Mark Graban's leanblog.org - Lean Healthcare, Lean Hospitals, Healthcare Kaizen, Lean Thinking, Lean Manufacturing, Toyota Production System

Podcast #292 – The Co-Authors of “Motivational Interviewing for Leadership”

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Today, our topic is something that I've really taken an interest in the past two years: “Motivational Interviewing.” See my past blog posts on this subject. I think it's a powerful methodology that will help anybody in their Lean transformation efforts… as well as our work engaging anybody in a small improvement.

“Motivational Interviewing” or M.I. is defined by Miller and Rollnick (in their seminal book) as a “collaborative conversation for strengthening a person's own motivation and commitment to change”

My guests for Episode 292 are the three co-authors of an excellent book, Motivational Interviewing for Leadership: MI-LEAD. They are (pictured from left to right in this order):

  • Jason Wilcox, Director of Education and Connected Care at VA Roseburg
  • Dr. Brian Kersh, Clinical Psychologist at New Mexico VA Health System
  • Dr. Elizabeth Jenkins, Clinical Psychologist/Courtesy Assistant Professor at University of South Florida

Beth and Brian are licensed clinical psychologists and Jason is a licensed clinical social worker. You can learn more about them, their book, and the training and coaching they offer by visiting their MI for Leaders website. See their bios here.

If you are looking for just one book on the subject, I recommend MI-Lead. The original textbook by Miller and Rollnick is surprisingly readable, but the book we're discussing today gives a great introduction to the methodology, but then quickly turns to workplace change issues instead of clinical therapy situations.

I hope you enjoy the discussion and find it as thought provoking as I did!


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For a link to use for this episode, refer people to www.leanblog.org/292


For earlier episodes of my podcast, visit the main Podcast page, which includes information on how to subscribe via RSS, through Android apps, or via Apple iTunes.  You can also subscribe and listen via Stitcher.

Links, Topics and Questions:

  • What is “Motivational Interviewing” and how is it helpful in helping people beat addictions?
  • How did you come to see parallel to workplace issues?
  • Is it appropriate to think of workplace change as a parallel to beating an addiction? What happens when are manager needs or organizational needs?
  • Was there, ironically, “resistance” to this different approach for therapy and addiction treatment amongst the clinical community, since it was radically different than that was practiced at the time?
  • A new approach (M.I. or Lean) can be rationally better, but individuals might have a feeling of “ambivalence” about change (ambivalence comes naturally, it's a “normal state for anybody to be in”) – we see two sides to things (changing and maintaining the status quo)
  • Why are people quick to label “resistors” as bad? Why do we need to have a conversation about change? How can you help resolve that ambivalence instead of writing that person off? What role do leaders play in how motivated a person is toward change?
  • How do we get people talking about their “why” for change? Asking the individual to articulate why…
    • In Lean, we often ask about the what and the how, but we try to explain the why? Telling instead of evoking? Our why might not be a motivator for somebody else…
  • Blaise Pascal: “People are generally better persuaded by the reasons which they have themselves discovered than by those which have come into the mind of others.”
  • Why it's good to hear “change talk” and how that's predictive of change
  • How do you help convince people to try M.I. without falling back on “telling” and instead “evoking” and looking for their motivation? How do you “invite” people to learn the material? Invite them to give it a try using some of the same approaches, such as open-ended questions and reflections.
  • What if you, as a leader, don't have time to engage people in a discussion? Can M.I. support the Lean / Toyota notion of “go slow to go fast?”
  • Do we sometimes forget to practice our own skills as coaches and M.I.-focused leaders?
  • Why is “the righting reflex” so strong in people? I wonder if those who work their way up through the ranks have a “stronger” righting reflex? Does that make it harder for them to change?
    • When someone is gung ho and ready for change, there are times when it can be helpful for a leader to tell people what to do and how… but when you're ambivalent, being told isn't as helpful (it only gives voice to one side of the discussion in our minds, so we tend to argue back to give voice to the other side of the ambivalence).
    • It's best to hold back that righting reflex, especially at first… until commitment has been reached
  • Talk about the “dance of change” and the process for helping to work through ambivalence
  • Getting input from staff, taking the time to do so, leads to better solutions through Lean and/or M.I. methods – but the discussion about the “reasons why' seems really important.
  • Leaders don't always need to have all of the answers… M.I. allows clinicians to not always have to have the answers, and can instead let organic answers come out of those you're working with.
  • What is the “spirit of M.I.” and the ways you have to be careful using tools without having the right spirit? Are there certain ethical considerations or cautions about misusing M.I.?
    • There's potential for misuse… these methods are powerful
    • The component of “compassion” was added to the “spirit of M.I.” in the 3rd edition of the core Motivational Interviewing textbook. M.I. shouldn't be used to manipulate others to do things that aren't in the best interest of others. M.I. is about helping others who have decided its in their best interest to change. Genuinely transformational leaders are interested in others…
  • Do you have tips about getting started practicing these methods? When would it be appropriate to get started? “Once you start using these methods, you'll notice the power of them.” You don't need to be formally certified to try this, but there are four main client-centered skills to learn and practice:
    • OARS: Open-ended questions, Affirmations, Reflective listening, and Summaries.
    • People might begin by just practicing open-ended questions or practicing reflections (we can practice our listening skills almost any time) and see what happens.
    • But once you try using these methods, they might see it's more complicated than it might have seemed originally. Training can be helpful.
    • Your staff members will give you immediate feedback… if they're more engaged, talking more about change, generating ideas and solutions and reasons for change… if they're energized, then you're moving in the right direction.
  • The co-authors are available for training and coaching.
  • How Brian found M.I. to be very helpful in the practice of Lean and an improvement project.
  • Their newly launched M.I. Lead website

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Mark Graban is an internationally-recognized consultant, author, and speaker who has worked in healthcare, manufacturing, and startups. 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 book is an anthology 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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