Management and Leadership in Clinical Practice 1 YOU cant ......and logically give up, name it (to...
Transcript of Management and Leadership in Clinical Practice 1 YOU cant ......and logically give up, name it (to...
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 ?