Management and Leadership in Clinical Practice 1

….. or if YOU can’t change a habit, how can you expect a patient to??

Gilly Mehraban 2020 (is it really?)

Module Aims

To enable the student to refine their expertise and skills in the formation and evaluation of patient management strategies within the context of podiatric care.

What does it really mean?

Its all about change – ask yourself if you can LEAD a change and make it last.

Lets get building your scaffolding!

What’s changed

since this year?

Plenty !!

We have gone from…. To this…..

New habits?

How many of you have started

something new?

Type it into the chat box

Do you have any idea what motivated

you?

• Strengths-based working

• Motivational interviewing

• Acceptance and commitment therapies

• CBT

• Positive psychologies

• Mindfulness-based relapse prevention

• Self-determination theories of motivation

• Harm minimisation

But what has actually worked for you?

Nudges (good and bad)

What nudges have the shops

used recently?

Examples of nudges:-

Non-smoking buildings

Smoking shelters further away

Change4life/Sugarswaps

Text reminders for appts

Automated calls to land lines

Less car parking spaces in health centres

Stairs at entrance rather than lifts

Have a go...

Think about 1 thing you really want (NO COVID) –more pay, a new waistline, a partner, a better relationship, good grades, a job, be more resilient, be fitter, a coffee and cake, a cigarette?

• What you done so far to get it?

• When are you going to start ?

• How are you going to plan it?

Costs now : benefit later

Pleasure now : consequences later

Who (for you) has turned out to be

a hero in all this mess?

Type it in. Why?

Answer these questions

How did you get to college/work/school?

What do you order when you go to your favourite take-away?

What did you do on Friday nights?

What time do you go to bed?

Which newspapers/magazines do you read?

Which perfume or aftershave do you wear?

Did you always sit in the same seat in lectures?

What have you learnt?

You have habits

You are not as flexible as you thought

Your thinking can influence your actions

Change is more difficult than you thought

That’s why our patients often do not respond to change easily

My soundtrack

1

Cheerleading

2

3

Your behaviour

Choose a health behaviour that you should obviously and logically give up, name it (to yourself!).

‘What’s the secret benefit of keeping this habit going?’ There will be an answer to this. How do you find this out?

4

What’s great

about my habit

Choose a health behaviour that you should

obviously and logically give up, name it (to

yourself!).

• What kind of comfort does it give you?

• What does it help you avoid / has helped you to

avoid in the past?

• What does it make easier?

• What does it protect you from?

• What parts of your life does it make easier to cope

with?

• How does it benefit your relationship/s – has it

benefitted past relationships?

Look at your collection

of needs!

1. Has staying the same way been solving a

problem that doesn’t need solving anymore?

2. Are your current habits solving a problem that

still exists?

Behavioural change

It is a process of stages

Understanding this process provides health care professionals with additional tools to assist patients who are struggling to change their health behaviour.

What are the stages ?

Stages of change

Pre-contemplation - think about behaviours

Contemplation - weigh up pros and cons

Preparation - prepare action plan

Action - seek support, reward success

Maintenance - develop strategies to cope with temptation

Relapse - identify triggers, reaffirm commitment to change

• I see now there are various understandable

reasons I am finding it difficult to change,

like……….

• I’d prefer to be fulfilling these needs long

term by doing things like……..

• In the short term I could distract myself from

the discomfort of not having these needs

met by…………

Homework!!!Choose 1 of the tasks - keep it up for 1 day

• I will not moan about restrictions

• I will give contact a friend I have not talked to for a while to say hi

• I will prioritise my morning for high value tasks

• I will find something nice to say to everyone!

• I will text something nice things to one of my family (do this now)

• I will do a bit more work/study than I am expected to do

• I will drink more water / eat healthy food

Could you manage a week?

Remember this slide?Your behaviour

Choose a health behaviour that you should obviously and logically give up, name it (to yourself!).

Ask yourself ‘What’s the secret benefit of keeping this habit going?’ There will be an answer to this. What do you get out of it?

Ask yourself the same question again: ‘How else could I get those benefits?’

Using the stages of change work out a simple strategy to change it.

Stages of change

• think about your behaviour (it may be something you need to improve)

• weigh up pros and cons

• prepare action plan

• seek support, reward, success (who/where from?)

• develop strategies to cope with temptation

• identify triggers to help reaffirm commitment to change

Is it this the simple secret of successful change?

• Movement

• Food

• Mind Power

• Family/Support network

Which health behaviours give us our biggest challenges in Podiatry??

How do we nudge someone to change?

Smoking

Obesity

Long term conditions

Dementia

Shoes

Emollient

Emollient

Nudges include changing our questions:-

• How many times do you think you will be able to apply cream this week?

• Where could you put it to remind you?

What strategies and skills do you need to elicit change?Identify them first.

Leadership skills

Ability to empower

Communication

Motivational interviewing

Good assessment skills

Health education

Emotional care

Cognitive care

5 strategies for change

• Set specific short term goals

• Set actionable goals

• Set goals you are confident you can attain

• Use cues- to- action to trigger behaviour

• Allow increase of self understanding through small steps

However your patients must be informed about:-

Medical choices

Treatment alternatives

Risks and benefits

Where would you get this information from?

Therefore….

Promoting self care may enable my patient to:

• Experience better health and well-being

• Prevent possible unnecessary hospital admissions

• Improve medicine compliance

• Have greater confidence and a sense of control

• Have better mental health and less depression

Summarise your strategy for your change

Write a start date on your list

What are your skills now? .......

Summarise your strategies and skills

I believe that the points listed below and discussed would help me achieve maximum health benefits for

my patient:

My skills:-

Leadership

Empowerment

Good communication / interviewing technique

Cognitive / emotional care

Educational/communication tools

Motivation

Empathy

Listening and reflecting with the patient

So what makes a good leader?

• Inspirational

• Excellent communicator

• Empowering

• Emotional awareness and self control

• Motivator/positive outlook

• Adaptability

• Team worker

My strategies:-

Establishing rapport

Achieve concordance

Self Management Programme

Patient centered / holistic approach

Expert Patient Programme

Patient Advice and Liaison Service

Local community groups and support networks…..

or are simple nudges just a little bit more effective????

Your future –

In the next 3 weeks what can

you learn/change to improve

yourself ?