SF General uses motivational interviewing to help patients identify their goals and take an active part in managing their health.
Collaborator (Non-Members)Larissa Thomas, Michelle Schneidermann
As nurses we have our goals for the patient—we want them to follow their medication regimen and be healthy. But our patients’ goals were often more lifestyle focused, like wanting to get their high school diploma or go to a family reunion. When our goals weren’t aligned to patient goals, it was really hard to motivate them to take care of themselves.
San Francisco General is a non-profit hospital and level 1 trauma center in San Francisco, CA. It has 598 beds and serves a diverse population, the majority of whom are lower income and do not speak English as their first language. Many are also illiterate in English as well as their preferred language. The hospital also serves individuals who may not have health coverage, housing or access to food. They enroll the most difficult to engage patients who have a history of substance abuse and poor health outcomes. Their transitions program began in 2009 and is influenced by the Care Transitions Program and Project RED.
What We Tried
Our transitions nurses attended motivational interviewing training and use this technique whenever we speak to patients. We try to really dig in and find out what makes patients tick. Once we know that, we can find a way to align our medical goals with their personal ones. For example, we had one patient in her 70s who kept getting readmitted because she wasn’t taking her water pills. When we learned that her goal was to get her high school diploma, we could have said, “That’s great, I think City College has a program you can join,” but instead we asked her more about it. “What’s preventing you from getting your diploma?” Then we learned that she couldn’t catch the bus because her feet were too heavy. She knew that her water pill would help with the swelling, but didn’t want to take it because it made her urinate in public one time. “Can you talk to your doctor about that? Maybe he can suggest different times to take your pills so that you don’t run into that problem anymore.” Ultimately she both took her medication and got her high school diploma, all because we found a way to tie our goals into hers.
Our patients are much more engaged during our conversations when we focus on their goals. When they’re engaged, we can do medication reconciliation, education, and goal setting without them even realizing it. In the above example the patient is now adhering to her medication regimen, but she’s doing it for herself, not because I told her to.
Patients are much more motivated when they’re in control. We don’t tell them how to achieve their goals, we ask questions to help them come up with their own plan.
Motivational interviewing takes time to learn. All of our transitions nurses attended training—but, if a hospital can’t afford that, it’s also something you can learn by observing others who do it well.