Have you used motivational interviewing to increase case acceptance? One of the most frustrating parts of being a dental provider is spending time with a patient who obviously needs treatment, but does not complete it. We try to explain it better, spend more time with them, offer third party financing, stand on our heads, and lay awake at night wondering if they went elsewhere. 

“What could I have done better?” is a good question to ask, but oftentimes it has nothing to do with how we present treatment, and everything to do with patient’s own limiting beliefs about their options. It can be the most stressful part of being a good clinician. 

I became a certified life coach a few years back and was taught motivational interviewing (MI) as a way to encourage forward thinking, autonomy, new belief formation, and action in my clients. I was surprised to find out how close my own style of case presentation was to MI when I was a clinical hygienist. It must be why I had such a high acceptance rate.

What is Motivational Interviewing?

Motivational Interviewing (MI) addresses behavior change over time. It’s been said that you cannot solve a problem with the same thinking that caused it. If a patient has been avoiding treatment for a long time, the thoughts that accompany the reasons need to be addressed. 

Patients will not say yes to treatment unless they believe they can have the outcome they desire. It may be ingrained in them that “going to the dentist is too expensive” or “our family is doomed for dentures.” Unless we find out what they believe, we will not be able to guide them toward creating new beliefs. They will simply repeat the same choice as before.

What Are The Stages Of Change?

1. Precontemplation: Patients are not even thinking about making a change
2. Contemplation: Patients are beginning to consider a change, but not ready for the commitment it takes
3. Preparation: Patients are preparing for action in the near future
4. Action: Patients are actively implementing a plan for change
5. Maintenance: Patients are maintaining healthy lifestyle changes they’ve made

The patients who call your office with questions are in the preparation stage. They are gathering information. Patients in your chair are in the action stage. They are ready to make a change and are deciding if you are the right person to help them. 

Change is a process. An unfolding. We have a tendency to think one session of oral systemic education will close treatment. It doesn’t. Find out what motivates them and tell them you will help them reach their goal on their timeline. Each patient has different beliefs to overcome. Hold their hand. It takes as long as it takes.

What Keeps Patients From Saying Yes?

In dentistry, treatment coordinators are basically care managers. The medical community has been using care managers for decades because behavior change and decision making are processes that take time. Most patients will not be ready to say yes without going through an internal process of changing their thoughts. 

Motivational interviewing in healthcare empowers patients to take control of their health. It was originally developed in the 1980s to help drug and alcohol abusers but has emerged as a strategy of positive reinforcement and collaboration when coaching someone toward making any change.

By addressing the fear a patient has around change and having someone they trust to guide them through their options, patients make progress faster, and tend to have more permanent results. The role of the interviewer is to sustain empathy and guide the patient, rather than being directive. The power of choice, with non-judgmental support, builds trust over time. 

MI is a relationship, not a phone call or quick check after a hygiene appointment. It should start with the first point of contact, and continue with each visit and encounter, as long as the patient is a member of the practice. It’s a culture that builds trust, which is key when presenting large treatment plans. The last thing you want a patient to feel is pushed.

Key Points Of Motivational Interviewing Questions

• Ask open-ended questions and express empathy

“I am so sorry you are going through this. What would a healthy mouth do for you?”

• Support and assist discrepancy

 “It is true that implants are an investment, but we can break this into phases you can afford.”

• Deal with resistance

 “What is holding you back from believing you can have a beautiful, healthy smile?”

• Support self-efficacy

“This is going to be a long process, but so worth it. We will walk you through it. You are going to be so glad you took action now versus waiting.”

• Encourage autonomy

Use the phrase “your.” Don’t say “We need to take care of this.” Keep ownership on them. “This is a big choice. We are here when you are ready to make your dental health a priority.”

Oars For Increased Case Acceptance

The American Academy of Family Physicians (AAFP) advocate motivational interviewing over other change strategies such as education, persuasion or scare tactics. MI is goal-directed and patient-centered. To help providers remember the key components, they suggest the OARS acronym:

• Open-ended questions
• Affirmations (expressing empathy and celebrating even small successes)
• Reflective listening (repeating words back to patients)
• Summarizing

Patients can sometimes get stuck in sustain talk, where they are not listening for how they can have what they desire, but are instead focusing on the past. “I quit smoking five years ago, but I started back up. I just can’t break the habit.” When they start to go back in time or tell stories, gently take control of the conversation, and redirect the focus to what they want in the future, how they will feel when they have it, and why it is possible now. By asking open-ended questions, the patient can start to see where their own limiting beliefs are, and the interviewer can make notes to keep what motivates them at the forefront of the conversation.

Earn A Patient’s Trust With Change Talk

Change talk is another tactic interviewers can use. It involves three layers: 

1. The desire to change
2. The ability to change
3. The need to change

The first call a potential client makes to your office is out of the desire to change. They are still exploring the ability (often due to finances), and need (often due to social and cultural factors). They may hit resistance within their beliefs on the first call, third appointment, or the morning of finishing treatment. Remember, this has nothing to do with your office or staff, but you CAN be of great assistance coaching them through their fears with reassurance and empathy. 

Whenever a patient begins to use sustain talk (the reasons they can’t have what they want), gently bring the conversation back to change talk (the reasons they can have what they want). Help them visualize a future with their ideal outcome in mind. 

What was their main motivator at the beginning of the process? Remind them how wonderful it will be to have what they want. Build value for the practice. Validate what is possible with affirming words and phrases:

“You are going to love being able to bite an apple again!”

“You are in the right place. Doctor ___ is the kindest, most gifted dentist I know!”

“I can’t wait to see you smile again. You deserve it.”

“You are going to look so beautiful at your daughter’s wedding!”

Building Trust Through Motivational Interviewing & What NOT To Do

Avoid telling a patient what is best for them, or directing their care for them. Ask questions and listen intently for a response. Say their words back to them so they know you are listening: “I heard you say you really want implants, but they are too expensive. Why do you think that?” By bringing current beliefs out into the open, you are building trust while addressing barriers to treatment in a way that puts the patient at the helm.

Trust is essential for attracting and closing high-value cases such as dental implants. By using motivational interviewing, trust is built faster, and patients accept treatment quicker. MI empowers patients to make their own behavior changes at their own pace. Next time you have a new patient in your chair, try using the questions above. If you’d like to learn more about how to use skills like this to increase implant case acceptance, click here to book a free strategy call.

“What Is Motivational Interviewing in Patient Care Management?” PatientEngagementHIT, 8 Feb. 2018, patientengagementhit.com/news/what-is-motivational-interviewing-in-patient-care-management

“How Care Management Improves Performance and Compliance.” Health Catalyst, 2 Jan. 2019, www.healthcatalyst.com/How-Care-Management-Improves-Performance-and-Compliance

“Motivational Interviewing-Stages of Change.” MassHealth PCC Plan. Retrieved August 1, 2019. https://www.masspartnership.com/pdf/MotivationalInterviewingStagesofChange.pdf