How to change your world?

Dr Richard Roope RCGP & CRUK Clinical Lead for Cancer

Wessex Cancer CSN GP Lead

Macmillan GP

RCGP/CRUK Cascade Workshop

October 23nd 2014

Birmingham

How to change your world…

How to change your world…

How to change your world…

Who is in your world…

Who is in your world…

• Who can GP Leads influence?

• Who can you influence

• 5 minutes in pairs…

Who is in your world…

• Who can GP Leads influence? • GPs – Primary Care engagement

• Cancer SCN Clinical Directors

• Area Teams MDs and ADs

• CCGs/NHSBs/HBs

• PHE (including screening hubs); NHS Health Scotland; PHW

• HWBs/LAs

• Hospital Trusts – “SSGs”

• Educators – Medical School, GP Trainers, First 5 groups, RCGP Study Days, Appraiser Trainers

• Public/Patients

How can we influence?

How can we influence?

• How will you influence…

How can we influence?

• How will you influence…

• Four common solutions:

How can we influence?

1. Share insight – then they will see…

2. Share knowledge – then they will know…

3. Share skills – then they will act…

4. Scare them – then they will change…

After Miller WR (2004)

How can we influence?

• Exercise 1

• In pairs – one will be the Primary Care Cancer Lead

one the SCN Assistant Director

How can we influence?

• In pairs – one will be the Primary Care Cancer Lead

one the SCN Assistant Director

• Cancer Lead – explain why Cancer Rehab should be adopted

• Explain why it should be

• Give three benefits

• Tell them how important this would be

• Persuade them to implement the scheme

• If they resist repeat even more persuasively…

How can we influence?

• SCN Assistant Director

• How did it feel?

• Did you agree to anything?

How can we influence?

• The Righting Reflex

• We have a desire to put things right – we want to make things better

After Miller WR and Rollnick S (2006)

How can we influence?

• The Righting Reflex

• Problem:

• People have a tendency is to resist persuasion especially when ambivalent

How can we influence?

• The Righting Reflex

• The approached feel invalidated:

How can we influence?

• The Righting Reflex

• The approached feel invalidated:

disconnected

How can we influence?

• The Righting Reflex

• The response:

How can we influence?

• The Righting Reflex

• The response:

unchanging

How can we influence?

• The Righting Reflex

• The consequence:

How can we influence?

• The Righting Reflex

• The consequence:

How can we influence?

• Exercise 2

• In pairs – change roles:

one will be the Primary Care Cancer Lead

one the SCN Assistant Director

How can we influence?

• Evoking/listening exercise:

How can we influence?

• Evoking/listening exercise:

• Listen carefully – give no advice. Ask these questions:

1. Why would you want to provide a Cancer Rehab service?

2. What would be the three best reasons to adopt this policy?

3. On a scale of 0-10 how important would it be to adopt this policy? Why are you at … rather than 0?

4. How would you implement the policy?

How can we influence?

• SCN Assistant Director

• How did it feel?

• Did you agree to anything?

How can we influence?

• Evoking/listening:

• The approached feel affirmed:

How can we influence?

• Evoking/listening

• The approached feel affirmed:

optimistic

How can we influence?

• Evoking/listening

• The response:

How can we influence?

• Evoking/listening

• The response:

How can we influence?

• Evoking/listening

• The consequence:

How can we influence?

• Evoking/listening

• The consequence:

How can we influence?

• Success ≠ Change – you do not need to evoke a commitment to change – you may not be able to…

• You do not have to have all the answers – you won’t have them

• You are not involved in combat – you would probably lose. It is more of a dance…

• Our role is to invoke the desire to change

How can we influence?

• Motivational Interviewing:

• Other centred

• Directive Method

• Aims to enhance motivation to change by addressing other’s ambivalence

How can we influence?

• Four principles: R-U-L-E

1. Resist the righting reflex

2. Understand the other’s motivations

3. Listen with empathy

4. Empower the other – encourage optimism and hope

After Rollnick, Miller and Butler – (2008)

How can we influence?

• Four skills: O-A-R-S

1. Open questions

2. Affirmation

3. Reflective listening

4. Summarise the discussion

After Amrhein (2003)

How can we influence?

• Four steps to change: D-A-R-N

• Desire: “It would be nice to…”

• Ability: “I could…”

• Reasons: “I have got to because…”

• Need: “I am definitely going to…”

• COMMITMENT: “I will/know/guarantee…”

After Amrhein et al (2003)

How can we influence?

• Change talk:

• Change occurs when people persuade themselves..

• Change stalls (if it ever started) when we attempt to persuade, force, pressure..

How can we influence?

• Change talk:

• Once you recognise it reinforce the “change talk”

How can we influence?

• Practise

• Supporting/supportive community

Key to change