How motivational interviewing can improve health workforce well-being

The National Academy of Medicine launched its National Plan for Health Workforce Well-Being in early October. Citing years of research defining the causes and effects of burnout in health professions, internationally recognized leaders in health care devoted two hours to a launch event for an all-hands-on-deck call to action supporting their plan, which had been developed over the course of several years by the academy’s Action Collaborative on Clinician Well-Being and Resilience.

The report focused on seven priority areas — culture, inclusion, institutionalization, mental health, policy, research, and technology — and called upon “actors” in 10 different groups (spoiler alert: if you’re reading this, you’re likely an actor) to take immediate action to improve the well-being of the health workforce. To achieve the goal set out in its title, the plan now needs to be broadly disseminated, change-makers must be activated, and advocacy must occur on the national level. It also needs some motivational interviewing (MI).

As a primary care doctor, motivational interviewing has been part of my toolbox since medical school. According to the Motivational Interviewing Network of Trainers, MI is a collaborative style of communication focused on an individual’s motivations toward achieving specific goals. It is respectful, curious, and empowering, and is particularly powerful when any of the following characteristics regarding change are present:

• Ambivalence is high.
• Confidence is low.
• Desire is low.
• Importance is low.

A common motivational interviewing example involves counseling around stopping smoking. I might ask a patient, “How important is it to you to quit smoking?” If it is very important, I’ll move on with, “How confident are you that you can make changes to support smoking cessation?” If importance or confidence is low, then the patient and I explore the reasons why and discuss how to increase them. But if importance is exceptionally low, then we may decide to revisit the question again in the future; the patient likely has higher priorities at that time. Sometimes we cycle through this for years before change takes place.

In Thomas Reith’s review of the origins of the word “burnout” in health care, he said that clinical psychologist Herbert Freudenberger first used the term nearly half a century ago, in 1974. In recent years, various reports have cited growing percentages of the health workforce afflicted with burnout, especially in the context of Covid-19. Burnout has been linked to higher costs and worse outcomes for patients, not to mention the pain and suffering inflicted upon members of health care teams who experience burnout.

Which brings me to motivational interviewing and the well-being of the health care workforce.

Here’s what I would ask the actors in health care:

“How important is improving health workforce well-being?” followed by “How confident are you that you can make changes to support improving health workforce well-being?”

The answers to these questions have long been underwhelming — so underwhelming that, if I were the primary care provider and health care the patient, I may have stopped after question number one. Because if improving health workforce well-being is not important, then it has “higher” priorities to address, like profit margins, research agendas, score reporting, accreditation metrics, patient satisfaction scores, and the like.

I find that heartbreaking. What could be more important than the well-being of the people doing the work, which directly translates into the well-being of patients they serve?

Even when health workforce well-being has been a priority, confidence in effective change has been low, with an emphasis on individual-level interventions. Covid-19 has shown the world that health care can change meaningfully at a systems-level, and it can do so rapidly. When lives are on the line, research can be conducted faster, knowledge disseminated more efficiently, and bureaucratic burdens reduced.

Lives are truly on the line in the context of health workforce well-being.

Fortunately, I am not health care’s primary care provider. And health care is not an individual experiencing ambivalence or low confidence. Instead, health care is a system of people who are brilliant, creative, caring, hard working, generous, and more. Despite the trauma experienced by health care workers — or perhaps because of it — their collective power as actors in the health workforce is immense. Relationships are the foundational element of system-level change, and relationships themselves are posited to be an antidote to burnout. In other words, the work of changing systems to improve well-being is itself a pathway to improve health workforce well-being.

So if you represent health workers, patients, health administrators, insurers, academic institutions, health professional societies, health IT companies, or media outlets, answer the first two motivational interviewing questions for yourself, as an individual:

“How important is improving health workforce well-being to you?” and “How confident are you that you can make changes to support improving health workforce well-being?”

The National Academy of Medicine’s National Plan for Health Workforce Well-Being offers 142 possible action steps across seven priority areas. Pick one. Find a partner(s). Strengthen your relationships and activate change. Lives depend on it, and you are playing a role in well-being right now. Make your influence count.

Sarah Smithson is a primary care physician and vice president of partnerships for Intend Health Strategies, a nonprofit organization focused on strengthening relationships between people at the heart of health care.