Coaching: Phase II of the new revolution in patient motivation

By Carol Jahn, RDH, MS

There was a time in my dental hygiene career when not recommending floss as the primary choice for interdental cleaning would have felt blasphemous. For a good portion of my clinical days, floss was “it” and everything else was “better than doing nothing at all.”

Times have changed. Most of us have come to understand that many people don’t like to floss. Not only that, in this era of evidence-based care, the reality is that there aren’t as many clinical trials on the efficacy of string floss as we would like to think.(1,2) As well, emerging evidence indicates that those devices once considered “better than nothing” often work as well, and for some parameters, better than string floss.(3,4,5,6,7) See Table 1.

• Compliance: yielding to the wishes of others
• Coach: to instruct, guide, or prompt

Coaching, especially coaching as used in the business sense, is founded on the idea that motivation is malleable, and everyone has the potential for change. Rather than the show, tell, do approach most of us have used for years, coaching involves collaborating with the patient to help them tap into their own goals, values, and aspirations and use them as a motive and resource for change. It requires shifting from being the expert delivering advice to the coach listening and guiding.(8)

Doing something different often feels uncomfortable. Coaching is a skill as well as an art form. There are many layers to mastery. A great place for dental hygienists to begin is with the guiding principles from motivational interviewing, a healthcare based type of coaching. Motivational interviewing has been found to outperform traditional advice-giving in the treatment of a wide range of behavioral-related conditions and diseases.(9)

Guiding Principles for Coaching(8)

Resist the righting reflex refers to the urge that many of us have when we see behaviors or perhaps absence of behaviors that “must” be corrected. The reason this often backfires is that it is natural to resist being persuaded, and commonly when this occurs there is push back.(8)

Understand what motivates your patients will provide insight into how they perceive their situation and where their values and concerns lie in changing. Giving the patient a voice to this helps them explore the possibilities and take up the argument for change.(8)

Listen to your patient seems like patient education 101; but it is actually a complex skill. Good listening skills involve allowing the patient adequate time to talk without interrupting as well as being able to ask appropriate questions, clarify responses, and summarize meaning.(8)

Empower your patient helps them understand that they can make a significant difference in their own health. In this role, practitioners act as facilitators by helping the patient bring their own expertise to the forefront such as what might be the right interdental aid for them.(8)

There are many great books on coaching including some specific to health care under the title of motivational interviewing authored by Stephen Rollnick. See Table 2. Will it feel awkward when you first start doing this? Absolutely! With time it will start to feel natural, and the responses and results you start to get with patients will make it all worthwhile.