Value-based purchasing and other drivers of change have led to improvements in models of care. One of these — the patient-centered medical home (PCMH) is being implemented in primary care practices around the country. The essence of a patient-centered medical home is that the primary care provider coordinates all of a patient's care with an emphasis on patient engagement and prevention.

In order for the PCMH model to be successful, providers much also change the way they approach and communicate with patients. Certainly, the first step is making the patient a part of the care team, but providers must also change the way they historically have engaged with patients.

Motivational interviewing and behavior action planning are two tools that can be used to help providers shift their approach to patients for more effective communication and mutual support. The video below shares on physician's experience using these tools with one patient.

Most providers may be able to recognize this "uncooperative" patient in their practice, usually one with at least one chronic condition. They may also realize a shift in their approach with patients to help them focus on future possibilities, instead of past failures, is needed.

Empower patients to choose to make improvements and accept accountability for their health. For those who recognize a need to do something different in order to get different outcomes, try the six steps below with patients who are ready to change behaviors.

  1. Listen for signs that patients are ready for change and then coach them in creating their personal vision and goals.
  2. Instead of telling patients what they "need to do," ask:
    • Is there anything you would like to do for your health in the next week or two?
    • On a scale from 1 to 10, how confident or sure do you feel about carrying out your plan?
    • Would it be helpful to set up a check on how things are going with your plan?
  3. Offer suggested behaviors relating to what the patient wants to improve and guide them to set SMART goals — specific, measureable achievable, relevant and timed.
  4. If their confidence level is low (below 7), facilitate problem solving with the patient.
  5. Build confidence and trust in the relationship by checking in with the patient and ask, "How is it going?"
  6. Recognize any success and improvement and offer reassurance.
  7. When new behaviors are secure and improvement has been made, ask patients what they want to do next.

Approximately 25 percent of patients will not be ready for change, in need of help or are already healthy. For these patients, respect their autonomy until you notice signs they are ready for a change in their health.