☰ Table of contents
Determining the capability and capacity of the practice for change is an important early step.3,19,20
Many factors affect your practice’s capacity for change. These include a wide array of strengths, skills, resources and competencies, including:
- leadership and decision-making
- communication and relationships
- management infrastructure
- information mastery (access to and use of information, such as clinical information system [CIS] capabilities). Each of these are discussed in more depth in subsequent sections.
Assessing your practice’s ability to change
What are our attitudes, beliefs and values about prevention activities and our patients’ ability to change?
Positive practice team beliefs and values about preventive care are associated with improved performance.21–24
Do we have sufficient skills?
Necessary skills include:
- motivational interviewing techniques/skills,25 interviewing strategies and effective behavioural strategies
- behavioural skills for brief intervention strategies22,26–28
- counselling skills.
Motivational interviewing (MI) underpins health coaching. In general practice, this is a very powerful approach. Many different programs and services that incorporate coaching use MI.
Behaviour change: GASP case study
GPs and PNs often find it challenging to help patients change their behaviour. They feel frustrated with their current approaches and often believe that alternative approaches, such as MI, are too difficult or time consuming.
In the GPs Assisting Smokers Program (GASP), GPs and PNs attend a 2.5-hour workshop that provides information on effective MI strategies and opportunities to practise/hone their approaches with simulated patients using vignettes that reflect real-world examples. Experienced facilitators oversee the role-plays, provide feedback and demonstrate effective strategies.
One MI skill is the ability to elicit ‘behaviour change’ talk. This means eliciting the beliefs, needs and reasons that often underpin the patient’s motivation to change their behaviour. One strategy is to ask about the patient’s desires, ability, reasons and needs. Possible questions include the following.
- How would you like things to change?
- What don’t you like about how things are now?
- What do you hope will be different?
- What do you think you would be able to change?
- Of the options you have considered, what seems most possible?
- Why do you want to lose weight? To stop smoking? To be more physically active?
- How do you think your diet is affecting your health?
- What about your behaviour causes you concern?
- What worries you about your behaviour?
- What concerns you?
- What can you imagine happening to you as a result of your behaviour?
- What do you think will happen if you don’t make a change?
GPs and PNs found their perceived skills and confidence rose following the workshop, as did their preparedness to use MI in their own settings.
– Assoc Prof John Litt and the GASP team, including Flinders University and Quitline South Australia
Do we have a supportive organisational infrastructure?
How can a practice, as an organisation, support preventive care? A systematised approach is needed, and includes:29–37
- a culture of QI
- practice policies that support preventive care
- clinical protocols and procedures that are modelled on existing guidelines
- a business plan that demonstrates viability and sustainability of the activity
- a range of delivery options (eg use PN skills; multidisciplinary clinics in areas such as asthma, multimorbidity, diabetes; referral options such as Quitline counsellors, exercise physiologists)
- information management, IT systems and CIS
- patient education and shared decision-making materials, waiting room resources
- screening and information-gathering materials and strategies
- consultation materials
- recognition of practice team achievements.
Can enough time be set aside for the process?
Adequate time needs to be set aside for meetings, planning the various activities and bringing everyone up to speed on the process. It is helpful to quarantine dedicated time during the week when the practice team can work on prevention activities.