Employee health coaching starts with motivational interviewing to build trust, get to the why and develop a plan together to change unhealthy behaviors.
“I need to lose weight.”
“I should quit smoking.”
“I want to start eating better.”
We loop these conversations over and over in our heads — sometimes obsessively — regarding lifestyle or behavioral changes we know we need to make.
But then come the excuses and second-guessing.
“I don’t have time.”
“It probably won’t even work.”
“Why should I seek help? They’ll just make me feel guilty.”
We set ourselves up for failure before we even begin because it’s far easier to carry on business as usual than to take action. Change is uncomfortable. It’s scary. There’s too much uncertainty.
In some instances, patients resent being told to change a behavior by a healthcare provider, or they simply never thought about the reasons why they feel the desire to change.
Today, healthcare providers increasingly utilize a proven employee health coaching technique called motivational interviewing to help patients unlock their “why.” The goal: build trust and partner with the patient for lasting behavioral changes.
In the 1990s, clinical psychologists William Miller and Stephen Rollnick developed a counseling approach to use patient motivation to spark positive changes in behavior and resolve ambivalence. At the time, they used the technique to help people overcome substance-abuse disorders, but within the last 10 to 15 years, healthcare providers began implementing motivational interviewing into general healthcare settings.
“In order to make positive changes, people really need to feel like they’re in control, and they have to take control,” says Tamara Golden, RN, Health Coach, and Leadership Development Specialist at Marathon Health. “What motivates them to make a change is within them, it’s not what we as health practitioners tell them to do. Because, more often than not, people don’t like to be told what to do.”
Sure, most patients won’t think twice to take a life-saving drug or undergo an emergency procedure, but when it comes to lifestyle and behavior change, Golden says patients often become resistant to taking orders from healthcare providers.
“Motivational interviewing truly puts the patient in control of their own healthcare,” she says. “We try to draw out their own motivation, because we, as practitioners, can’t assume that we know what’s really motivating the person.”
She adds, “You can take three women who want to lose weight, for instance. One may want to avoid diabetes. Another wants to be able to get down on the floor and play with her kids, while the third one just wants to look good in her skinny jeans.”
Understanding the true motivation behind the desired lifestyle change helps patients align their values with their behaviors. For example, if a patient values raising children and being present for their family — yet they smoke — the patient endures a significant risk of chronic disease and cancer that could cut their life short.
“We help them to see how their behaviors don’t align with their own values, and that’s much more motivating to people,” Golden says. “It’s very effective because it’s so patient-centered. It’s all about what’s important to them, and as a result they’re more likely to follow through.”
Once a health coach or other practitioner understands the “why” behind the change, they can craft a personalized plan of action that’s both attainable and goal-oriented.
“We’re trying to understand the gap between where they are today and where they want to go,” says Lisa Murphy, RN, MBA, Vice President of Organizational Development at Marathon Health. “There’s always a reason, and understanding the real motivation behind the change helps us guide them, and then we figure out what’s going to work for each patient.”
Christine Ritchey, a Health Coach and Family Nurse Practitioner at Marathon Health, says she recently worked with a patient who wanted to lose significant weight through exercise alone, but he didn’t want to minimize his alcohol consumption. She knew he’d just resist if she told him to stop drinking, so she empowered him with information and let him chart his own path.
“He got to the point where he was like, ‘I’m not getting where I want to be. So, maybe I do need to look at how many calories I’m taking in with alcohol,’” Ritchey says. “I said, ‘Bingo!’”
Ritchey says once the patient realized his daily alcohol intake hindered his ability to shed pounds, he took control and made the decision on his own to stop drinking, a decision that ultimately helped him lose 50 pounds.
For Marathon Health, motivational interviewing isn’t just a hollow buzzword on a break room sign. “It’s the coaching language we speak,” Murphy says. “We train the entire company on what we call the health coach mindset. Whether you’re in marketing, training or business intelligence, you’ll have an understanding of what that means and how it impacts your role.”
Murphy says training focuses on actively listening to patients, asking open-ended questions, avoiding making assumptions or passing judgments, and allowing the patient to drive the conversation.
“Even if a patient is only coming in for a weight check and not going to see the provider, there are things our medical assistants or nurses can say to keep that health coaching language going through all these touchpoints,” Murphy says. “We do a lot of affirmations and a lot of encouragement. We celebrate small successes with our patients, and it can happen with any team member.”
Marathon Health provides four levels of certification in motivational interviewing. All employees receive training on the health coach mindset, while medical assistants and nurses go through the second level, which places an added emphasis on the customer experience. Marathon Health providers, health coaches, physical therapists, behavioral health counselors and registered dietitians go through the third level. This includes a three-month process where they participate in interactive simulations with health coach educators where they put their learnings into practice. The fourth level is a 12-month internal advanced certification program for clinicians that champions professional development and meets the national standards for training, education, and assessment standards to sit for the National Board-Certified Health & Wellness Coaches (NBC-HWC) credential.
Golden says some new Marathon Health providers initially appear skeptical of the interviewing technique, but quickly change their mindset after seeing the results.
“Oftentimes, providers come to us from traditional hospital settings, where they do the traditional thing and tell the patients what to do and they see low compliance,” she says. “Once they start putting motivational interviewing into practice, they’re blown away by our level of compliance. Our coaches, clinicians and practitioners love it.”