Making PCMH Transformation a No-Brainer Doug Rossier, MBA drossier@transformed.com

Objectives Upon completion of this session, you will be able to: Share habit-forming tactics for your practice to trial Use a habit template to craft plans (part of PlanDoStudyAct) for testing interventions Evaluate and prioritize behavior change initiatives

Agenda William Habits Activity Why this works Healthcare examples Recent findings about the subconscious brain Healthcare examples Success in other industries

Non-compliant diabetic, obese and mentally challenged… William Non-compliant diabetic, obese and mentally challenged…

Third Year Resident Frustrated with inability to make progress with William

Care Manager Margie Please help!

Care Manager Margie

Result The following week, giddy resident tells Margie: “one full week of 3/day blood sugars!” What did you do?

DM Trial self-mgmt: blood glucose log, review log and talk about process with patient …2 physicians (1 with, 1 w/o EES) Repetitive behavior you want to elicit: Pt is to record blood glucose level daily, Context immediately after waking up and going to the bathroom. Cue Put the glucometer right by the sink, where they brush their teeth. Reward ?Brushing teeth when done (clean feeling) ?Get to eat breakfast ?Satisfaction of filling it out ? Go get morning cup of coffee Training Must be done daily for an extended period of time to become habitual. Will try with patients for two weeks.

Habits Have Four Parts Context The situation that the subconscious has identified Cue The prompt that makes the subconscious ‘do’ Reward Some good feeling of some sort Repetition The ‘doing’ must be consciously repeated often enough for the subconscious to take it over

Enhanced Engagement Strategies Diabetics Need to use glucometer and record daily CHF patients Need to weigh and record daily Hypertensives Need to take and record blood pressure daily

Personal Example Context Cue Reward Repetition

Activity Repetitive behavior you want to elicit: Context Cue Reward Training Appeal to the senses – the more the better Eliminate thinking whenever possible Choose a stable context Identify rewards Eliminate punishments - 4 times as powerful as adding a reward drossier@transformed.com

independent of goals & intentions. Habits A habit is a pattern of action, thinking, or relating that is both automatic & has a quality of lack of awareness about it. Habits are automatic behaviors that are activated by cues in a stable context independent of goals & intentions.

Recent Findings About the Subconscious Brain as much as ~95% of behavior is subconscious ~5% is conscious choice Limbic system Cerebellum Basal ganglia (habits) Hippocampus (memories) Amygdala Cerebrum Prefrontal cortex 15 Repetitive, learned behavior Multiple actions Five Senses Habits Entrenched Planning, envisioning, language One thought at a time Dr. Neale Martin, Neurobiologists & Cognitive Psychologists http://www.sublimebehavior.com/knowledge/habit-research Duke University, UCLA, Yale, Northwestern, USC, Univ of Bath, Utrect Univ. Brain pictures provided by Sublime Behavior

Inpatient Example senses, no-thinking, doing, context The University of Michigan Health System in Ann Arbor developed a patient communication tool called Dear Doctor, a bedside notepad to enhance patient-centered care. sample question space for questions: diagnostic and treatment tests and procedures medications miscellaneous questions. senses, no-thinking, doing, context http://www.beckershospitalreview.com/quality/how-a-simple-notepad-enhances-patient-centered-care.html?utm_source=H2RMinutes+PCMH+Sept.+11%2C+2013&utm_campaign=PCMH+Minutes+09%2F11%2F13+&utm_medium=email

Result The patients who used the DD notepad had their questions answered by their physician more often than the control patients. Furthermore, 93 percent of patients using the DD notepad said they would use it again in the future. reward

Smoking Cessation Education Example Putting a smoking cessation kit on the exam room doorknob for patients who need smoking cessation education.

Result “Documented smoking cessation education rates went from 6% pre-intervention to currently 98.5% and I know at least initially we had about a 2-3% absolute reduction in smokers. Our measurable was the documented cessation advice; our hope was lower smoking rates. “

Results Across Industries -Habitual behavior overrides doctor intent -Swiffer $B product -Febreze $B product -Fastest selling 3G handset in history (as of 2008) - $504M/year increase in Avg Revenue Per User (53%) -Users consumed data at a rate 5-6 times the avg

Prioritizing behavior change initiatives Change one behavior at a time and the patient will see progress and learn how to change on his own High reward High frequency Easy to do texting vs. driving a car

What Will You Trial in Your Practice? Doug Rossier, MBA drossier@transformed.com