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Grant Corbett Principal Behavior Change Solutions, Inc. North America’s Foremost Experts on Patient Adherence BCS, Inc. ACCOUNTABILITY: What Motivates.

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Presentation on theme: "Grant Corbett Principal Behavior Change Solutions, Inc. North America’s Foremost Experts on Patient Adherence BCS, Inc. ACCOUNTABILITY: What Motivates."— Presentation transcript:

1 Grant Corbett Principal Behavior Change Solutions, Inc. North America’s Foremost Experts on Patient Adherence BCS, Inc. ACCOUNTABILITY: What Motivates Employees.

2 Accountability: What Motivates Employees BCS, Inc. Session Objectives This session will consider Accountability: 1.What it is. 2.What we want. 3.How to get it.

3 Accountability: What Motivates Employees BCS, Inc. Accountability: Is this it?

4 Accountability: What Motivates Employees BCS, Inc. A definition of “accountability”: “Personal choice and willingness to contribute to an expressed or implied outcome.” A question: “How do you make people accountable for their health?” 1. Accountability: What it is

5 Accountability: What Motivates Employees BCS, Inc. 1.Can we “instill” accountability? 2.Accountability only enables negative feedback after a decision or action. 3.Does best evidence and practice support that programs can “make people accountable”? 1. Accountability: What it is Potential problems with this question:

6 Accountability: What Motivates Employees BCS, Inc. “What motivates employee ‘personal choice and willingness to contribute’ to health?” Specifically, what is the evidence and are we applying it in our programs? 2. Accountability: What we want A better question:

7 Accountability: What Motivates Employees BCS, Inc. 3. Accountability: How to get it Two Worldviews on How to Get It

8 Accountability: What Motivates Employees BCS, Inc. 1. The Deficit Worldview 3. Accountability: How to get it

9 Accountability: What Motivates Employees BCS, Inc. They don’t see (e.g., denial, lack of insight) They don’t know They don’t know how They don’t care The problem is (an empty glass): 3. Accountability: How to get it

10 Accountability: What Motivates Employees BCS, Inc. Insight: If you can just make people see, then they will change Knowledge: If people just know enough, then they will change Skills: If you can just teach people how to change, then they will do it Hell: If you can just make people feel bad or afraid enough, they will change Thus, the solution is (to fill the glass) by giving them: 3. Accountability: How to get it

11 Accountability: What Motivates Employees BCS, Inc. 3. Accountability: How to get it Just published study (BMJ, May 26): Salter and colleagues analyzed pharmacist-patient discourse during medication review consultations. What they found: Advice giving without being asked was common and “was often resisted or rejected (by patients) and created interactional difficulties…”. What about accountability: Advice giving occurred “despite deliberate displays of competence and knowledge by patients.”

12 Accountability: What Motivates Employees BCS, Inc. 2. The Competence Worldview 3. Accountability: How to get it

13 Accountability: What Motivates Employees BCS, Inc. Asking for their insight Evoking their knowledge Assuming that patients have skills Enhancing self-efficacy The solution is (to draw water from the well) by: 3. Accountability: How to get it

14 Accountability: What Motivates Employees BCS, Inc. What do Competence Worldview programs look like? A clinical example: Motivational Interviewing 3. Accountability: How to get it

15 Accountability: What Motivates Employees BCS, Inc. Rubak and colleagues (2005) in the British Journal of General Practice concluded from a review of 72 RCTs: “(Motivational interviewing) outperforms traditional advice giving in approximately 80% studies…The meta-analysis shows significant effects of motivational interviewing for combined effect estimates of body mass index, total blood cholesterol, systolic blood pressure, blood alcohol concentration and standard ethanol content…on many different areas of intervention. The review has shown that motivational interviewing can be effective even in brief encounters of only 15 minutes and that more than one encounter with a patient increases the likelihood of effect. Motivational Interviewing

16 Accountability: What Motivates Employees BCS, Inc. Aliotta, S. L., Vlasnik, J. J., & Delor, B. (2004). Enhancing adherence to long-term medical therapy: A new approach to assessing and treating patients. Advances in Therapy, 21, Bennett, J. A., Perrin, N. A., & Hanson, G. (2005). Healthy aging demonstration project: Nurse coaching for behavior change in older adults. Research in Nursing and Health, 28, Berger, B. A., Liang, H., & Hudmon, K. S. (2005). Evaluation of software-based telephone counseling to enhance medication persistency among patients with multiple sclerosis. Journal of the American Pharmacists Association, 45, Broers, S., Smets, E. M. A., Bindels, P., Evertsz, F. B., Calff, M., & DeHaes, H. (2005). Training general practitioners in behavior change counseling to improve asthma medication adherence. Patient Education and Counseling, 58, Hayward, P., Chan, N., Kemp, R., & Youle, S. (1995). Medication self-management: A preliminary report on an intervention to improve medication compliance. Journal of Mental Health, 4, Kreman, R., Yates, B. C., Agrawal, S., Fiandt, K., Briner, W., & Shurmur, S. (2006). The effects of motivational interviewing on physiological outcomes. Applied Nursing Research, 19, Robles, R. R., Reyes, J. C., Colon, H. M., Sahai, H., Marrero, C. A., Matos, T. D., et al. (2004). Effects of combined counseling and case management to reduce HIV risk behaviors among Hispanic drug injectors in Puerto Rico: A randomized controlled trial. Journal of Substance Abuse Treatment, 27, Rose, J., & Walker, S. (2000). Working with a man who has Prader-Willi syndrome and his support staff using motivational principles. Behavioural and Cognitive Psychotherapy, 28, …MI & Medication RCTs

17 Accountability: What Motivates Employees BCS, Inc. …MI in the Real World

18 Accountability: What Motivates Employees BCS, Inc. Financial Incentive Physician initiated, written action plans Communication training for patients Reminders (e.g., letters, alarms, telephone) Self-monitoring Other competence-based programs Other programs that can be “competence” based:

19 Accountability: What Motivates Employees BCS, Inc. 1.The Principle of Social Investment TM 2.The Principle of Discrepancy TM 3.The Principle of Accessibility TM 4.The Principle of Expectancy TM The Principles of Change TM Competence-based Principles

20 Accountability: What Motivates Employees BCS, Inc. What You can Do: Communicate this… Accountability programs (whether to motivate patient adherence or a healthy lifestyle) work, not because they demand or instil accountability, but because they value and evoke employee competence and commitment. 3. Accountability: How to get it

21 Accountability: What Motivates Employees BCS, Inc. Behavior Change Solutions, Inc. Grant Corbett Principal Behavior Change Solutions, Inc. 52 Cherie Road St. Catharines, ON CANADA L2M 6L7 Tel: Fax:


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