Learn how to get your "yes"

This second article in a series about behavioral change looks at how you can use Motivational Interviewing to help your staff members look at their goals and the changes they need to make to reach them.

In the last installment of this series, we were introduced to Sharon, a dental team member who is habitually late to work. This meant the rest of the team had to “cover” for her, which got the daily schedule off to a bad start-something we all know is difficult to recover from. Punitive measures, such as scowls and other subtle expressions of anger from team members, didn’t motivate Sharon to arrive earlier. Looks like it’s time for a different approach!

The conversation

Could the office manager use the “Motivational Interviewing” technique to motivate Sharon to make a behavior change? This technique is designed to help team members express their goals and then examine whether their current behaviors are likely to help them achieve those goals.

When asked, Sharon told her office manager that her goal is to work in an environment where she feels respected and is viewed as a valuable team member. Sharon also mentioned that she sure doesn’t feel that way at work now, giving the office manager a chance to help her see that her chronic late arrival at work negatively impacts the other team members and affects the way they treat her. Here’s how the conversation could go from there:

Office manager:  “I wonder how you are going to earn their respect and feel like part of the team with your pattern of arriving late nearly every day?”

Sharon: “Maybe you are right. I hadn’t thought of it that way. I guess if I am going to be a team player I’d better figure out how to get to work on time.”

Office manager: “What will need to change so you can be here sooner?”

Sharon: “I guess I can ask the babysitter to arrive 15 minutes earlier than she has been.”

Office manager:  “You’ve come up with a great remedy for this situation. I bet the other team members will react differently to you when you are at work on time. How soon can you arrange for this change that you’ve suggested?”

The follow-up

In this scenario, the office manager has helped Sharon see that something she wants-an amicable work environment-won’t be obtained unless she changes her behavior. And, most importantly, she came up with the solution to the problem. This approach is much more of a ‘win-win’ exchange than an angry confrontation where demands for punctuality are made, accompanied by an ‘or-else’ threat. Confrontation, threats and inciting guilt do not result in meaningful behavior changes and usually elicit defensiveness, resistance and additional anger.

In the next installment of this series, we’ll look at how to effectively motivate patients toward behavior change. The differences between using the traditional patient education approach (often with unsuccessful outcomes) and using Motivational Interviewing skills for effective change will be explained.

Why it works

This demonstration of the Motivational Interviewing technique can be used to facilitate a variety of behavior changes. This approach uses the compelling concept that people will do what they want to do. The first step is to help them realize what outcome they are seeking. Then guide them to look at current practices that prevent the desired outcome. Because the person who needs to make the behavior change is really the “expert” about his or her life, it is essential that he or she decides whether to and how to change a behavior to get the desired outcome. This is sometimes referred to as “verbalized intention.” It is much more powerful to hear yourself commit to something than it is to merely agree with someone’s advice.

As an example, the individual who says, “I guess if I want to prevent gum disease, I’ll need to floss,” is much more likely to comply than the person who was led into agreement by a dental hygienist saying, “ You will start flossing every day, won’t you?” Once the “change talk,” such as ‘I’ll need to floss” occurs, the clinician will need to consolidate that intent and elicit a verbalized intention to change. The patient’s autonomy is respected, which is an impressive attribute of Motivational Interviewing.