More on “Motivational Interviewing” as a Method for Workplace Change Leadership

addictionBack in December, I wrote about a method called “Motivational Interviewing” (MI), something I learned about from a social worker who was also at the Lean Startup Conference. It’s funny how these worlds intersect sometimes.

I saw parallels between people being addicted to food, drugs, or what have you (the reason the MI method was created) and people being addicted to old behaviors in the workplace (such as blaming others, not planning, or jumping in to be the hero). I recently ran across Ron Oslin, who is an internal Lean coach at CapitalOne. He has been using the MI method and has trademarked the phrase “addicted to the status quo.” It’s apt.

I’ve chatted with Ron and will be doing a podcast with him soon.

Here is a video webinar of Ron giving a great overview of Motivational Interviewing:

You can find more resources at his website: One System / One Voice.

I recommend an article that he had published in the AME publication, Target: “Addiction to the Status Quo” (PDF)

From the Core Text

I’ve been revisiting the core text I’ve read on Motivational Interviewing, the book by Miller and Rollnick. If you think in terms of the ADKAR change model, I have Awareness of the method, desire to use it, and a bit of knowledge. What I don’t have yet is Ability and Reinforcement, which would come through the practice of these methods (in the workplace, not a clinical setting).

I’ve been going through my Kindle highlights from the book and will share a few of them here:

“The path out of ambivalence is to choose a direction and follow, to keep moving in the chosen direction.”

Ambivalence is a state where a person can say things like “I want to quit smoking” or “I know I need to stop giving answers to my employees, instead of letting them think,” but the mind also gives reasons WHY they should continue the old behavior. There are short term benefits, such as smoking being relaxing to the person or the manager thinking they need to solve that problem right now and they don’t have the luxury of developing others and their problem solving skills.

As Lean thinkers, are we, at times, addicted to our old ways of doing things, such as “you always have to start with 5S?”

Hear Mark read the post (learn more about the podcast series):


In MI, the role of therapist or coach is to get the addict to articulate reasons why they should change… and to have those self-directed positive statements about changing outweigh the statements about keeping the status quo.

Change is a process, not an event (as we learn in my workshop). Ron summarizes the MI process well in this PDF. In MI, you don’t tell people to change and you don’t tell them why they should change… or how they will change. You’re trying to be supportive and evoke it from the person who is deciding to change.

As Ron summarizes, “Five key communication skills used throughout MI are asking open questions, affirming, reflecting, summarizing, and providing information and advice with permission.” Some of that will be very familiar to a Lean thinker or somebody who has learned to coach in a Lean way.

The phases of the MI process are engaging, focusing, evoking, and planning.


As I’ve learned in my practice of Lean, relationships matter. This is true in MI or as a Lean transformation facilitator. You can’t just jump into giving recommendations (and maybe you shouldn’t give answers or advice in most settings… or until the time is right). The authors advise against falling into the “expert trap” — and consulting clients often want you to rush into giving them answers.

“The first of four basic processes in MI is to engage the client in a collaborative working relationship.”

And the authors say:

“Because in MI we differentiate engaging from the process of establishing goals (focusing; see Part III), we define engaging as the process of establishing a mutually trusting and respectful helping relationship.”

I think the same relationship building is necessary, more broadly, with Lean or Kaizen (continuous improvement). Leaders need to build trust… they need to understand their team members, rather than just mandating that everybody improve.


This reminds me of the Toyota methodology of “practical problem solving,” where you often work to narrow the scope of the problem that you’re wanting to solve.

“Focusing is the process of becoming clear about goals and direction in MI, providing the foundation for subsequent evoking and planning to help lift this burden… Even in seemingly simple situations, though, direction and goals can quickly become complicated.”

There are three styles of focusing in MI:

  1. Directing (the coach “gently makes a recommendation” to see how it’s received) – “as a default approach for promoting client change it has serious limitations,” say the authors.
  2. Following (“what would you like to talk about today?”)
  3. Guiding (“Guiding promotes a collaborative search for direction, a meeting of expertise in which the focus of treatment is negotiated. The client’s agenda are important, and any limitations inherent in the context are taken into account. The clinician’s expertise is also a possible source of goals.”)


It’s hard to get past the status quo… as the authors say:

“The discomfort of conscious ambivalence can lead one to stop thinking about it or to resolve that the status quo really isn’t all that bad after all, or at least that there’s nothing that can be done about it. That, of course, perpetuates the status quo.”

In the evoking phase, the MI coach is evoking the client to engage in “change talk,” which includes preparation talk:

  • Desire (“I want to get Lean”)
  • Ability (“I’m able to start engaging employees in continuous improvement”)
  • Reasons (“Employees will be more engaged and we’ll improve quality and our performance as a result”)
  • Need (“We really need to try something different”)

From that, we can move to mobilizing change talk:

  • Commitment (“I will start rounding and asking about problems and ideas every day”)
  • Activation (“I’m ready to try this today”)
  • Taking steps (“I got some Kaizen cards printed up”)

“This process occurs in MI by literally talking oneself into change.”

The authors advise:

“If you hear change talk, do more of what you’ve been doing. If you encounter increasing sustain talk and discord, try something different. An advantage in learning MI is that once you know what to listen for, your clients will provide immediate, ongoing feedback to help you improve your skills.”

Only once the client / patient has convinced themselves to change and to take action can you then go into planning the change. I see a lot of Lean facilitators jumping right into Planning… this causes problems and what seems like “resistance” when you haven’t built relationships and trust, then you haven’t framed the problem, and when you haven’t gotten the client to articulate a need for change that’s deeper than “the boss told me to.”

More to come… you might also want to check out my change management workshop that incorporates an innovative and interactive computer simulation… learn more here.

Thanks for reading! I’d love to hear your thoughts. Please scroll down to post a comment. Click here to receive posts via email.

Now Available – The updated, expanded, and revised 3rd Edition of Mark Graban’s Shingo Research Award-Winning Book Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement. You can buy the book today, including signed copies from the author.

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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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