Fresh Views

Transform Primary Care Encounters: 7 Practical Tips to Get Started

If it ain’t broke, don’t fix it. Once you know what works, do more of it. If it’s not working, do something different. – Steve de Shazer and Insoo Kim Berg, pioneers of solution-focused brief therapy

Our last blog spotlighted the power of words and using person-first, strengths-based language in diabetes related conversations in primary care. As we continue our series on transforming primary care encounters by incorporating solution-focused techniques, maybe your interest is piqued by this new approach, but you’re not quite sure how to begin to incorporate it into your practice?  Today we share 7 practical tips to get started. 

1 – Ask “exception” questions. Exceptions are times when an expected problem does not occur. These are times we want to identify, focus on, and encourage the client to explore. These exceptions help the client move towards their desired future. Here are 2 examples of “exception” questions:

  • You mentioned that you typically struggle to be physically active in the evenings but you were able to go to the gym after work last week? How did you manage to do that?
  • Cooking meals at home has been a challenge for you, yet you cooked two times last week. What changed to allow you to make that happen? And what else?

2 – Use person-first, strengths-based language. This may seem simple, but is hugely impactful. This means using language that is neutral, non-judgmental, and free from stigma. Language that is inclusive, respectful, and imparts hope. Word choice that fosters collaboration with your client and is person- centered. Focusing on language can remove the stigma associated with diabetes.

3 – Practice problem-free talk. By incorporating this one impactful change you will already notice how the quality of visits and client engagements will improve – building the therapeutic relationship, hope, and motivation. The conversation at the beginning of an encounter is critical to build the therapeutic relationship. By starting the conversation with the goal of the client, you acknowledge that you are focused on their needs and desires and are committed to helping to meet their goals.  Two great ways you could begin a visit are to ask your client:

  • What would make this a successful appointment for you? 
  • At the end of this visit, what would you need to know/learn to say this was worth your time?

4 – Ask the Miracle Question.

The Miracle Question applied to diabetes is one tool or technique in a solution-focused tool-box to help clients envision a future that is more problem-free. 

  • Miracle Question: If you could fast-forward to a time where you feel satisfied with your diabetes management, what will be different in your life that will let you know things are better?

You can learn more about the Miracle Question applied to diabetes in a previous blog post here. The Miracle Question helps people identify those “exceptions” mentioned in #1. The Miracle Question challenges a person to look past their obstacles and feelings of hopelessness to focus on possibilities, opportunities, and a vision for the future. The goal is to help one identify what they’ve actually known all along, and that they have the power to make choices and changes that can move them forward. By focusing on “exceptions”, goals become different. Focus turns to what is desired in our life instead of what “won’t happen” anymore.

5 – Ask eliciting questions. When incorporating a solution-focused approach you need to ask eliciting questions to uncover solutions and guide the individual. It is key that these questions are open-ended and help the individual see how they can be successful. Instead of asking  questions that focus on the problems (since living with a chronic condition cannot benefit from a “quick fix”), instead, explore their strengths and resources they already possess and how those resources can apply to their diabetes management.

  • What has been going well since I last saw you?” 

That one question can  start the visit on a positive note, acknowledge  the work that it took to accomplish that, and then leverage how the client can continue those positive behaviors and build on them for future health success. Questions can also focus on details when the person identifies a success:

  • How exactly did you do that? What exactly did you do differently?

6- Ask future visioning questions. These questions can focus on the short-term or long-term views of the client’s preferred future. These questions help the individual realize that solutions are possible and help them see their desired future state. As you recall one of the key tenets is the client is the expert about their own life and their own diabetes. (Read more about experts here)

  • What would you like to see yourself doing in the next (day, week, month) to move you forward towards your goals? And what else? 

Following up with “what else?” encourages people to dig deeper and think through in detail what they are capable of.

7 – Use scaling questions. Scaling questions are a great tool to move away from all or nothing thinking. They focus on progress, motivation, and confidence.

  • On a scale of 0-10 where 0 is not confident at all and 10 is very confident, how much confidence do you have that you can meet your goal to (insert personal goal here)?  

If less than a 7, follow up with one of these:

  • What could move you to a 7? 
  • What would need to happen to move you one number higher?
  • What would one number higher look like? 
  • How would others notice you’re more confident?
  • How come you’re not at a lower number? How did you do that?

Keep reading our series on incorporating a solution-focused approach when managing T2D in the primary care setting. Our next blog will focus on therapeutic inertia. Curious what that means? Stop back by in 2 weeks as we share more tips to build your solution-focused tool-kit over time. 

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If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

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Deb is employed by Dexcom, but her words and opinions in this blog are her own.

Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.