)
Slide 23
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 24
HealthChange
Health Literacy
 Health
Condition
 What can be
done to manage
this condition
 What I will do
to manage this
condition (How?)
© 2016 HealthChange Australia
What
Why 
(Information)
(Motivation)
 
 
 
Decision
Macro view
Line
Micro view
(HCM Mini Guide p. 9 & 10)
Slide 25
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 26
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 clients’ or patients’ tasks into overarching
behavioural categories (self-management objectives) in
order to create a person-centred self-management plan
© 2016 HealthChange Australia
(HCM Mini Guide p. 10)
Slide 27
HealthChange®
Manage Diabetes
Menu of Options
Manage
Medications
Effectively
Engage in Diabetes
Treatment
Activities
Manage Diabetes
Effectively
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
Use and take care of
monitoring and
injecting equipment
Manage wounds and
dressings effectively
Recognise and act on
signs of improvement
Register with NDSS
and join Diabetes
Australia
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
Attend a diabetes
education program
Manage weight and
waist circumference
Engage social support
Other...
Manage other health
conditions effectively
Other...
Compile and maintain
personal medical
records
Other...
Other...
©2016 HealthChange Australia
www.healthchange.com
This is a principle,
not a rule!
© 2016 HealthChange Australia
(HCM Mini Guide p. 11)
Slide 29
Readiness
Importance
Confidence
knowledge
}
Action
Listen to your
intuition, but when in
doubt, ask the client!
© 2016 HealthChange Australia
(HCM Mini Guide p. 12)
Slide 30
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 31
Elicit information from the client 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
(HCM Mini Guide p. 13)
Slide 32
WAIT for a response
Why
Why
Am
Am
I
I
Talking? Taking Notes?
© 2016 HealthChange Australia
8 seconds is a
common
response time
(HCM Mini Guide p. 14)
Slide 33
Provide pens and paper and invite every
client 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
(HCM Mini Guide p. 15)
Slide 34
When you don’t succeed…
...try a different strategy!
Discuss trial and error
and reduce the
number of your ‘no
show’ clients
© 2016 HealthChange Australia
(HCM Mini Guide p. 16)
Slide 35
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
(HCM Mini Guide p. 43)
Slide 36
Activity:
How are you using these
Practice Principles currently?
1. Rate yourself you your use of each of the Practice
Principles using the PPET form in your workbook
2. Small group discussion - Consider a challenging client
who is not progressing
– Where is the client on their behaviour change
pathway?
– Which Practice Principles might help you?
© 2016 HealthChange Australia
Slide 37
BEST barriers to action and facilitators for change
Behaviours
Emotions
Situations
Thinking
PSMP
Decision
Framework
Essential Behaviour
Change Techniques
BEST Barriers & Facilitators
Behaviours
Emotions
Situations
Thinking
Person-Centred Practice Principles
HealthChange® Behaviour Change Pathway
© 2016 HealthChange Australia
Slide 38
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
(HCM Mini Guide p. 17)
Slide 39
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 clients?
© 2016 HealthChange Australia
Slide 40
Topic 3:
What health service providers can do to
Click
to client
edit master
style and
increase
readiness,title
willingness
confidence to follow referral, treatment
and lifestyle recommendations using
HealthChange® Methodology
© 2016 HealthChange Australia
Slide 41
HealthChange® Essential Behaviour Change Techniques
PSMP
Decision
Framework
Essential Behaviour
Change Techniques
BEST Barriers & Facilitators
Behaviours
Emotions
Situations
Thinking
Person-Centred Practice Principles
HealthChange® Behaviour Change Pathway
© 2016 HealthChange Australia
Slide 42
HealthChange® Decision Framework
PSMP
Decision
Framework
Essential Behaviour
Change Techniques
BEST Barriers & Facilitators
Behaviours
Emotions
Situations
Thinking
Person-Centred Practice Principles
HealthChange® Behaviour Change Pathway
© 2016 HealthChange Australia
Slide 43
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
© 2016 HealthChange Australia
[Mini Guide p. 19]
Slide 44
Set the scene and explain your role
Create a comfortable environment and
Set up positive and accurate expectations
© 2016 HealthChange Australia
Slide 45
Activity: Explain your role
Elements:
1. Who you are and how you work
• Collaborative approach
2. What you won’t do (address negative expectations)
3. What’s in it for them (state the benefits and create
positive expectations about your service and their
role in their care)
4. State how long the consult will take (and ask
permission to proceed if relevant)
© 2016 HealthChange Australia
(HCM Mini Guide p. 20)
Slide 46
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 47
Sample phrasing for checking a person’s knowledge
and understanding of their clinical issues
•
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 you like to spend a little time talking about this?
© 2016 HealthChange Australia
(HCM Mini Guide p. 22 and 23)
Slide 48
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 49
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 client
• Check their broad knowledge and understanding of each
general recommendation
• Establish why taking action on these recommendations
might be beneficial for this client or patient
• Acknowledge current actions (what they are already doing)
First ask, then offer!
© 2016 HealthChange Australia
[Mini Guide p. 24]
Slide 50
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 51
Step 3: Prioritise and choose categories to work on in
this consultation
•
•
•
•
•
Prevent the client from becoming overwhelmed
Prioritise broad lifestyle and treatment categories
Balance duty of care with client fully-informed choice
Clarify what the client 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
Slide 52
Client case demonstration
Video – Darren low back pain
Promoting health literacy and prioritising long
and short-term areas for patient action
© 2016 HealthChange Australia
Slide 53
Do the first few steps right and the rest will follow!
© 2016 HealthChange Australia
Slide 54
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 client to opt out
c) Client ‘maybe’
Use RICk-focused decisional balance, and/or
Determine if the client needs more
information to make a decision
© 2016 HealthChange Australia
[Mini Guide p. 28]
Slide 55
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
client! But, be careful how
you ask your questions
(HCM Mini Guide p. 29)
Slide 56
Activity:
How many different ways can you think of to ask
about importance and confidence without
actually using these words?
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...
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
(HCM Mini Guide p. 30)
Slide 57
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 client to want to work on this?
© 2016 HealthChange Australia
[Mini Guide p. 31]
Slide 58
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 59
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 60
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 61
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
(HCM Mini Guide p. 35)
Slide 62
Step 6: Choose & refine personalised goal option/s
Help the client 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 63
Step 7: Discuss an action plan
Discuss as much detail as necessary
for the client to feel confident.
Invite the client 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 64
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?
© 2016 HealthChange Australia
(HCM Mini Guide p. 38)
Slide 65
Step 8: Identify & address barriers
Engage in problem solving to identify and address BEST
barriers to action and facilitators for change
Behaviours
Emotions
Situations
Thinking
© 2016 HealthChange Australia
Social circle
dynamics
Personal
Medical & Factors Physical and
rehab
system
dynamics
[Mini Guide p. 39]
other
external
factors
Slide 66
Common everyday thinking barriers…
© 2016 HealthChange Australia
Slide 67
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
(HCM Mini Guide p. 40)
Slide 68
Client case demonstration
Video – Terry
Identifying and addressing
thinking barriers
© 2016 HealthChange Australia
Slide 69
Step 9: Check RICk again
To check whether the client’s personalised goals are
workable and that the client 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 70
Step 10: Consider review, referral and support
• Review consultation scheduling: the lower the
client’s overall confidence, the sooner the next
consult should be
• Discuss other supports for the client
• Check RICk for attending referral appointments
• Track client 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 71
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 72
What service providers need to ask themselves to help clients
Does the client 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 client? What other support might they need?
Build Importance
© 2016 HealthChange Australia
Build Confidence
Build Confidence
(HCM Mini Guide p. 5)
Slide 73
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 74
HealthChange® Personal Self-Management Plan
PSMP
Decision
Framework
Essential Behaviour
Change Techniques
BEST Barriers & Facilitators
Behaviours
Emotions
Situations
Thinking
Person-Centred Practice Principles
HealthChange® Behaviour Change Pathway
© 2016 HealthChange Australia
Slide 75
HealthChange® Personal Self-Management Plan
The patient’s personal roadmap and 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 76
Client 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 77
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
Slide 78
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 79
HCM Implementation Levels or Stages
Language
Person-centred
Practice
Principles
Complementary
Behaviour
Change Skills
© 2016 HealthChange Australia
Health
Literacy
Decision
Framework
Evaluation
Slide 80
Activity:
From what we have covered today, what are
you going to do to refine your service delivery
to be more person-centred?
Write down 3 things that you
are going to do as a result of
attending this workshop
© 2016 HealthChange Australia
Slide 81
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 82
© 2016 HealthChange Australia
Slide 83
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 84
Getting to know you
1. Your name
2. Your role
3. The common conditions you/your
team helps patients to manage
4. The biggest challenges that you face in
working with your patients, clients or
service users
• Managers or administrators may like to the service
users associated with their organisation and/or their
other stakeholders (staff, management, colleagues etc.)
© 2016 HealthChange Australia
Return
Slide 85
© 2016 HealthChange Australia
Slide 86
HealthChange® Menu of Options
©2016 HealthChange Australia
www.healthchange.com