Podcast #306 – Mark D. Valenti, Motivational Interviewing and Health System Improvement


My guest for Episode #306 is Mark D. Valenti, the manager of training, education, and workflow integration for the Enhanced Community Care Management (ECCM) at Highmark Health.

In this episode, Mark and I talk about the use of “Motivational Interviewing” methods and mindsets in the ECCM program and how “everyday closer to better” is part of their mantra.

We discuss the MI approach and how it's different than traditional healthcare or change management models that focus on telling people to change (or why they should change). There are many lessons that I think are helpful in any workplace or personal change context.

ECCM is a “clinician-led, patient-centered approach [that] focuses on prevention, high-quality and compassionate care, patient engagement and satisfaction, and health outcomes.” According to Highmark, “In the first year, the ECCM program has provided a large Pennsylvania health plan with total medical care cost savings of greater than 19% for engaged members; equivalent to one inpatient admission per year per member engaged. More than 1,500 members are enrolled across more than 60 provider sites.”

To learn more about the ECCM program, you can contact them via this email address.

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For a link to this episode, refer people to www.leanblog.org/306.

Topics and Info for this Episode:

  • Mark's background is in behavioral health
  • Was introduced to Lean about a decade ago – did you view Lean as being different than Continuous Quality Improvement (CQI)
  • “Everyday closer to better” – make at least one improvement today
  • Is CQI a more welcoming label to people in healthcare? More relevant to frontline staff?
  • 25 front-line nurses are working with the top 5% of their patients (those who are always in the hospital) in the ECCM program
  • How do you define “motivational interviewing?”
    • “Quite simply, it's helping people change”
    • Applies to staff and patients
  • Do you want to sustain your current behavior or do you truly want to change?
    • Motivational Interviewing (MI) helps people talk through their ambivalence
  • How is MI a different way of communicating about change?
    • Instead of just dumping information on people, you want people to realize why they want to change… only then should you develop a plan for change
    • Traditional change management focuses on the planning
    • Telling patients what to do might make the patient feel shamed
    • Tap into intrinsic motivation

My podcast with Daniel Pink on motivation:

  • The textbook Motivational Interviewing
  • What can you do if somebody has low motivation for change?
  • MI respects the autonomy of individuals
  • The coach isn't personally responsible for the choices of those we are helping
  • How “the righting reflex” turns people off
  • Do you tell people that huddles will save them time, or do you acknowledge “you've been thinking about this…” (an affirmation)?
  • How does this approach connect to the Lean idea of “respect for people?”
  • Traditional healthcare is about fixing others, where MI provides an approach that allows people to help themselves
  • How can you draw out or evoke people's motivations instead of telling them why they should change?
  • How empathic statements like “this seems really hard for you” can be helpful
  • Lack of knowledge about what to do is usually not the barrier to change – confidence might be lacking
    • Instead of trying to sell people on why, stop and listen instead
  • Give learners a chance to be vulnerable and explain how they would like to be guided in change
  • How coaching and real-time feedback is helpful to the nurses they are working with
  • Any final advice or thoughts for people who are interested in MI?

More Info:

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 Podcasts.  You can also subscribe and listen via Stitcher. Please leave us a review and rating!

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Here is a great follow up discussion with Mark.

    Questions include:

    DB: Tell us more about motivational interviewing, and why that’s so central to ECCM’s work.

    NB: Do you feel like when you or the nurses talk with people, they’ve been craving someone to ask these questions, or is it more often that someone hasn’t thought about the change they need to make?


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