Presented by Paola Torres, Sr. Performance Improvement Manager at Healthfirst in NYC Learning objectives: Become familiar with the spirit, theory, and practice of Motivational Interviewing (MI) Identify your customer’s readiness for change based on key communication indicators Learn basic MI communication techniques to help your clients resolve their ambivalence and develop intrinsic motivation to change Paola Torres Paola Torres is a Lean Six Sigma Master Black Belt and continuous improvement professional with 17 years of experience in the Healthcare industry. She is currently a Sr. Performance Improvement Manager at Healthfirst in NYC. Prior to joining Healthfirst, she was the Director of Supply Chain Transformation and Integration at NYU Langone Health. As a Lean Six Sigma practitioner and coach, she has led over 40 cross-functional Kaizen/Rapid Improvement Events (RIE) integrating change management concepts and adult learning theory into applied process improvement science. A native of Colombia, she received her BS in Microbiology from Javeriana University in Bogota and MPA in Health Care Management from New York University.

1. Motivational Interviewing:
The Key to Effective
Conversations About Change
Hosted by
Host: Mark Graban
Senior Advisor, KaiNexus
Mark@KaiNexus.com
Presenter: Paola A Torres, MPA, LSSMBB
Sr. Performance Improvement Manager at Healthfirst
paolatorres.pena@gmail.com

2. About Paola Torres
• Works in New York City – HealthFirst
– Sr. Performance Improvement Manager
– Lean Six Sigma Master Black Belt and continuous
improvement professional
• 17 years of experience in the Healthcare
industry
• Led over 40 cross-functional Kaizen/Rapid
Improvement Events (RIE)
• BS in Microbiology from Javeriana University
in Bogota, Columbia
• MPA in Health Care Management from New
York University

3. Learning Objectives
Become familiar with the spirit, theory,
and practice of Motivational
Interviewing (MI)
Identify customer’s readiness for
change based on key communication
indicators
Learn basic MI communication
techniques to help your clients resolve
their ambivalence and develop intrinsic
motivation to change

4. Take a moment to think about
the following and type in the
chat:
• What motivated you to
attend this webinar?

5. What is Motivational
Interviewing?
A collaborative conversation style that
seeks to elicit and strengthen a person’s:
ü motivation
ü commitment to change
Miller and Rollnick, 2009

6. Does MI Work?
• Motivational interviewing: a systematic review and
meta-analysis
Motivational interviewing in a scientific setting outperforms traditional advice giving in
the treatment of a broad range of behavioral problems and diseases. Rubak at all . Br J
Gen Pract. 2005 Apr;55(513):305-12. PMID: 15826439; PMCID: PMC1463134.
• The Missing Piece in Improvement: Understanding
How to Motivate Change
“I’m often asked about the best way to motivate people. Learning to unleash intrinsic
motivation is a particularly challenging skill. I am a huge proponent of the principles
of motivational interviewing. The underlying idea behind motivational interviewing is
that you don’t tell people to change; instead, you help them recognize that
they want to change. “Julia Moore | Wednesday, March 13, 2019 IHI Blog

7. Behavioral Change Motivational
Interviewing
Case
Studies
Agenda

8. Mechanism for Change
Pre
contemplation
Contemplation Action Maintenance
Motivational
Enhancement
Strategies
Relapse
Intervention
Relapse
Management
and
Prevention
Transtheoretical Model (Prochaska & DiClemente, 1986)
Graphic credit to Dr. Jonathan Fader, PhD

9. “I know what needs to
change to optimize their
processes, but nobody is
listening to me!!”
The Righting Reflex

11. Behavioral Change Motivational
Interviewing
Case
Studies
Agenda

12. Take a moment to think about
the following:
• What did you discuss during
your last meetings with a
customer/client?
• What if your client or
customer was “told” to work
with you?

13. MI Capability
Collaboration, Acceptance,
Evocation
and Compassion
Interviewing OARS, Listening
Mechanism for Change
MI Process, MI Principles
Graphic adapted from Lucas, B. (2019), Why we need to stop talking about 21st century skills.

14. MI Process
What are we
here to talk
about ?
Who is this
person?
Why is
this
important
to you?
Evoking
Focusing
Engaging
How are we
going to
change?
Planning

15. Open Ended
Affirmations
Reflections
Summaries
Gagneur A. Motivational interviewing: A powerful tool to address vaccine hesitancy. Can Commun Dis Rep.
2020;46(4):93-97. Published 2020 Apr 2. doi:10.14745/ccdr.v46i04a06

16. Open Ended
Affirmations
Reflections
Summaries
• We had a consultant here last year,
nothing changed
• We are already working on this!

17. Motivational
Interviewing
Case
Studies
Behavioral Change
Agenda

18. MI Process
Who is this
person? Evoking
Focusing
Engaging
Planning

19. Take a moment to think about
the following:
• Where was the first time
you met your in-laws
• Did you ask all the
questions that you had in
your mind?

20. Engaging – Case Study
The Supply Chain Case Study:
• Find “the defects” or reasons why
nursing units did not have supplies
needed on time
• A dateline to identify root causes was
given to the process improvement team

21. “We already worked with a
consultant here last year and
nothing changed”
• Trust
• Partnership
Engaging - Questions

22. “We already worked with a consultant here last
year and nothing changed”
• I understand, it most be tremendously frustrating to invest
time working with a consultant and not see the benefits, what
matters to you is to make sure the clinical care team has what
they need to do their job
• Your department manage a super complex operation we can
run the hospital without your team!
Engaging – OARS

23. Engaging - Avoid
The Premature Focus Trap The Expert Trap
The Label Trap

24. MI Process
Who is this
person? Evoking
Focusing
Engaging
Planning
What are
we here to
talk about?

25. Take a moment to think about
the following:
You just got assigned a new
project, things are busy at work.
You spouse/partner wants you to
take time off to go on vacation,
what is your response to that
request ?

26. “The accounts payable department
Case Study:
• The director of the department is
extremely dissatisfied current
workflow to process credit memos
• He reached out to the company's
process improvement team
Focusing – Case Study

27. Focusing - Questions
“We want to ensure our members
account balance information is accurate
and decrease the time it takes to send a
bill and also ensure bills go out without
any defects”
• Goals
• Dancing or wrestling?

28. We want to ensure our members account balance information is
accurate and decrease the time it takes to send a bill and also
ensure bills go out without any defects- I don’t know where to
start!
• It sounds like there are a lot of opportunities here and improving
the member’s experience is a top priority for you
• Let’s discuss them more in detail, tell me more about the account
balance information…
Focus – OARS

29. ELICIT-PROVIDE-ELICIT
Elicit: Would it be ok if I share with you how this
issue was addressed before?
Provide: Your processes are all interconnected,
we can start by identifying the beginning and end
point of some them…
Elicit: What are your thoughts about this
approach?

30. Focusing - Avoid
The Righting Reflex Taking Control
Task Completion

31. MI Process
What are we
here to talk
about ?
Who is this
person?
Why is
this
important
to you?
Evoking
Focusing
Engaging
Planning

32. Take a moment to think about
the following:
• Do you believe you can
influence your client’s
readiness for change?

33. Evoking – Case Study
The Emergency Department (ED) Call Center
Case Study
During day 3 of Kaizen event with ED call
center, several team members expressed the
following statement:
◦ “We would like to call the patients specialist
and confirm their appointments, but we
don’t have time”.

34. We would like to call the patients specialist
and confirm their appointments, but we don’t
have time”.
• Why
• Arguing or telling
Evoking - Questions

35. Evoking - Elicit Change
Talk
D Desire
A Ability
R Reason
N Needs
C Commitment
A Activation
Ts Taking Steps

36. Evoking - Elicit Change
Talk
D Desire
• What services do you envision providing 5
years from now?
A Ability
• If you were to call a patient’s specialist how
much time would it take?
R Reason
• What are the advantages of speaking with a
patient’s specialist?
N Needs
• How important is it for you as a call center nurse
to speak with a patient’s specialist?

37. Evoking - Avoid
The Wrong Question
Taking Sides

38. MI Process
What are we
here to talk
about ?
Who is this
person?
Why is
this
important
to you?
Evoking
Focusing
Engaging
How are we
going to
change?
Planning

39. Planning - Case Study
“Director of care management
department reached out and
indicated that IT system
changes implemented through
a previous kaizen needed to
be included in the new care
management system.

40. Planning – Questions
“We are ready to test these
changes in our new care
management system.”
• Steps
• To evoke vs. “to tell”?
• Permission

41. Evoking - Elicit Change Talk
C Commitment
• There are good reasons to run a small
pilot with our private practice patients
A Activation
• We are ready to run the pilot
Answer: when will you do it?
T Taking Steps
• I scheduled a meeting to discuss key
activities for the pilot

42. Engaging Focusing Evoking Planning
The MI Process
Who Where Why How

43. Customer’s
Ambivalence
Motivational Interviewing
Behavioral
Change/Action
Project Success
Takeaways

44. Do you want to learn more about Motivational
Interviewing?
Motivational Interviewing: Helping
People Change
Miller, William R., and Stephen
Rollnick
https://motivationalinterviewing.org/tra
ining-motivational-interviewing-0
Change management and process
improvement resources for
practitioners
https://www.leanconnectome.com/

45. Announcements
(Then Q&A)

46. Future Webinars
• Training Team Office Hours
– August 12th, 1 pm ET
– KaiNexus customers only
• Next Webinar
– “The Wheel of Sustainability” – Adam Lawrence
– August 10th, 1 pm ET
– Open to everybody!
Register: www.KaiNexus.com/webinars

47. Other Resources
blog.KaiNexus.com
KaiNexus.com/webinars

48. KaiNexus Podcasts
• www.KaiNexus.com/podcasts
• Subscribe via:
– Apple Podcasts
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– Spotify

49. Q&A
• Web:
– www.kainexus.com
– blog.kainexus.com
• Webinars on Demand:
– www.kainexus.com/webinars
• Social Media:
– www.twitter.com/kainexus
– www.linkedin.com/company/kainexus
– www.facebook.com/kainexus Host: Mark Graban
Senior Advisor, KaiNexus
Mark@KaiNexus.com
Presenter: Paola A Torres, MPA, LSSMBB
Sr. Performance Improvement Manager at Healthfirst
paolatorres.pena@gmail.com