Contents
Slide 1. Using Self-Management Support in Your Coaching Approach
Slide 2. Chronic Care Model
Slide 3. Self-Management Support
Slide 4. What is Self-Management?
Slide 5. Patient Educ. vs. SMS
Slide 6. Self-Management Tasks in Chronic Illness
Slide 7. Collaborative care
Slide 8. What Self-Management Support isn’t…
Slide 9. Self-Management in CCM
Slide 10. Using the Five A’s as a Facilitator
Slide 11. Assess
Slide 12. Tips on Assessing Your Practice Team
Slide 13. Advise
Slide 14. Tips on Providing Advice
Slide 15. Agree
Slide 16. Tips to Create Agreement
Slide 17. Assist
Slide 18. Tips on Assisting Patients
Slide 19. Problem Solving
Slide 20. Thoughts on Team QI Literacy
Slide 21. Arrange
Slide 22. Tips for Follow-up
Slide 23. Personal Action Plan
Slide 24. Confidence Ruler
Slide 25. For More Information on Self-management Support
Slide 1: Using Self-Management Support in Your Coaching Approach
Mike Hindmarsh
Hindsight Healthcare Strategies
QIIP Practice Facilitator Training
May 12-13, 2008
Toronto, ON
Slide 2: Chronic Care Model
Diagram of Chronic Care Model, which includes Community and Health System. Community includes Resources and Policies. Health System includes Health Care Organization, which includes Self-Management Support, Delivery System Design, Decision Support, and Clinical Information System. Community and Health Systems overlap somewhat and lead to productive Interactions between Informed, Activated Patient and Prepared, Proactive Practice Team, leading to Improved Outcomes.
Slide 3: Self-Management Support
- Emphasize the patient’s central role in managing their illness.
- Use effective self-management strategies that include assessment, goal-setting, action planning, problem-solving, and followup.
- Organize internal and community resources to provide ongoing self-management support to patients.
Slide 4: What is Self-Management?
"The individual’s ability to manage the symptoms, treatment, physical and social consequences and lifestyle changes inherent in living with a chronic condition."
Barlow, et al. Patient Educ Couns 2002;48:177.
Slide 5: Patient Educ. vs. SMS
| Information and skills are taught. | Skills to solve pt. identified problems are taught. |
| Usually disease-specific. |
Skills are generalizable.
|
| Assumes that knowledge creates behavior change. | Assumes that confidence yields better outcomes. |
| Goal is compliance. | Goal is increased self-efficacy. |
| Health care professionals are the teachers. | Teachers can be professionals or peers. |
Slide 6: Self-Management Tasks in Chronic Illness
- To take care of the illness.
- To carry out normal activities.
- To manage emotional changes.
Based on work by Corbin and Straus.
Slide 7: Collaborative Care
"If physicians view themselves as experts whose job is to get patients to behave in ways that reflect that expertise, both will continue to be frustrated. Once physicians recognize patients as experts on their own lives, they can add their medical expertise to what patients know about themselves to create a plan that will help patients achieve their goals."
Funnell & Anderson. JAMA 2000;284:1709.
Slide 8: What Self-Management Support isn’t…
- Didactic interaction.
- Sage on the stage.
- You should.
- Finger wagging.
- Lecturing.
- Waiting for patients to ask for help.
Slide 9: Self-Management in CCM
Flowchart of self-management process. In the center is Personal Action Plan, which has the following items:
- List specific goals in behavioral term.
- List barriers and strategies to address barriers.
- Specify Followup Plan.
- Share plan with practice team and patient’s social aupport.
An arrow leads up to Assess Beliefs, Behavior and Knowledge. Arrows lead from Assess to Arrange followup (e.g., visits, phone calls, mailed reminder) and Advise on specific information about health risks and benefits of change. Arrows lead back and forth between the Personal Action Plan and Arrange and Advise. Two more arrows also lead back and forth between the Personal Action Plan and Assist: Identify personal barriers, strategies, problem solving techniques, and social/environmental support and Agree: Collaboratively set goals based on patient’s interest and confidence in their ability to change the behavior. In addition, an arrow leads from Agree to Assist.
Slide 10: Using the Five A’s as a Facilitator
Using the Five A’s as a Facilitator.
Slide 11: Assess
Risk factors, Beliefs, Behavior and Knowledge.
Slide 12: Tips on Assessing your Practice Team
- Ask questions about them; get to "know" them.
- Provide feedback to team when appropriate.
- Assess their view of QI progress and how easy/difficult it is to get things done.
Slide 13: Advise
Provide specific information about the benefits of practice change.
Slide 14: Tips on Providing Advice
- Make the source of advice clear (medical knowledge or best practice).
- Personalize advice to the FHT/CHC environment.
- Listen more than you talk.
- Have a key message for each idea you present.
- Don’t overwhelm them with information.
Slide 15: Agree
Foster collaboration in selecting ideas for change.
Slide 16: Tips to Create Agreement
- Base goals and measures and team’s priorities.
- Let them start where they want.
- Do not judge ideas for change.
- Do not make them agree with you.
- Team consensus on testing ideas is not critical unless there is obvious opposition or discomfort.
Slide 17: Assist
Using behavior change techniques (problem solving, counseling) to aid the team in acquiring skills, confidence to test ideas quickly.
Slide 18: Tips on Assisting Patients
- Use other teams as examples.
- Address helplessness.
- Learn and use a problem-solving approach.
- Link to the assessment of barriers and environment.
- Avoid telling them what to do.
- Avoid speeches.
- Avoid cheerleading.
Slide 19: Problem Solving
- Identify the problem.
- List all possible solutions.
- Pick one.
- Try it in the next testing cycle.
- If it doesn’t work, try another.
- If that doesn’t work, find a resource for ideas.
- If that doesn’t work, accept that the problem may not be solvable now.
Slide 20: Thoughts on Team QI Literacy
- People can read and function above their cognitive level on topics that interest them.
- People are very sensitive about being talked down to.
- Be cognizant of power inequities among team members.
Slide 21: Arrange
Schedule follow-up contacts to provide ongoing assistance and support as needed.
Slide 22: Tips for Follow-up
- Try a wide variety of methods, whichever team prefers (in person, phone, email).
- Make sure follow-up happens, team trust can be destroyed by missed follow-up.
- Determine follow-up based on team preference.
Slide 23: Personal Action Plan
- Something you WANT to do.
- Describe:
- How.
- What.
- When.
- Where.
- Frequency.
- Barriers.
- Plans to overcome barriers.
- Confidence rating (1-10).
- Follow-Up plan.
Source: Lorig et al, 2001
Slide 24: Confidence Ruler
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
|---|---|---|---|---|---|---|---|---|---|
| Not Confident | Unsure | Somewhat Confident | Very Confident | ||||||
Slide 25: For More Information on Self-Management Support
Thanks.
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