How Psychology and Motivational Interviewing Can Support Q. I.

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Exploring the links between Quality Improvement, Motivational Interviewing and psychology.

As the first point of access for patients in need of care, General Practices operate on the frontlines of healthcare. The daily demands of effectively meeting patient needs while also performing proper due diligence in maintaining NHS standards and fulfilling all corresponding regulatory requirements can be difficult to balance. As a result, many General Practices—in my experience—can be quite demonstrative of an organisation that is typically quite chaotic. Staff don’t often have the time to stop and think about whether certain processes are working for them in a way that is efficient, time effective, and enhances staff and patient experience because they’ve been put in a position where they are firefighting all day long. These challenges have been very much enhanced by the COVID 19 pandemic.

This is where implementation of Quality Improvement (QI) comes in. In fairly simple terms, the general premise of QI involves making systems and processes work as efficiently as possible. Just as the title suggests, it is a very practical, and often process related, perspective on how organisations can improve their approach to delivering a service—that commonly involves lots of complex processes—in a way that is efficient and ensures that those processes work for them rather than against them. And, in the context of health and social care, in a way that benefits the patient experience as well.

What QI offers to a General Practice is simply the time to step back and reflect on whether what’s been implemented very quickly is actually the best solution for that practice in terms of efficiency, staff, and patient experience. Sometimes it is but often times it isn’t. We use different methodologies to give people the headspace to almost scientifically check that certain processes are working for them in a way that serves them and their patients best. What QI methodologies sometimes fall short on is proven approaches to supporting the process of change. This is something psychologists have been evidencing for decades and one such psychology-informed approach that complements behaviour change and the implementation of Qi more generally is Motivational Interviewing (MI).

We’ll look more deeply into what it is in another blog but, to sum it up, MI Motivational Interviewing is a collaborative conversation style. Historically, it was born in the addictive field of therapy to help people change unhelpful problem-drinking behaviours but, now, it is used within the context of what we call “person-centred” collaborative conversations. It is what would be considered a person-centred approach and despite it’s therapeutic beginnings, is now utilised in a broad range of contexts. MI is an evidence-based approach that can be used in a way that facilitates and enhances changes in behaviour, not just with addiction, but with a whole range of things—you name it! You’ll often see MI motivational interviewing integrated into some kind of health and/or social care system.

What Psychology and MoMI tivated Interviewing offer to QI in particular, is to help people develop the interpersonal skills needed to deliver the QI methodology effectively. Whereas Quality Improvement has a very heavy emphasis on what to do, MI Motivational Interviewing is much more focused on how to go about it. So, when you combine the QI methodology of what to do with the Psychology of —in the MI—of how to do it, what you’ve got is a much more robust approach to genuinely making improvement.

Oftentimes, the reason systems and processes are broken is because people have been unable to adequately respond to changes that can be really complex. Therefore, QI is fundamentally rooted in changes in behaviour. And, because MI is a behaviour-change approach, it not only offers that very person-centred collaborative approach to problem solving but it is also fundamentally designed to help people who are really uncertain about change start to move towards really important changes.

The routine work that Xytal Healthcare Management do is very much underpinned by an effective really nice blend of not only what’s done, but also how to do it. One of the best examples of this is the Care Navigation and Enhanced Communication Skills Programme that has been developed in response to General Practices having to change very rapidly in terms of access for patients and in the processes related to booking appointments. We’ve moved very much from a scenario whereby a patient is offered an appointment with a GP when they request it, the reception is asked for it, to more of a requirement for reception teams to —very skilfully —establish whether what the patient has requested is the right thing for them in terms of the symptoms they might report and prior medical history, for example. whether they’re on any medication and/or have a long-term condition, and so on.

General Practice really understands the need to be able to care-navigate rather than simply offer an appointment if it’s available, and this requires much more skill. So, Xytal have responded to that by combining QI processes to help practices check that their systems are aligned to this very new way of working along with training for reception teams in evidence-based psychological and MI skills to be able to do that. While amending systems and processes to accommodate that change offers some support, what reception teams often lack is simply the skills and the confidence to have those conversations with patients—some of whom might not be very happy about what it is that they’re offered and/or may be reluctant to discuss the symptoms they’re experiencing. So, when you combine QI with, with MI and psychological skills in that way, what you’ve got is a really good example of how that blend can work really well together in response to a common challenge in General Practice.

As you can see, MI Motivational Interviewing has an awful lot to offer! Psychologists and people who work in therapeutic settings have known for a very, very long time that empathic listening and a more collaborative approach to problem solving genuinely leads to better outcomes than approaches that are much more directive and don’t engage with staff in a way that they feel valued as a participant in any kind of change process. Often, I see organisations struggle when staff feel that they’ve been dragged into change rather than invited as an active participant and consultant in that change. Psychology and MI offer a general transferability of a much more person-centred approach to routine conversations with staff and to scenarios where general practices having to respond to change very rapidly.

There’s also transferability with leadership. We all understand the importance of being a compassionate and collaborative leader who is also capable of being directive. Most MI Motivational Interviewing offers all that and is evidence based, with a mountain of research indicating positive outcomes across a broad range of different contexts that utilise MI as the communication approach. The difference made by implementing what psychologists have long known about how to engage with people in a way that leads to better outcomes is like the secret ingredient needed to make QI work. In my work with Xytal, the aim is to implement that ingredient in a very innovative way so that it is fully integrated across everything we do.

This blog was written by Dr Charlotte Hilton.

Quality Improvement involves making systems and processes work as efficiently as possible.