Planning for Action Phase: Let's GOOOO!
This is the next post in our series on how to assess a patient's (or anyone’s for that matter) readiness to change and how to guide a quick conversation for each stage of readiness. The first article in the series is named The First Rule for Successful Lifestyle Conversations is to start with Readiness. This discusses the use of the Readiness Scale or Ruler to determine readiness.
The second, is Rolling with Resistance. This discusses conversation strategies to deal with the Pre-Contemplation, Not Ready or “I can’t” or “I won’t” group that score a 0-3/10 on the Readiness Scale. .
The third, Moving to Maybe, discusses the patient in the Contemplation Phase or “Thinking” about changing and scores a 3-5/10 on the Readiness Scale
This post covers the Planning or Preparation Phase, the “I will” phase that comes before starting the behavior. Patients score between a 5-7/10 on the readiness scale and have found motivation to take action in the near future. They have been thinking about options and barriers to making them happen and have been working on a feasible plan to try.
A great question to start with is asking about their “Why”.
What are your dreams for the future? What do you want to be able to do as you age?
This helps create a vision of what they want to be able to do in the future and links the behavior changes they are planning now to their future health. It also can be helpful for them to revisit that statement when motivation is low, pulling them forward into the future to strengthen their determination to become that vision.
Next...
What do you think you could commit to doing starting next week? Even something small, done consistently can make a big difference in your health.
This is where you co-create a SMART goal (or as coaches, we like to call them experiments). The patient starts with an idea they have been thinking about and you work together to make sure it is Specific enough to Measure whether they did it or not. The goal needs to be Action-based (small steps to where they want to go). They need to be Realistic (break big ideas into smaller, easier steps) and have a Time Frame in which to accomplish a goal.
It doesn’t have to take long.
For example: I will walk 10 min on Mon, Wed, Friday after dinner for the next 2 weeks.
If you have more time, asking:
"Who can support you?” will help them think of a partner to do the activity with, which may bring more motivation, joy and accountability.
To create the best opportunity for success, having a goal that the patient feels is realistic and also confident they can achieve is important. To quickly get you to that spot, ask:
“On a scale from 0-10. How confident are you that you can achieve the goal you’ve set for yourself?” If the answer is 0-7/10, see if you can make the goal a little easier…less duration, not as many times per week…so you can “right-size” the goal and they fall in the sweet spot of 8-10/10.
Choices of great lines to end with are:
“This prescription works like those I send to the pharmacy. Instead of the pharmacy filling this one, you are!
“Don’t let perfection get in the way of your progress. Small steps done consistently give you the best benefit.”
“Make sure you celebrate every time you do your action, as it helps rewire your brain.”
“Spend a minute each morning, visualizing yourself following through with your goal.”
“Just keep showing up for yourself!”
When you close the conversation, share with them that you have confidence that they can achieve this goal and build on it, or repeat the process and add new ones. This can be inspiring. Let them know you are interested to hear how things are going at the next visit.
This is a short lifestyle conversation but when done consistently, can lead to improved patient follow through and better outcomes. By incorporating coaching concepts using the evidence on behavior change, these conversations can help patients up their motivation, gain self-empowerment, and have them become a contributing player in their health care team. It is easy to get hung up on how many changes a patient needs to make to live a healthy lifestyle. You can help them take the first easy step with an expectation of more small steps to follow.
They just have to start somewhere. Make it easy.
Most people already know what they need to do, it is the starting that is hard.
Your caring presence and voice can be the turning point to their transformational change.
Are you in the Planning Phase of trying to more or structured incorporate lifestyle conversations into your patient visits? Let us ask you this:
“What small step can you commit to doing starting next week?”
We'd love to have you share in the comments.
If an educational and motivating video for the patient to watch prior to a patient visit and a set of pre-printed “script” pads for these conversations would be helpful, check out our HealthyChange Scripts Kit.
HealthyChange Scripts Stages of Readiness Series: Quick Navigation
Use this series to guide your conversations based on where your patient scores on the Readiness Scale.
Start Here: The First Rule for Successful Lifestyle Conversations is to start with Readiness
0-3/10 (Pre-Contemplation): Rolling with Resistance
3-5/10 (Contemplation): Moving to Maybe
5-7/10 (Planning Phase): You are currently reading this post.
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