BCS, Inc.
North America’s Foremost Experts on Patient Adherence
ACCOUNTABILITY:
What Motivates Employees.
Grant Corbett
Principal
Behavior Change Solutions, Inc.
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
Session Objectives
This session will consider Accountability:
1. What it is.
2. What we want.
3. How to get it.
grant.corbett@behavior-change-solutions.com
Accountability: Is this it?
Accountability: What Motivates Employees
BCS, Inc.
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
1. Accountability: What it is
A definition of “accountability”:
“Personal choice and willingness to
contribute to an expressed or implied
outcome.”
A question:
“How do you make people accountable for
their health?”
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
1. Accountability: What it is
Potential problems with this question:
1. Can we “instill” accountability?
2. Accountability only enables negative
feedback after a decision or action.
3. Does best evidence and practice
support that programs can “make
people accountable”?
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
2. Accountability: What we want
A better question:
“What motivates employee ‘personal choice
and willingness to contribute’ to health?”
Specifically, what is the evidence and are
we applying it in our programs?
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
3. Accountability: How to get it
Two Worldviews on How to Get It
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
3. Accountability: How to get it
1. The Deficit Worldview
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
3. Accountability: How to get it
The problem is (an empty glass):
•
•
•
•
They don’t see (e.g., denial, lack of insight)
They don’t know
They don’t know how
They don’t care
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
3. Accountability: How to get it
Thus, the solution is (to fill the glass) by giving them:
•
•
•
•
Insight: If you can just make people see, then they will
change
Knowledge: If people just know enough, then they will
change
Skills: If you can just teach people how to change, then
they will do it
Hell: If you can just make people feel bad or afraid
enough, they will change
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
3. Accountability: How to get it
Just published study (BMJ, May 26): Salter and
colleagues analyzed pharmacist-patient discourse during
medication review consultations.
What they found: Advice giving without being asked was
common and “was often resisted or rejected (by patients)
and created interactional difficulties…”.
What about accountability: Advice giving occurred
“despite deliberate displays of competence and
knowledge by patients.”
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
3. Accountability: How to get it
2. The Competence Worldview
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
3. Accountability: How to get it
The solution is (to draw water from the well) by:
•
•
•
•
Asking for their insight
Evoking their knowledge
Assuming that patients have skills
Enhancing self-efficacy
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
3. Accountability: How to get it
What do Competence Worldview
programs look like?
A clinical example:
Motivational Interviewing
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
• Motivational Interviewing
Rubak and colleagues (2005) in the British Journal of General
Practice concluded from a review of 72 RCTs:
“(Motivational interviewing) outperforms traditional advice
giving in approximately 80% studies…The meta-analysis
shows significant effects of motivational interviewing for
combined effect estimates of body mass index, total blood
cholesterol, systolic blood pressure, blood alcohol
concentration and standard ethanol content…on many different
areas of intervention. The review has shown that motivational
interviewing can be effective even in brief encounters of only
15 minutes and that more than one encounter with a patient
increases the likelihood of effect.
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
…MI & Medication RCTs
Aliotta, S. L., Vlasnik, J. J., & Delor, B. (2004). Enhancing adherence to long-term medical therapy: A
new approach to assessing and treating patients. Advances in Therapy, 21, 214-231.
Bennett, J. A., Perrin, N. A., & Hanson, G. (2005). Healthy aging demonstration project: Nurse
coaching for behavior change in older adults. Research in Nursing and Health, 28, 187-197.
Berger, B. A., Liang, H., & Hudmon, K. S. (2005). Evaluation of software-based telephone counseling
to enhance medication persistency among patients with multiple sclerosis. Journal of the American
Pharmacists Association, 45, 466-472.
Broers, S., Smets, E. M. A., Bindels, P., Evertsz, F. B., Calff, M., & DeHaes, H. (2005). Training
general practitioners in behavior change counseling to improve asthma medication adherence. Patient
Education and Counseling, 58, 279-287.
Hayward, P., Chan, N., Kemp, R., & Youle, S. (1995). Medication self-management: A preliminary
report on an intervention to improve medication compliance. Journal of Mental Health, 4, 511-518.
Kreman, R., Yates, B. C., Agrawal, S., Fiandt, K., Briner, W., & Shurmur, S. (2006). The effects of
motivational interviewing on physiological outcomes. Applied Nursing Research, 19, 167-170.
Robles, R. R., Reyes, J. C., Colon, H. M., Sahai, H., Marrero, C. A., Matos, T. D., et al. (2004). Effects
of combined counseling and case management to reduce HIV risk behaviors among Hispanic drug
injectors in Puerto Rico: A randomized controlled trial. Journal of Substance Abuse Treatment, 27, 145152.
Rose, J., & Walker, S. (2000). Working with a man who has Prader-Willi syndrome and his support
staff using motivational principles. Behavioural and Cognitive Psychotherapy, 28, 293-302.
grant.corbett@behavior-change-solutions.com
…MI in the Real World
Accountability: What Motivates Employees
BCS, Inc.
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
• Other competence-based programs
Other programs that can be “competence” based:
•
•
•
•
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Financial Incentive
Physician initiated, written action plans
Communication training for patients
Reminders (e.g., letters, alarms, telephone)
Self-monitoring
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
• Competence-based Principles
The Principles of ChangeTM
1. The Principle of Social InvestmentTM
2. The Principle of DiscrepancyTM
3. The Principle of AccessibilityTM
4. The Principle of ExpectancyTM
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
3. Accountability: How to get it
What You can Do: Communicate this…
Accountability programs (whether to
motivate patient adherence or a healthy
lifestyle) work, not because they demand or
instil accountability, but because they value
and evoke employee competence and
commitment.
grant.corbett@behavior-change-solutions.com
Accountability: What Motivates Employees
BCS, Inc.
Behavior Change Solutions, Inc.
Grant Corbett
Principal
Behavior Change Solutions, Inc.
52 Cherie Road
St. Catharines, ON
CANADA L2M 6L7
Tel: 905-937-1441
Fax: 905-937-5858
Email: grant.corbett@behavior-change-solutions.com
grant.corbett@behavior-change-solutions.com