COACH’S CORNER: Preventing Re-Hospitalization with Motivational Interviewing

Preventing re-hospitalizations is an important focus in today’s long-term care community. Re-hospitalizations are expensive — the federal government estimates (pdf) that they cost up to $17 billion annually — and pose additional health risks to frail consumers, including hospital-acquired infections, side effects of new medications, and the downsides of being transferred to an unfamiliar environment.

Clearly, there is a lot at stake for consumers and providers when hospitalization is not prevented.

The truth is, preventing unnecessary hospitalizations requires a team effort between an interdisciplinary support team and the consumer. Both have an important role in working effectively together for the highest quality outcomes.

Consider this example:

Marie is living in her own apartment in New York City and is supported by a managed long-term care organization that coordinates a team of support staff to help her successfully live at home. Marie has multiple diagnoses, and in particular is prone to grand mal seizures. She self-administers her medication, and does not tend to take her seizure medications as prescribed because she doesn’t like the way they make her feel. When Marie has a seizure, she inevitably ends up in the hospital, and this could be avoided through better medication management.

Health care professionals face independent thinkers like Marie all the time. We support individuals who have the right to not follow the care plan as advised by his/her support team. We find ourselves — fairly frequently — managing the tension between what we think is best for the patient and what they want for themselves. When this tension is not well managed, it can negatively impact patient outcomes and lead to hospitalizations.

The good news is that there are learnable skills to help the interdisciplinary team successfully support consumer direction. I recently got certified in motivational interviewing (MI), which is a way of applying coaching skills to conversations with consumers that helps them tap into their own motivation to change a behavior that is negatively impacting their life or their health. Let’s face it: We can advise Marie to take her seizure medication all day long, but it’s up to her to determine her path.

Motivational interviewing is a person-centered counseling style for addressing the common problem of ambivalence about change. In Marie’s case, she doesn’t want to have seizures, but she also doesn’t want to feel the side effects of her seizure medication. This causes her to be ambivalent about changing her behavior. Many older approaches to behavior change relied on the health care professional to persuade or even intimidate the patient into changing or “complying.” Let’s be honest: Telling a patient (or anyone for that matter!) what to do usually doesn’t lead to change.

MI is an extension of the PHI Coaching Approach®. MI relies upon the skills of open, curious questions, affirmations, reflective listening, and summarizing to help a person move beyond their ambivalence and tap into their own motivation to change. These conversations are goal-oriented, yet consumer-directed.  MI is definitely a necessary skill set for interdisciplinary team members in today’s environment.

If your organization is interested in a skill-building seminar on motivational interviewing, please send me an e-mail.