How To Implement Self-Management Support into Your Practice
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The specific skills that are
really important to use for self management support, I think the biggest one is the open-ended question. Really just getting
the patient’s story. And letting them know that
you want to know them. You want to hear their story. Building that relationship so
that that builds trust so that then it’s easier to contemplate
making a behavior change if you have a relationship
with somebody. Mostly what I do I
feel like is listen. And then reflective listening,
which is a really important self management skill. So it sounds like instead of
making your back worse maybe it’s helping you. It might be helping me… Once you get it, it
makes it so much easier. Because we’re just mirroring to
the patient what they’re telling us so that they can better
understand and also so we can. Bringing the patient more into
the conversation and instead of talking about them,
talking to them. Those are things we do naturally
and now we have names for them and now we can think about
how to implement them more systematically specifically
to improve care. I think I can say with complete
confidence right now that everybody loves this system of
working with patients on self management for chronic problems. What we’ve tried to do here is
integrate collaborative goal setting into the clinical visit. And the way that we do
that is we have the nurse, the triage nurse, start the
goal- setting process with the patients when they come in to
have their blood pressure taken. So she helps them to
identify health care goals. She starts the action
plan with them. And then when they’re ready to
see me they bring that paper with them to me and I’m able to
go over their goal with them, go over their action
plan with them. Clarify things, sometimes make
some changes, encourage them, reinforce that and that has been
the way that we have integrated the goal setting into the
context of the medical visit. The way I look at it the team
has got to work together. I like to empower them. Either the nurse practitioner or
the respiratory therapist comes in and takes their inhaler and
their aerochamber and says show me how you use it. They might spend 20 minutes
doing that whereas I’m seeing another patient. So from my personal point of
view that makes it much more efficient. So you go about five
days a week to the gym? We work together. We really are a team
working for my health. I feel that not only am I
working hard for me but that each and every
one of my team is. We bring the family in sometimes
extended family members. And then in every clinic visit
we go over the areas that have become challenging for them or
that they’re confused about. We know how important the
team is and so we make it our business to work closely
together and figure it out. There wasn’t a particular day
that I came in and everything changed. But there definitely was a
moment when I realized this is so much better. And … being in a place where
I felt like I could continue to make improvement. When I see a patient it’s
finding the key that opens that door that will make them want
to take care of themselves. It’s also the follow
up that helps. If I am keeping track of what
she’s doing and we are keeping track of that and giving her
the support at every step of the way. When we have a patient who’s
been designated with a chronic illness, first thing is the
provider-patient encounter. The providers then include
our health coaches. So some of it is a little bit of
a hand off to the health coach because the health coach is
going to be the person who is going to follow along
with the patient. This means follow-up phone calls, could be group visits, individual visits. Many of the health coaches
are very independent in taking patients into a room and
following up with them on their self management support. What we did was we shifted the
basic education from the exam room so that the providers were
able to maximize their time with patients dealing with the more
difficult complexities of the disease process. And a lot of the chronic illness
basic education was left for the health coaches and medical assistants to have with patients. Since the beginning of this
epidemic Harlem Hospital has been in the business of
treating and providing care. And they learned early on that
peer interaction is positive. So that if a person can see
another person’s success they would buy into the therapy. When I meet somebody I say, I was where you were in that seat… We face a lot of challenges with
patients who don’t buy into self management. At that point, that’s
where a peer is valuable. And the more they learn
about their illness, the more successful they become. And they start to get excited. And they start to find,
I want to find out more, I want to do more. I want to be more. I have a mission. I have a goal. I have an objective,
and it’s wellness. We’re really asking them to
change their behaviors and to do that it’s so important for us to
recognize that we have to change our own behaviors first. A lot of medical providers
didn’t come into this job asking patients what they want,
what feels right to them. They’re used to telling. So it’s really about us looking
at our own behaviors and how we can be more patient-centered and
then supporting each other in making those behavior changes. As far as giving advice to
someone who’s thinking about embracing self management, I’d
say give it a go, give it a try. You can make a big difference
by doing some simple things. The open ended question. Reflective listening. Staff engagement. Relationship building. Basic education. Collaborative goal setting. People meeting their goals and
then wanting to set new goals. That is so fabulous!

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