Self-management, The Value and Application with Chronic Condition

Populations

Margaret Rose LMSW, CAADC, CCS, ACT Workforce Development Cherry Health

Self -Management Objectives

• Case for self-management • Outcomes we can achieve using self-

management • Introduction to the 4 key skills of self-

management

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Case for self-management

• Patients become partners in their own healthcare – Non-pharmacological treatment is an important

part of chronic disease management – Provides the patient with tools and skills to

management their health – Builds patient confidence in their ability to

manage and maintain active full-filling lives

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Self-management is an important component of integrated healthcare • Successful healthcare must include the patient

as an expert in themselves – Patient involvement improves the likelihood of

achieving and maintaining healthcare goals – Long-term it is predicted it will improve the

Institute for Health Improvement Triple AIM • Improved cost, satisfaction and quality

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Patient Self Management

Increased skills +

Confidence, ability to make changes =

Improve outcomes and decrease costs

Bodenheimer, T., Lorig, K., Holman, H., Grumbach, K. Patient Self Management of Chronic Disease in Primary Care JAMA, November 20, 2002

Planning

4 Key Skills of Self-management • Information gathering

– The approach of exchanging information with permission and attitudes

• Self-efficacy – Exploring the patients level of confidence and building

their confident • Behavior Change

– Goal setting and clear objectives developed in partnership • Technical Skills

– Using problem-solving, resources, and decision-making

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The Groundwork

• Goal Setting – Specific – Measureable – Attainable – Relevant – Time Bound

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SPECIFIC What do you want to accomplish?

“I want to do better in history”

“I want to increase my history grade from an 85% to a 90%.

MEASURABLE All goals should have a way to evaluate whether or not they were accomplished.

“I want to run the mile better.”

“I want to improve my mile time by 30 seconds.”

ATTAINABLE Goals must be something you are capable of reaching – and in your control! Which would be a better goal for an injured quarterback?

“I will help my team to win the

Super Bowl next year.”

“I will rehabilitate my knee so that I can play football

again next season.

RELEVANT Make goals that are relevant to you specifically and in your area of influence.

Which goal is better for a teacher?

“My goal is to discover a cure for cancer”

“My goal is to inspire at least one student to become a doctor

to research a cure for cancer”

TIME - BOUND Make sure that you have a time set as a “deadline” so your goal is not unending.

“My goal is to be able to run a half marathon.”

My goal is to run in a half marathon

by May of 2014.

Why is it so hard to change?

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Activity

• Think of something you’ve wanted to change in your life but haven’t done so.

– Share your thoughts

• What are the reasons and barriers

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Behavior Change

Beliefs lead to

behaviors

• Priorities • Goals

• Steps

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• We all have attitudes and beliefs about our role in facilitating change – “How we see them is how we treat them,

and how we treat them is how they become” Zig Zigler

Attitudes

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Attitude: “I’ll scare you into change”

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Attitude: “I’ll get to the bottom of this”

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Attitude: “You are guilty”

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Attitude: “I’m overwhelmed”

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Attitude: “I have a solution. Let me help”

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• We all have attitudes and beliefs about our role in facilitating change

Attitudes

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Choose an Effective Attitude

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Attitude:

• Curiosity

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Attitude:

• Partnership

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Attitude: • Acceptance

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Competence or Deficit? What is your world view?

• Capacity to change is within

• May have to dig, but it’s in there!

• Insight & knowledge is lacking

• Fill the glass for them!

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Behavior Change

• Behavior won’t stick if patient isn’t able to make their own. – They are the source of the solution – Help them find it! (Don’t fix it)

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Who has influence? Every touch point = opportunity

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Working With Challenging Patients ABC Model

Activating Event Beliefs Consequences

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“…be self-aware of the difference between developing a treatment plan and collaborating with patients about the implementation of that plan into daily actions.”

Naik, et al. Archives of Internal Medicine, March 2011

Comparative Effectiveness of Goal Setting in Diabetes Mellitus Group Clinics.

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Continuing to Learn Self-management and Expand Motivational Interviewing Skills

• “One-shot” trainings don’t promote competent practice (Miller & Mount, 2001; Walters et al., 2005)

• Initial training with follow-up coaching based on direct observation of practice is “gold-standard”

• Peer-learning groups have shown some usefulness

• You will learn from your patients if you know what to look for!

Resources for Learning MI

• Motivational Interviewing Network of Trainers www.motivationalinterviewing.org

• Guilford Press – Applications of Motivational Interviewing Series

www.MiCCSI.org