ACCOUNTABILITY: What Motivates Employees .

1. ACCOUNTABILITY:What Motivates Employees. grant.corbett@behavior-change-solutions.com

2. Session Objectives This session will consider Accountability: • What it is. • What we want. • How to get it.

3. Accountability: Is this it?

4. 1. Accountability: What it is A definition of “accountability”: “Personal choice and willingness to contribute to an expressed or implied outcome.” A question: “How do you make people accountable for their health?”

5. 1. Accountability: What it is Potential problems with this question: • Can we “instill” accountability? • Accountability only enables negative feedback after a decision or action. • Does best evidence and practice support that programs can “make people accountable”?

6. 2. Accountability: What we want A better question: “What motivates employee ‘personal choice and willingness to contribute’ to health?” Specifically, what is the evidence and are we applying it in our programs?

7. 3. Accountability: How to get it Two Worldviews on How to Get It

8. 3. Accountability: How to get it 1. The Deficit Worldview

9. 3. Accountability: How to get it • They don’t see (e.g., denial, lack of insight) • They don’t know • They don’t know how • They don’t care The problem is (an empty glass):

10. 3. Accountability: How to get it Thus, the solution is (to fill the glass) by giving them: • Insight: If you can just make people see, then they will change • Knowledge: If people just know enough, then they will change • Skills: If you can just teach people how to change, then they will do it • Hell: If you can just make people feel bador afraid enough, they will change

11. 3. Accountability: How to get it Just published study (BMJ, May 26): Salter and colleagues analyzed pharmacist-patient discourse during medication review consultations. What they found: Advice giving without being asked was common and “was often resisted or rejected (by patients) and created interactional difficulties…”. What about accountability: Advice giving occurred “despite deliberate displays of competence and knowledge by patients.”

12. 3. Accountability: How to get it 2. The Competence Worldview

13. 3. Accountability: How to get it The solution is (to draw water from the well) by: • Asking for their insight • Evoking their knowledge • Assuming that patients have skills • Enhancing self-efficacy

14. 3. Accountability: How to get it What do Competence Worldview programs look like? A clinical example: Motivational Interviewing

15. Motivational Interviewing Rubak and colleagues (2005) in the British Journal of General Practice concluded from a review of 72 RCTs: “(Motivational interviewing) outperforms traditional advice giving in approximately 80% studies…The meta-analysis shows significant effects of motivational interviewing for combined effect estimates of body mass index, total blood cholesterol, systolic blood pressure, blood alcohol concentration and standard ethanol content…on many different areas of intervention. The review has shown that motivational interviewing can be effective even in brief encounters of only 15 minutes and that more than one encounter with a patient increases the likelihood of effect.

16. …MI & Medication RCTs Aliotta, S. L., Vlasnik, J. J., & Delor, B. (2004). Enhancing adherence to long-term medical therapy: A new approach to assessing and treating patients. Advances in Therapy, 21, 214-231. Bennett, J. A., Perrin, N. A., & Hanson, G. (2005). Healthy aging demonstration project: Nurse coaching for behavior change in older adults. Research in Nursing and Health, 28, 187-197. Berger, B. A., Liang, H., & Hudmon, K. S. (2005). Evaluation of software-based telephone counseling to enhance medication persistency among patients with multiple sclerosis. Journal of the American Pharmacists Association, 45, 466-472. Broers, S., Smets, E. M. A., Bindels, P., Evertsz, F. B., Calff, M., & DeHaes, H. (2005). Training general practitioners in behavior change counseling to improve asthma medication adherence. Patient Education and Counseling, 58, 279-287. Hayward, P., Chan, N., Kemp, R., & Youle, S. (1995). Medication self-management: A preliminary report on an intervention to improve medication compliance. Journal of Mental Health, 4, 511-518. Kreman, R., Yates, B. C., Agrawal, S., Fiandt, K., Briner, W., & Shurmur, S. (2006). The effects of motivational interviewing on physiological outcomes. Applied Nursing Research, 19, 167-170. Robles, R. R., Reyes, J. C., Colon, H. M., Sahai, H., Marrero, C. A., Matos, T. D., et al. (2004). Effects of combined counseling and case management to reduce HIV risk behaviors among Hispanic drug injectors in Puerto Rico: A randomized controlled trial. Journal of Substance Abuse Treatment, 27, 145-152. Rose, J., & Walker, S. (2000). Working with a man who has Prader-Willi syndrome and his support staff using motivational principles. Behavioural and Cognitive Psychotherapy, 28, 293-302.

17. …MI in the Real World

18. Other competence-based programs Other programs that can be “competence” based: • Financial Incentive • Physician initiated, written action plans • Communication training for patients • Reminders (e.g., letters, alarms, telephone) • Self-monitoring

19. Competence-based Principles The Principles of ChangeTM 1. The Principle of Social InvestmentTM 2. The Principle of DiscrepancyTM 3. The Principle of AccessibilityTM 4. The Principle of ExpectancyTM

20. 3. Accountability: How to get it What You can Do: Communicate this… Accountability programs (whether to motivate patient adherence or a healthy lifestyle) work, not because they demand or instil accountability, but because they value and evoke employee competence and commitment.

21. Behavior Change Solutions, Inc. Grant Corbett Principal Behavior Change Solutions, Inc. 52 Cherie Road St. Catharines, ON CANADA L2M 6L7 Tel: 905-937-1441 Fax: 905-937-5858 Email: grant.corbett@behavior-change-solutions.com