ACCOUNTABILITY: What Motivates Employees'

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ACCOUNTABILITYWhat Motivates Employees.
grant.corbett_at_behavior-change-solutions.com
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Session Objectives
This session will consider Accountability

• What it is.
• What we want.
• How to get it.

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Accountability Is this it?
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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?
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1. Accountability What it is
Potential problems with this question

• Can we instill accountability?
• Accountability only enables negative feedback
  after a decision or action.
• Does best evidence and practice support that
  programs can make people accountable?

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2. Accountability What we want
A better question
What motivates employee personal choice and
willingness to contribute to health? Specifical
ly, what is the evidence and are we applying it
in our programs?
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3. Accountability How to get it
Two Worldviews on How to Get It
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3. Accountability How to get it
1. The Deficit Worldview
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3. Accountability How to get it
The problem is (an empty glass)

• They dont see (e.g., denial, lack of insight)
• They dont know
• They dont know how
• They dont care

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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

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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.
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3. Accountability How to get it
2. The Competence Worldview
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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

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3. Accountability How to get it
What do Competence Worldview programs look like?
A clinical example Motivational Interviewing
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• 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 studiesThe 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
contenton 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.
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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, 145-152. 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.
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MI in the Real World
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• Other competence-based programs

Other programs that can be competence based

• Financial Incentive
• Physician initiated, written action plans
• Communication training for patients
• Reminders (e.g., letters, alarms, telephone)
• Self-monitoring

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• 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

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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.
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Behavior Change Solutions, Inc.

• Grant Corbett
• Principal
• Behavior Change Solutions, Inc.
• 52 Cherie Road
• St. Catharines, ON
• CANADA L2M 6L7
• Tel [phone]
• Fax [phone]
• Email grant.corbett_at_behavior-change-solutions.com