Wouldn’t it be nice if you could send patients home from the hospital or physician’s office and count on them to follow through with all the recommendations for how to finish their healing, improve a chronic health condition, or increase their overall health status? Let’s face it, health is a complex concept. It’s even more complicated (and costly) to manage the health status of someone with multiple health or chronic conditions. According to the Centers for Disease Control and Prevention (CDC), chronic disease accounts for approximately 75 percent of the nation's aggregate health care spending or an estimated $5,300 per person in the U.S. each year. For those covered under Medicare, 96 cents per dollar is spent on managing chronic disease and for those covered by Medicaid, its 83 cents per dollar. Chronic disease and the nation’s aging population, combined with other existing risk factors (tobacco use, poor nutrition, lack of physical activity), lead to the conclusion that we must do a better job of changing patient behaviors if we are to improve our country’s health status.
Patients' failure to follow physician recommendations is a well-documented link to poorer outcomes and higher health care costs, but strategies to address the problem remain elusive. Think back to when you were a child and your parents told you to do something. Even if their directive was in your best interest, you likely shrugged it off and hoped that it would be forgotten. All of us are aware of how difficult it is to change human behavior, so just telling patients what to do may not yield the health outcomes we target. Achieving and maintaining a healthy population require an entire influence strategy.
We have historically struggled to change patient behavior because many times we employ only one strategy to elicit change—persuasion. Persuasion is basically telling the patient what to do, and although it may lead to results initially, it is usually short term and unsustainable. Instead, in order to achieve long-lasting change, we must employ an influence strategy. Influence involves:
- Using long-term, deeply entrenched strategies.
- Understanding an individual’s knowledge/skill base and personal motivation.
- Enlisting skill building as a major component of the strategy.
- Interlocking behaviors with the entire social support network around the patient.
- Changing minds, hearts, and eventually actions.
Here are five ways you can assist your patients in changing behavior:
- Build trust in the relationship. A strong relationship is essential to helping patients change behavior. Here are some questions to ask in order to assess whether trust is present:
- Does the patient truly feel that you are acting in their best interest?
- Do they feel you are taking the time necessary to truly understand their personal issues and needs before applying a solution?
- Do you understand their health goals and the results they wish to achieve?
- Address the knowledge/motivation gap. Don’t assume patients know how to do what you’re asking or believe it’s the best approach for them. Typically patients who don’t follow through either can’t or won’t because they don’t see the value of changing. If patients don’t have the will to make a change, they won’t be successful. Here are some questions to address their knowledge and motivation:
- Do they understand the “why” behind what you are asking them to do?
- Do they get the connection between what you are asking them to do and how it will achieve their personal health goals/results?
- Do they know how to do what you are asking?
- Do they believe this is the best choice for them?
- Are they willing to do it?
- Help them build their winning team. It’s tough to change behaviors, especially if patients have engaged in certain behaviors their entire life. A good social support network is important to increase odds of success once they leave your facility. Here’s how to know if they have a winning team behind them:
- Do they have someone at home to encourage them?
- Do they need a health coach to help them navigate the changes?
- Do they know of other resources in the community that can help?
- Are they comfortable reaching out to others for help?
- Take barriers out of their environment. Many times patients know what to do but may not be able to do it because of restrictions in their environment. Here are some questions to ask:
- Does their home environment support or hinder the change?
- Do they have access to the resources or equipment they need to make the change?
- Can they afford to make the changes necessary?
- Show them positive changes over time. Make it visual! A health scorecard that shows the behavior changes and impact on health outcomes goes a long way to sustain the new behaviors. Assist them in developing a reward program focused on positive behaviors and achieving their health goals/outcomes. Once the desired health outcome is achieved, help them develop a plan for maintaining and sustaining the positive behaviors that helped them get there.
If we apply a comprehensive influence strategy that takes into account personal, social, and structural components, we increase our odds of effecting positive change in our patients’ lives for the long term. It is ok if you need to start small by testing this approach with a few patients. Once you have a greater understanding of how your patients react to changes in behavior, you can fine-tune your methods and expand this process to additional patients. Your greatest accomplishment will be looking back at your patients’ outcomes and how you played a critical role in their success. The time to start is today.