THE CLINICIAN AS CHANGE AGENT

Recognizing both the difficulties and resistance to change, researchers continue to examine the nature of change and how healthcare professionals can motivate, educate, and support individuals throughout the process of change. All clinicians serve as change agents, whether they realize it or not. A change agent is a person or group that facilitates the change process (Grandison, 2022).

Change is essential for patients (and their loved ones) to achieve maximum wellness. Most, if not all, patients need to make some types of behavioral change. But providing adequate education and finding the time to teach makes working as an effective change agent challenging for clinicians.

Grandison (2022) suggests five ways to be an effective agent, which are adapted below for the healthcare setting.

Embrace Resistance

People are often resistant to change, and healthcare professionals must become comfortable when dealing with such resistance. Patients who must change diets, take new medications, or deal with a newly diagnosed chronic illness are likely to deny that a change is necessary. This can be an instinctive reaction to bad news. If healthcare professionals anticipate resistance, they will not be taken off guard when it occurs. It is important to identify common sources of resistance and plan for a variety of ways to address them. (See also “Factors Affecting Change” later in this course.)

Co-Create the Vision

Healthcare professionals, patients, and families should work together to create a vision of patient behavioral change. Frequent and consistent communication among these groups is absolutely necessary. Since time to facilitate change can be limited, it is helpful to develop a consistent manner of providing patient education, including establishing objectives, no matter the setting. While it is true that most healthcare facilities have written education materials to distribute, such materials are often not sufficient. It is imperative that actual learning be evaluated.

Get Buy-In

Patients and families will not change their behavior unless they want to change and have the means to do so. Getting “buy-in” has its foundation in realism and practicality. If patients see the change goal as achievable, they are more likely to buy in. Therefore, part of the education to achieve behavioral change must include a complete assessment, including issues such as finances, ability to plan meals, available transportation options, etc., to make sure the plan is achievable. These types of assessment questions should be included on any and all education assessment forms. Information gathered are then used to implement change.

For example, a patient at risk for obesity-related conditions may not feel the need to lose weight. The patient may say they “feel fine” and that they enjoy eating, especially at family get-togethers. They may also believe that any significant weight loss is impossible given their family’s eating habits. In cases such as these, it is imperative that families become invested in helping the patient “buy in” to achieve weight-loss goals. Healthcare professionals can meet with both patient and family members to discuss what factors might motivate them all to work on behavioral change. For instance, changes in what is served at family gatherings may allow for calorie reduction while maintaining social contact. Or incorporating exercise into family activities (such as walking together after meals) might seem more inviting if it allows the patient to spend more time with grandchildren.

Other patients may already want to change health-related behaviors to live longer or to feel better but may be unable to acquire what is necessary (e.g., the funds to purchase prescribed medications) to make necessary changes. It is imperative that healthcare professionals have knowledge of various resources designed to help offset healthcare expenses and that they share such knowledge with patients and families.

Create a Track Record

The vision of change must be implemented in a practical way. Consistency is important and helps to make the education process more time efficient. A written tool for assessment (with space for individualization) and the education plan should be documented in the medical record. This helps the entire healthcare team track what progress (or lack of progress) has been made. Ways of facilitating patient compliance, change, and patient/family education should be part of all staff meetings. Consistent discussion and established ways of implementing education in healthcare help to create a track record of success, or lack of success, and can improve outcomes.

Make Change Normal

It is important to help patients and families view change as normal, although this is easier said than done. Few people “love” change. Whether a change in one’s healthcare routine is temporary (for acute issues) or long-term (for chronic issues), helping change to become a regular part of a patient’s health maintenance will go far in facilitating compliance.

It is important to approach present behavioral health change as a “normal” process and to avoid making it overly complicated. Goals must be realistic and achievable. For example, a patient who is dealing with severe hypertension and has consumed a diet high in sodium throughout their life is not likely to immediately reduce their salt intake significantly. Expecting an immediate, total reduction in salt intake is unrealistic for patients such as this. Instead, the clinician can break the target goal of reduced sodium intake into incremental decreases.