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Helping Patients Heal Themselves

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Helping Patients Heal Themselves

Helping Patients Heal Themselves

Date: 09/01/2016

Unhealthy behaviors exacerbate many of the most common chronic diseases afflicting adults today, including obesity, diabetes and arthritis. Patients, to get better, have to change deeply ingrained behaviors.

“In the past, physicians’ way of treating the behavioral part has been to say something like, ‘You really should stop drinking,’” says Colleen Christmas, director of the Internal Medicine Residency Program at Johns Hopkins Bayview Medical Center. “As you can imagine, the success rate for that intervention wasn’t very high.”

But there are ways to get patients engaged in their own care and motivated to change, and thanks to rehabilitation psychologist Nicole Schechter and Stephen Wegener, director of the division of rehabilitation psychology and neuropsychology, physicians and other care providers across Johns Hopkins Medicine are receiving training in patient engagement. Schechter and Wegener started their Patient Engagement Training program three years ago to teach nurses, social workers, community health workers and physicians to engage patients as partners in their health care and to teach new health behaviors — something that has long been part of the rehabilitation process.

Over the last three years, Wegener, Schechter and the director of the Brain Rehabilitation program, Kate Bechtold, have trained more than 350 health care providers to employ strategies from communication science and motivational interviewing, to enhance patient engagement and achieve the goal of patient-centered care at Johns Hopkins Medicine.

For example, motivational interviewing, an evidence-based set of principles and skills originally developed for work with individuals with addiction disorders, helps patients make decisions about taking an active role in their health. It gives practitioners a way of being with and collaborating with patients to make changes that will improve overall health outcomes. This approach can also improve satisfaction with care.

“Patients who feel understood and listened to, have their priorities, goals and values respected, are going to feel more satisfied with their care,” says Schechter, “and are likely to be more engaged in their care.”

To help providers develop patient engagement skills, the training includes three stages: planning, initial training and maintenance. During the planning phase, Patient Engagement Team works with the leaders of the team they will be training to understand who will be trained and what their goals are.

The second phase, initial training, includes a 60- to 90-minute lecture to learn about the values, principles and skills of patient engagement. Training then provides four to seven hours of basic training and one hour of additional training for patient engagement champions, who assist in ongoing maintenance activities for their teams.

The final maintenance phase lasts for one year and supports ongoing development and practice of participants’ acquired skills. The patient engagement champions create a maintenance plan for the group and have monthly training goals. Schechter provides materials and exercises that can take five to 15 minutes each to help maintain and refresh trainees’ skills.

“Our program is different from others across the country because it is in-person skills based training as opposed to online passive learning,” says Schechter, “and we have a maintenance program to ensure participants receive continuing development of their skills. Many other programs underestimate the importance of maintenance in provider skill development.” 

Since starting the program, data from participants indicates they are very satisfied with their training and believe it is useful in practice. Now Wegener and Schechter are conducting initial studies to determine the impact of the program on participant knowledge, attitudes and skills.