the power of persuasion the gentle art of influencing people to do something that you want them to...

The Power of PersuasionThe gentle art of influencing people to do something that you want them to do because they want to…

Ruth Medak, MD, FACPMedical Director of Hospice CareProvidence Hospice

Tuesday, March 25, 201412:00–12:45 p.m.

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IIS Innovation Project Team

Kelleen BernardTeam Lead

Leigh Bohannon QI Specialist

Dawn PlanteProject Assistant

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Norms

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Use the chat feature Tell us what organization you are with and

who is in the room with youThere will be questions and

discussion at the end of the presentation

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About the IIS Innovation Project

CMS-funded demonstration projectGoals

Increase the number of medical practices electronically submitting adult immunization data to ALERT IIS

Engage providers in activities to improve immunization delivery and rates in Oregon

Improve quality of care for Oregon Medicare beneficiaries

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Today’s purpose learn how to engage staff more actively in

preventive care delivery understand important barriers to providing

preventive health services and how to overcome them

learn strategies for persuading patients to follow through on recommended preventive screenings or vaccinations

hear how to incorporate decision tools that facilitate the provider-patient partnership

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Ruth Medak, MD, FACPMedical Director, Providence Hospice

Dr. Medak is the former medical director for Acumentra Health. With more than 20 years as a practicing internist and 15 years in healthcare quality improvement, she represents QIO process improvement teams in the field, including in projects to improve primary care through EHR-assisted and population-based approaches.

Dr. Medak is ABIM certified in Internal Medicine and Hospice and Palliative medicine and is interim medical director for Providence Hospice and Home Services.

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Persuasion

The gentle art of influencing people

to do something that you want them to do

because they want to…

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What do you want to get out of today’s time

together?

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Participants will be able to describe

important barriers to providing preventive care services

strategies for persuading people to follow through on recommended preventive screenings or vaccinations

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How is persuading a patient to get CRC screening like getting a child to do homework?

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Lessons about persuasion from daily

life

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Appeal to what’s in it for themClear expectations (what, when,

where, how)Consistent messageConsequence for failure

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Why don’t patients follow recommendations?

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Common attitudes about patients

Noncompliant Or poor case

Procrastinator Or significant barriers

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Reasons for failure to follow recommendations

Beliefs and culturePast experienceFearsLogistics

Listen to the patient to decide how to make your best “case”

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Beliefs

Risk Low for everyone No family history of cancer Excellent personal health

Benefit Little or none for me

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Beliefs and culture

Source of healthCultural and religious beliefsRole in the family and communityTrust or distrust of health care system

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Fears

Fear of Pain Preparation Complications Finding cancer

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Other issues

Logistics Time off work Transportation

CostLiteracy

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Colorectal cancer screening factsLack of insurance

98% less likely to have a regular PCPget a CRC screening recommendationget screened

Low literacy Low CRC screening (even with insurance

coverage)

Source: American Cancer Society, 2008.

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Colonoscopy instructions as seen by someone with low literacy

Your naicisyhp has dednemmocer that you have a ypocsonoloc. Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv eocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.

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Old words in a new light

How would you respond to Would you like to have a pneumococcal

vaccination today? You’re 55 now, so you’ll need to get a

colonoscopy sometime before you’re 60. I’d like you to schedule a mammogram.

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“So, Doc…How long do I have to ignore your advice?”

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Critical discussion elements

WhatWhyWhenWhat if…

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Other tactics

Be positiveSpeak for the PCP

Be prepared to cease and desist.Save your energy to try next time.

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Operationalize advocacy

Identify patients due for tests and services Remind patients with prior

recommendation or order

Administer vaccinations Schedule mammograms Educate about CRC screening

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You’ve identified a target…

Dr. “X” (or NP or PA) wants all of his/her patients to get a pneumococcal vaccination colorectal cancer screening biennial mammogram or any other service

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A positive approach

“I’d like to give you your vaccination before your PCP sees you…”

“The referral coordinator will help you schedule a colonoscopy while you’re waiting.”

“Do you have any questions about the test?”

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A positive approach

“The mammography center can usually schedule tests within 2 weeks. So, we’ll expect to receive your report by the 1st of next month.”

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How do you respond?

“I’m healthy and I never get sick. Why do I need a pneumococcal vaccination/flu shot?”

“Nobody in my family has ever had breast cancer/colon cancer.”

“I’ve heard that the prep is awful!” “I’m afraid that they’ll find cancer.”

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Conclusions

Persuasion is a skill that anyone can learn.

You have the power to save lives and improve health.

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Questions?Ruth Medak, MD, FACPMedical Director of Hospice CareProvidence Hospiceruth.medak@providence.org

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To join the IIS Innovation Project

Contact the IIS team Kelleen Bernard | Team Lead

kbernard@acumentra.org | 503-382-3953 Leigh Bohannon| QI Specialist

lbohannon@acumentra.org | 503-382-3934

Go to www.acumentra.org/immunization

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For additional information about the IIS webinar series

Contact Leigh Bohannon | QI Specialist

lbohannon@acumentra.org | 503-382-3934

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Your feedback is very important to us. Please complete the evaluation.

Our next webinar will be:Tuesday, May 27, 2014

“Running Reports in ALERT IIS”

This material was prepared by Acumentra Health, Oregon’s Medicare Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 10SOW-OR-IIS-14-06