Behavior Change Detective: Effectively Coach by Finding the Smallest Action that Matters

Behavior Change DetectiveOne participant in a recent sustained engagement workshop talked about a frustrating patient she had who continually over-utilized the emergency room. Despite careful coaching and instruction, when he felt ill his first stop was always the ER. Finally the care manager decided to probe more deeply on the issue. Why wasn’t he following instructions?

It turned out that this patient lacked a basic ability to read. He wasn’t able to do anything with the written materials his care team had given him. When he felt ill, he couldn’t Google his symptoms and make an educated decision whether emergency care was needed. He certainly couldn’t research whether he should make an appointment with his primary, go to urgent care, or go to the ER.┬áLacking the ability to make a nuanced decision, this patient opted for the place where he knew he’d get the most immediate relief for his symptoms (and, no doubt, his anxiety).

One of the best practices we use to coach people is to think about what is the most critical first step to change. We ask, what is the smallest action that matters? In this case, what mattered was getting the patient information he could use despite his illiteracy. This information may have taken the form of:

  • A visual decision tree created by a care manager during an appointment while talking with the patient
  • Verbal education outlining appropriate actions for the patient’s most common problems
  • Providing written information not to the patient, but to a family member or caregiver
  • The urgent care department’s phone number, written in bold ink on a magnet or wallet-sized card, for the patient to keep and refer to when he feels the need to seek emergency care

If you try to solve health behavior problems without really talking to the person and asking questions to understand what’s causing them trouble, you may miss the opportunity to fix the root problem. In this case, lecturing the patient about proper medical utilization would be a miss, but more patient education with reminders he can decipher might be more effective.

Can you think of examples where it was hard to help someone change because you didn’t know what that smallest important action was? How did you figure it out?