Podcast #292 - The Co-Authors of "Motivational Interviewing for Leadership"

Today, our topic is something that I've really taken an interest in the past two years: “Motivational Interviewing.” See my past blog posts on this subject. I think it's a powerful methodology that will help anybody in their Lean transformation efforts… as well as our work engaging anybody in a small improvement.

“Motivational Interviewing” or M.I. is defined by Miller and Rollnick (in their seminal book) as a “collaborative conversation for strengthening a person's own motivation and commitment to change”

My guests for Episode 292 are the three co-authors of an excellent book, Motivational Interviewing for Leadership: MI-LEAD. They are (pictured from left to right in this order):

Jason Wilcox, Director of Education and Connected Care at VA Roseburg
Dr. Brian Kersh, Clinical Psychologist at New Mexico VA Health System
Dr. Elizabeth Jenkins, Clinical Psychologist/Courtesy Assistant Professor at University of South Florida

Beth and Brian are licensed clinical psychologists and Jason is a licensed clinical social worker. You can learn more about them, their book, and the training and coaching they offer by visiting their MI for Leaders website. See their bios here.

If you are looking for just one book on the subject, I recommend MI-Lead. The original textbook by Miller and Rollnick is surprisingly readable, but the book we're discussing today gives a great introduction to the methodology, but then quickly turns to workplace change issues instead of clinical therapy situations.

I hope you enjoy the discussion and find it as thought provoking as I did!

Streaming Player (Run Time 58:17)

For a link to use for this episode, refer people to www.leanblog.org/292

For earlier episodes of my podcast, visit the main Podcast page, which includes information on how to subscribe via RSS, through Android apps, or via Apple Podcasts. You can also subscribe and listen via Stitcher.

Links, Topics and Questions:

What is “Motivational Interviewing” and how is it helpful in helping people beat addictions?
How did you come to see parallel to workplace issues?
Is it appropriate to think of workplace change as a parallel to beating an addiction? What happens when are manager needs or organizational needs?
Was there, ironically, “resistance” to this different approach for therapy and addiction treatment amongst the clinical community, since it was radically different than that was practiced at the time?
A new approach (M.I. or Lean) can be rationally better, but individuals might have a feeling of “ambivalence” about change (ambivalence comes naturally, it's a “normal state for anybody to be in”) – we see two sides to things (changing and maintaining the status quo)
Why are people quick to label “resistors” as bad? Why do we need to have a conversation about change? How can you help resolve that ambivalence instead of writing that person off? What role do leaders play in how motivated a person is toward change?
How do we get people talking about their “why” for change? Asking the individual to articulate why…
- In Lean, we often ask about the what and the how, but we try to explain the why? Telling instead of evoking? Our why might not be a motivator for somebody else…
Blaise Pascal: “People are generally better persuaded by the reasons which they have themselves discovered than by those which have come into the mind of others.”
Why it's good to hear “change talk” and how that's predictive of change
How do you help convince people to try M.I. without falling back on “telling” and instead “evoking” and looking for their motivation? How do you “invite” people to learn the material? Invite them to give it a try using some of the same approaches, such as open-ended questions and reflections.
What if you, as a leader, don't have time to engage people in a discussion? Can M.I. support the Lean / Toyota notion of “go slow to go fast?”
Do we sometimes forget to practice our own skills as coaches and M.I.-focused leaders?
Why is “the righting reflex” so strong in people? I wonder if those who work their way up through the ranks have a “stronger” righting reflex? Does that make it harder for them to change?
- When someone is gung ho and ready for change, there are times when it can be helpful for a leader to tell people what to do and how… but when you're ambivalent, being told isn't as helpful (it only gives voice to one side of the discussion in our minds, so we tend to argue back to give voice to the other side of the ambivalence).
- It's best to hold back that righting reflex, especially at first… until commitment has been reached
Talk about the “dance of change” and the process for helping to work through ambivalence
Getting input from staff, taking the time to do so, leads to better solutions through Lean and/or M.I. methods – but the discussion about the “reasons why' seems really important.
Leaders don't always need to have all of the answers… M.I. allows clinicians to not always have to have the answers, and can instead let organic answers come out of those you're working with.
What is the “spirit of M.I.” and the ways you have to be careful using tools without having the right spirit? Are there certain ethical considerations or cautions about misusing M.I.?
- There's potential for misuse… these methods are powerful
- The component of “compassion” was added to the “spirit of M.I.” in the 3rd edition of the core Motivational Interviewing textbook. M.I. shouldn't be used to manipulate others to do things that aren't in the best interest of others. M.I. is about helping others who have decided its in their best interest to change. Genuinely transformational leaders are interested in others…
Do you have tips about getting started practicing these methods? When would it be appropriate to get started? “Once you start using these methods, you'll notice the power of them.” You don't need to be formally certified to try this, but there are four main client-centered skills to learn and practice:
- OARS: Open-ended questions, Affirmations, Reflective listening, and Summaries.
- People might begin by just practicing open-ended questions or practicing reflections (we can practice our listening skills almost any time) and see what happens.
- But once you try using these methods, they might see it's more complicated than it might have seemed originally. Training can be helpful.
- Your staff members will give you immediate feedback… if they're more engaged, talking more about change, generating ideas and solutions and reasons for change… if they're energized, then you're moving in the right direction.
The co-authors are available for training and coaching.
How Brian found M.I. to be very helpful in the practice of Lean and an improvement project.
Their newly launched M.I. Lead website

Introduction

Mark Graban: Hi, this is Mark Graban. Welcome to episode 292 of the podcast. It is November 9th, 2017. Today's topic is something I've taken a real interest in over the past two years: a methodology called motivational interviewing. I think it's a powerful methodology that can help anybody in their Lean transformation efforts, as well as in our work engaging people in small improvements.

Motivational interviewing, or MI, is defined by Miller and Rollnick in their seminal textbook as a collaborative conversation for strengthening a person's own motivation and commitment to change. My guests today are three co-authors of an excellent book on this topic, Motivational Interviewing for Leadership: MI-LEAD.

They are Jason Wilcox, the director of education and connected care at VA Roseburg; Dr. Brian Kersh, clinical psychologist at the New England VA Health System; and Dr. Elizabeth Jenkins, a clinical psychologist and courtesy assistant professor at the University of South Florida. Brian and Beth are licensed clinical psychologists, and Jason is a licensed clinical social worker.

You can learn more about them, their book, and the training and coaching they offer at their website, miforleaders.com. If you're looking for just one book on this subject, I recommend MI-LEAD. The original textbook by Miller and Rollnick is surprisingly readable, but the book we're discussing today gives a great introduction to the methodology and then quickly turns to workplace change instead of clinical therapy situations.

I hope you find this discussion as thought-provoking and helpful as I did. For links to their book, their website, their bios, and more, go to leanblog.org/292.

What Is Motivational Interviewing?

Mark Graban: I'm very pleased to be joined today by Jason Wilcox, Brian Kersh, and Beth Jenkins. Thank you all for being here. To jump right in, Brian, can you start by giving an overview of what's meant by the phrase and the method “motivational interviewing”? How do you see it helping people?

Brian Kersh: Thank you, Mark. Motivational interviewing is a way of communicating with other people to help them resolve their ambivalence around change by eliciting and strengthening their own motivation for change. That's a nice overview of what's meant by motivational interviewing.

Mark Graban: What are some of the origins of this method as a way of helping people?

Brian Kersh: It started in treating addictions, in particular alcohol use disorders. And it was very different from the traditional approach of badgering people into change, or forcing them to change by confronting them and telling them why they needed to change and how to go about it.

So it's a real shift. Rather than forcing or trying to coerce somebody to change, you're making change come from them, which is where it comes from in the first place. Motivational interviewing is about helping people change by having them identify their own how and why around change.

It started in addictions, quickly demonstrated itself to be very effective in that area, and then moved into other areas of changing behavior, like the healthcare setting, and even the legal setting. And now we're seeing it used in other settings as well.

From the Clinic to the Workplace

Mark Graban: As an engineer, not a psychologist, it's interesting to think that attempts to badger people would ever have been seen as effective in a clinical setting. I can see why badgering people into change isn't effective in a workplace. What led to the recognition that there was potential benefit in trying a different approach?

Dr. Elizabeth Jenkins: This is Beth. In the workplace, whether it's individual change or organizational change, we've all seen that there are opportunities for change to happen, and times when change needs to happen. All three of us were doing a fair amount of training with folks using motivational interviewing for individual change, and we began to see that it had great applications in organizations, and for leaders who are struggling to engage the folks they're working with and be successful without sacrificing their own agendas.

Mark Graban: Maybe we can come back to this point later — the difference between a clinical therapy setting, where the focus is hopefully on the patient's needs, and a workplace, where it gets more complicated because there are organizational needs that a manager or leader feels obligated to push, as opposed to just evoking. Do you have a quick thought on that, Beth?

Dr. Elizabeth Jenkins: Absolutely. It can be a real dance, because you've got multiple agendas at play, and they're obviously not always the same. It can take some real collaboration to find a shared agenda.

The Origins of MI — and Resistance to It

Mark Graban: We'll come back to how to find that shared agenda. But in terms of history, when did motivational interviewing evolve or start being used in the original addiction setting? Is it decades?

Dr. Elizabeth Jenkins: I believe it became more well known as it was introduced at a conference, around 1983, if I have this correct. Before that, Bill Miller had been on a sabbatical, and some of the folks he was working with there were curious about his approach to working with addictions. He was very effective, but his approach wasn't like everyone else's.

So they began to meet for brown bag lunches where they could pick his brain and get a better understanding of why he was doing what he was doing and what was behind the choice points along the way. As he'll often tell folks, as he heard himself speak, he came to this model of motivational interviewing. It has grown exponentially since that time, but he first introduced the theory at a conference in 1983.

Mark Graban: I'm fascinated by the idea that there may have been resistance to this new approach within the addiction therapy world. I wonder how the creators of motivational interviewing led people to even investigate it. A lot of the listeners of this podcast struggle with the fact that they have a methodology — namely Lean — that they think is better, and they're frustrated that people might not embrace it. I imagine there was a similar evolution within the clinical realm, if any of you want to comment.

Brian Kersh: I'll jump in. This is Brian. Anytime you have a new therapy, including one that's significantly different from what's in vogue at the time, you're going to have resistance, just as there's resistance to any change. Which is quite germane to our conversation.

This was radically different from a lot of what was being done at the time, which tended, especially in the addictions world, to be much more confrontational. It's also very different from the Alcoholics Anonymous approach. You may see some parallels, but it doesn't focus on the need for a higher power, you don't have to confess that you have a problem, and so on. So the main resistance was that it was very different from other therapeutic approaches for treating addictions.

It came to be accepted over time, first, because many counselors found it more consistent with their natural therapeutic style. A lot of us as therapists were trained to be human-centered, client-centered, or patient-centered, and motivational interviewing fits with that nicely. And of course, the more it was studied, the more it demonstrated a strong evidence base, which led to more adoption.

Ambivalence Is Normal

Mark Graban: One thing that always stands out to me when I'm reading about motivational interviewing is the idea that something new can be rationally better, and people may even say, “Yeah, I know it would be better to do such and such.” Can one of you elaborate on the idea of ambivalence? In a workplace, leaders or individuals might express a desire or a need to do something. Why does that so often get people stuck in a state of ambivalence instead of moving forward?

Jason Wilcox: Mark, this is Jason. You're talking about the ambivalence that comes naturally to an employee in a workplace as change comes about?

Mark Graban: Yes. And how that state of ambivalence is natural. It's not meant to be a negative label, any more than — as you point out in the book — “resistance” should be used to label something as pathological. It's quite natural, right?

Jason Wilcox: Right. Ambivalence is a normal state for anybody to be in. Often it's just the reality that we see two sides to things. We love the way things have been. We appreciate what we've been able to demonstrate and the success we've been able to show. Then all of a sudden this new change comes in, and it shocks the system.

Then we can see the possible benefits going forward, so we get this mixed bag of pros and cons — of staying in the processes we're comfortable with, or changing to new processes, with the benefits or possible consequences of that. It becomes a natural state for employees once change comes about in an organization. As leaders start talking about change, people start feeling that ambivalence.

Dr. Elizabeth Jenkins: I might add to what Jason was saying: it's a normal part of any type of change. When we're ambivalent, each of us has an awareness of the reasons for and the reasons against, and it's really about sorting through that. When we come at it from the approach of motivational interviewing, we look at ambivalence as a normal, expected part of the process.

Don't Write Off the “Resistant” Employee

Mark Graban: As an early student of motivational interviewing, I've started becoming more aware — in my own mind, or sometimes in the writing of others — of a common pattern in the Lean world. Somebody has an approach that's clearly rationally better, resistance comes up, and a lot of people are quick to label those resistors as bad: “We need to start moving people out of the organization.”

Can you talk more about having a conversation about change? What are some ways of resolving that ambivalence instead of saying, “Ugh, they're resistant, they're bad, we need to force them to change”?

Brian Kersh: That's a great question. First, it's important to recognize that as leaders, we have a definite role in, and an impact on, where the people we're leading are in the change process. Simply writing an employee off — labeling them as resistant or not a team player — is inaccurate. Instead, we recognize that as leaders, we have a role in how motivated that individual is toward changing.

Ambivalence is a normal part of the change process, in our personal lives and at work. So when an employee is normally and naturally not 100% on board with change, it behooves us as leaders to work with them. Before we have them jump into the change process, have them identify why they might want to change. What do they see as the benefits of change? How might they go about implementing it? How does this change fit with the employee's values and goals?

Once the employee starts to identify their reasons for change — their how and their why — they're much more likely to get on board with the change being discussed. Then, and only then, do we go forward with implementing the change plan.

Their Why, Not Yours

Mark Graban: What you said there, about asking the individual to articulate why change is important — I think that's pretty revolutionary. Within the Lean framework, people are on board with asking employees for input about the what and the how. But I've been guilty of this myself: trying to explain the why, telling the why. That seems like an important lesson from motivational interviewing — we should draw that out. Do you find in workplaces that employee motivation for change is well aligned with the organization? Is part of the leader's role to create that alignment?

Jason Wilcox: I was going back to what you said — that it comes out naturally that we want to explain the why and just give people the information. But when we explain the why, our why may not be a motivator for somebody else. We need their why. You're identifying the important issue of allowing them to identify what drives them to go forward.

I had a leader one time, when I was training him on some of these concepts, who said, “I don't want to go down this road. I want to be able to just tell people, ‘This is what you need to do,' and then they go do it.” So we talked that through: “What normally happens when you do that? What kind of responses do you get?” And he was able to start identifying some of the pushback he gets.

In a healthcare setting, what we're about to change might truly be beneficial for a patient. But if we just tell the why and tell people what to do, that motivation might be missing, or we didn't process through that ambivalence well and help them identify their own desire to go forward. When we take the time to see what's going on with them, pull out the motivations within them, and help those grow, that's when you see people really flourish, grab onto change, and make it their own. Beth, what were you going to say?

Dr. Elizabeth Jenkins: I was just thinking about a quote. It's interesting, because it was made back in the 1600s. Pascal said that people are generally better persuaded by the reasons they have discovered themselves than by those that have come into the minds of others.

Even though that came out in the 1600s and motivational interviewing didn't begin to take shape until the 1980s, it's the heart and soul of motivational interviewing. If the reasons don't come from the changer's mouth — from within the person who's considering change — then even if somebody attempts change for a short time for somebody else's reasons, it generally doesn't stick. We now have decades of research on motivational interviewing across multiple populations where we've seen that.

There's good and bad in that. The good news is that at any given time we can see how a conversation with an individual, or an interaction with an organization, is going based on what we're getting back. If we're getting back what we call “change talk” — statements about somebody's desire, ability, reasons, or need for change — we're on the right track. That's actually predictive of change.

On the other hand, if we try to shove down somebody's throat all the reasons we can think of that support change — the reasons that make sense to us — those things coming out of our mouths are not predictive of change. They can actually have the opposite effect, pulling what we call “sustain talk” from the potential changer. In other words, all the arguments for why they can't — the “yes, buts” we often hear when we're trying to encourage somebody.

Teaching MI Without Telling

Mark Graban: There seems to be a fractal problem here. You're authors of a book, and I say this as an author too: a book is, in a way, a telling approach. There's no way around it. A book tells people, “Here's a methodology. It's better. It gets better results. It fits better with the way people are.” When you're talking with leaders, how do you apply MI concepts so you don't fall back on telling them, “You need to embrace this,” and telling them why? You need to evoke their reasons for adopting this new approach to change, right?

Dr. Elizabeth Jenkins: Yes. I definitely see that. Some of the people who come to our workshops were “voluntold” that they had to come — which is the complete opposite of what we're going to discuss with them.

Jason Wilcox: I'd say it's an invitation. We invite them to learn the material. Sometimes we have leaders like the one I mentioned, for whom this goes against what they feel is the right way to lead. The best we can do is invite them to give it a try, and we use the same skills we teach. We use open-ended questions to find out what their thoughts are. We reflect their thinking and feelings on the topic, and help open a door for them to try out some of these skills. We do our best not to go in and force them, or tell them, “This is how it has to be,” or “This is the best way,” or “You have to change to this kind of leadership.”

Going Slow to Go Fast

Mark Graban: That takes me back to leaders who say, “I just want to tell people what to do.” Why do leaders stay in that status quo? Maybe they'd say, “We don't have time to engage everybody in a discussion. I know what the answer is, and we're under a lot of pressure.”

Have you seen in workplace settings that the directive, telling approach creates false starts? There's a Toyota-ism about going slow to go fast. It seems like MI might fall into that — you make an investment in the conversation, and it's a good investment because it actually helps bring about change. What are your thoughts?

Jason Wilcox: Oh, absolutely. Obviously we're not all perfect, and sometimes in the rush of the day we forget to practice our own skills.

Case in point: I had an employee who I needed to get a project done by a certain time. I brought him in and said, “Hey, I need you to get X, Y, and Z done by this date.” He said, “Oh, sure,” and left. This is one of my top employees — he does an excellent job. The next thing I know, things weren't getting done. I brought him in and asked, “What's going on?” He had every excuse under the sun, and this was not typical behavior for him.

All of a sudden I caught myself realizing I hadn't invested the time to talk with him, ask some questions, and use motivational interviewing to find out where he was and what he thought, and guide him on it as well. As soon as I backed up and took the proper steps, it's funny how things changed. He had ideas he wanted to add, it got really creative and exciting, and I ended up with a better product than I thought I was going to have in the end.

The Righting Reflex

Mark Graban: That's a great example of taking that time and making that investment. There's another element of human nature that comes out in discussions of MI. Ambivalence is normal; resistance is normal. Can you talk about the phrase “the righting reflex”? As tempting as it is to say leaders shouldn't tell people what to do or give them answers, there's some human nature involved there. Maybe we should be understanding of people who are trying to “right” others?

Brian Kersh: I'll jump in. This is Brian. We develop the righting reflex as leaders, and as healthcare providers. It's the urge to jump in and help — to jump in and fix. Leaders and healthcare providers have strong problem-solving skills. That's what got us here in the first place. You have to know how to solve problems, and you have to be able to jump in and fix.

That certainly has a time and a place. When somebody is ready — when they're gung ho for change — a leader telling them what to do and how to do it can be helpful. The problem is that when we're ambivalent, having somebody tell us what to do and how to do it gives voice to only one side of the internal dialogue going on in our minds.

So what we tend to do, as an ambivalent person being told what to do, is argue back. As Beth said earlier, we say, “Yeah, but,” because we're giving voice to the side of the argument in our head that the leader isn't voicing.

We're not saying a leader should never offer ideas about what to do and how to do it. But it's best to resist the righting reflex initially, especially while the employee or team member is still ambivalent, and instead encourage that team member to be the voice of the champion — to have it come from the employee rather than from us as the leader. Rather than pushing on one side of the ambivalence and eliciting the other, we elicit the side for change, and we only offer the what and the how when the employee is ready for it — when he or she is asking for it in order to take steps toward change.

Mark Graban: So once the stage of commitment has been reached, it would be less dysfunctional to plan together, or to give direction, once there's agreement to move forward on solving a problem?

Jason Wilcox: Right. It becomes a collaboration.

Brian Kersh: Exactly. Once there's readiness for change and a commitment to change from the team member, and they're wanting additional information — we've gotten to where we are as leaders for a reason. Part of that is that we have knowledge, expertise, and the ability to solve problems. So of course we can share that. But it's when the team member wants it, when they're asking for it, when they're not generating it on their own, and when they're ready for change.

Finding a Shared Agenda

Mark Graban: Let's come back to what Beth called the “dance” when there are different agendas within the organization. Can you talk about the process for working through that? I imagine a lot of the time it's not a simple, quick discussion that leads to some magic outcome. It's a process, and it takes time. Do you have another example that might illustrate a situation like that?

Dr. Elizabeth Jenkins: I'll describe the process a little, and then I'm thinking of some examples Jason has from his work. When we as leaders are having a discussion with somebody about potential change, the first step is not jumping into the hows, which is what Brian was alluding to. It's talking with the person in a way that shows our curiosity.

When I'm doing trainings, I'll often tell folks, “Put your curious hat on.” Ask questions. Hear the individual. What's their point of view? What are their thoughts, their values, their goals? And then how does the agenda you're bringing to the table as a leader potentially fit with that?

By starting from a listening stance, and then working with that individual to move into more of a problem-solving stance, we're much more likely to get to a shared agenda — a shared focus that's collaborative and ends in the results we're both looking for. Jason, would you be willing to share a couple of examples? I know I've heard you tell some good ones.

Jason Wilcox: Sure. There was one leader I was working with who struggled to figure out how to communicate with her staff. She felt like she'd try to talk with them, but she felt so disconnected. So we came down to the core concept of finding that shared agenda — meeting people where they are and finding a way forward where we both feel good about the direction we're going.

She described a situation where she was trying to get staff to adopt some changes in a clinic. She went down there, saw what was happening, said, “No, you need to be doing it this way, that way,” and got very directive with them. She told me, “I don't get it. It seems like this is the fifth time I've told them.”

So we went over some ideas: “Have you thought about going down there, sitting with them, and asking, ‘What might be beneficial if we go this direction?'” Taking some time to hear their voices. We practiced using some of MI-LEAD.

She left, and when she came back she told me how great it went. It totally changed the conversation. It was funny, because she literally couldn't sit still in her chair. She was so excited: “It made such a difference when I just sat there and used these things that I thought were so simple.” And this part amused me. She said, “Even when you were telling me these things, I didn't get why they would work, because they're so simple. How are these little techniques going to make such a difference?”

She said they had a great response. She started hearing their concerns and the things they really wanted to see in the clinic, and she was able to guide them to see how that fit in the same direction they all wanted to go with patients. Over time, as we kept talking, she reported that the change persisted, and they even started coming up with more ideas. That creativity often comes out when people use MI-LEAD with their employees. They got really excited, and it became a top-notch clinic.

A Lean Example: The Overtime Question

Mark Graban: Thinking back to the earlier story, there's a compelling argument that taking that time and getting that input leads to better solutions. That sounds like the collaboration we often see in a “Lean culture” — leaders getting input instead of being expected to have all the answers. But this collaboration around the reasons why still jumps out to me. It's one reason MI has resonated with me.

I'm reminded of a story. I was working with a hospital laboratory. They had great leadership, and we were going into microbiology. The lab director and the chief pathologist certainly had their ideas about why Lean was going to be important. I forget the genesis of it, but we agreed that I, as an outsider, would go in and have a very open-ended discussion. I knew some of these folks, because I wasn't brand new to the organization. I asked, “Why should we improve things in microbiology?”

They talked about clinical quality, and they talked about their workload. The director had been afraid to bring up the issue of overtime — that we needed to reduce overtime. Sure enough, the employees brought it up themselves, because they wanted to get home on time. The director had been afraid it would be seen as cutting their paychecks. In that case, they discovered there was great alignment.

I wonder how it would've worked out — well, I guess we could predict the answer — if he had pushed the idea that we need to reduce overtime. They probably would have pushed back. I'm curious what you think.

Autonomy and the People on the Fence

Dr. Elizabeth Jenkins: We all like to feel we have some degree of autonomy. That's human nature. If I ever forget that, I come home at the end of the day to two teenagers, and they never fail to remind me how important that sense of having choices is.

If my daughter comes in and I tell her, “You need to unload your backpack, pick up your room, and set the table,” I'm going to get an argument. But if I ask her what she thinks will help the night move along so we can get to the delicious dinner we smell cooking, she's probably going to come up with some of those ideas on her own. It's about the way we approach it, and whether we're supporting the need all of us have to feel like we have some input. We push back when we don't.

Jason Wilcox: Right. And those employees may or may not have pushed back. But you might have seen some employees walk away thinking, “Man, he's taking away our overtime,” and feel grumpy about it, while others felt happy about it. You can end up with that, because people might move to the other side of the spectrum with that ambivalence.

Dr. Elizabeth Jenkins: Especially if they're sitting on the fence at the beginning. The people who are already convinced one way or the other are less of a concern. But for the folks on the fence, who have reasons to go both ways, it's not difficult to tip them by pushing too hard — and then they'll right that canoe, if you will, by going the other direction.

Leaders Don't Need All the Answers

Jason Wilcox: Can I highlight one thing you said, Mark, that I really liked — that leaders don't always have to have the answers? When I first started teaching motivational interviewing in the clinical world, I loved showing clinical staff how MI frees us from always having to have the answers. It's nice to let that organic answer come out of the person, and it's the same with leaders.

It's empowering. It makes you feel like a collaborative leader who makes things happen, when it's this organic, natural thing coming out of the employee that you're helping to guide. You don't have to always have the answers, and you don't have to always try to get people to follow the answers and directions you bring to the table.

The Spirit of MI and the Risk of Manipulation

Mark Graban: One thing I really like is the concept of the “spirit of MI.” I think there are parallels to the Lean methodology. I'm sure every listener has a story about somebody using a tool in a way that violated the spirit of Lean.

It's probably fair to say there are certain ethics around motivational interviewing. These methods shouldn't be misapplied. This isn't about a leader having a new way of manipulating people into doing what the leader wants. Are there cautions? Or is it impossible to misuse because people will detect it and check out?

Brian Kersh: I don't believe it's impossible to misuse. We take pains to talk about the ethical application of motivational interviewing in our book because of the potential for misuse. Motivational interviewing works. It helps people make change, and it's powerful, so there's potential for misuse.

The developers of motivational interviewing are Bill Miller and Steve Rollnick, and certainly others have contributed over the years. In the third edition of their core book, they explicitly added compassion to the spirit of MI. The way they define compassion is that what we're doing is in the best interest of the person we're working with. What we do as clinicians is in the best interest of the patient. What we do as leaders is in the best interest of the people we're leading.

They added it explicitly because they had already seen people — partly in the business world — learning MI to manipulate others. For instance, people in sales were using it to improve their sales, not necessarily in the best interest of the people they were selling to, but in their own best interest as salespeople.

So you have to be cautious as a leader, because it's tempting, especially when you have leaders above you, to get your team to achieve the goal by any means necessary. Motivational interviewing is meant to be pro-social. It's meant to be helpful to the people you're using it with. We spend a lot of time discussing the spirit for exactly that reason, because there's a temptation for a leader to use this powerful technique to force staff members to make a change. We want it to be about helping people who have come to the conclusion themselves that it's in their own best interest to change.

Mark Graban: That's where the workplace dynamic comes up again. A lot of leaders might say, “Sure, the ideal is to be a servant leader. You take care of the employees, and they'll take care of the patients.” But there are times when people say, “Look, the organization expects me to achieve certain goals.”

It comes back to leaders sometimes viewing employees as a means to an end, instead of engaging them — and, as one of you said earlier, recognizing the role leaders have in their employees' motivation. I'm not sure if that was a question or a statement. Does anyone have a reaction, or a better thought to build on my rambling?

Dr. Elizabeth Jenkins: We could misuse aspects of motivational interviewing to achieve a change that benefits us as leaders. I would hope folks wouldn't, but they certainly could. The potential downside is that while you may get what you're after on the front end, at what cost to your long-term relationship with that employee or supervisee?

Motivational interviewing at its core is about the relationship you have with that individual and the investment you're putting into them. If there were positions where we led folks we had no vested interest in and could replace without any loss, we might not choose to use motivational interviewing, because the relationship and the engagement are such a core piece of what we're doing. So by definition, we're pulling in some of that servant leadership.

Most of us have had a leader, supervisor, or boss at some point in our careers who was a transformational leader — the one who inspired us to go above and beyond the basic expectations of our job. The folks who embody what a transformational leader is genuinely care about our well-being as well as their own. That's a long-term investment that pays off, and the dividends are ongoing. So we could misuse it, but it would probably be short-lived.

When MI Isn't the Right Tool

Jason Wilcox: I'd add that it's always fun to sit down with leaders I've worked with over the years when they want to throw situations at me. We'll process them and talk about how MI applies and how they could use it. If you're used to other models of leadership, you might sit back and ask, “How could this really work?”

But at times they'll bring up situations where motivational interviewing is definitely not appropriate. My point is that some of the techniques aren't appropriate for every situation with an employee, and leaders need to identify when they are and when they aren't. We can always carry the spirit of motivational interviewing with us in every situation, but not all the techniques fit every situation.

Mark Graban: Thank you for clarifying that. There might be a time to be directive — don't misuse MI, and recognize when you're not practicing it.

What I take away from MI, and why I see it as really compatible with a Lean or Toyota-type culture, is respect for people at a deep and meaningful level, combined with taking the long-term perspective, as you pointed out, Beth. Principle number one of the Toyota Way management philosophy says — I'm paraphrasing — make decisions based on what's best for the long term, even at the expense of the short term. A lot of organizations don't try to emulate that. What I hear in this is that longer-term perspective, combined with servant leadership, respect for people, and engaging people. It's a great approach.

Getting Started: Four Core Skills

Mark Graban: As a final question: other than your book — which I highly recommend to listeners, Motivational Interviewing for Leadership, available on Amazon, including as a Kindle book — how and when would it be appropriate for somebody to start practicing these methods?

Jason Wilcox: I'd say while you're reading it. The book has lots of exercises, and we encourage you to start giving the different techniques a try. Once you start trying them, you'll notice their power.

Mark Graban: And you don't need to be formally certified to try some of these approaches, right?

Dr. Elizabeth Jenkins: One of the things we teach people almost immediately is four core skills that are client-centered: open-ended questions, affirmations, reflections, and summaries. Often people begin by practicing open-ended questions. They'll practice reflecting what they hear other folks saying to them. That's something we can do in just about any situation. Pretty much everyone loves to be listened to, even if we're just practicing our listening skills. So there are opportunities in all kinds of settings to begin using some of those skills and see what happens.

Jason Wilcox: And no, they don't need to be certified. But as people start trying these skills, they'll find they're more complex than they seem on the surface. That's where training might be needed, to get more in-depth skill building.

Brian Kersh: I'll piggyback on what Beth and Jason are saying. As you start trying these skills, your employees and team members will give you immediate feedback on whether you're using them well. If your team members are more engaged, if they're talking more, if they're talking more about change, if they're generating ideas, solutions, and reasons for making the change, if they're getting energized — then you're moving in the right direction. That's one of the neat things about just getting started with the skills.

And to Jason's point about additional training, the three of us are available for training and coaching. If anybody wants additional help learning these skills, that's available from us, and it's available from others as well.

Final Thoughts

Mark Graban: I'm interested in that, so I'll follow up offline. One other thought before I ask each of you for a final word. As I've read the books and taken a day-long workshop, I've found that, even individually, I have a better understanding of my own ambivalence in certain circumstances. If I notice change talk in my own inner monologue, I try to steer myself toward the change talk that's more indicative of change. I wonder if anyone else finds that a personal starting point — a way of thinking through these concepts before working with others.

Can I ask each of you for a final thought, whether it's a reaction to that or anything else you'd like to leave listeners with? Let's start with Beth.

Dr. Elizabeth Jenkins: Along the lines of what you just said about listening for change talk, I use that as a gauge at any given time. I want to know how a conversation with an individual is going — am I making progress, or am I making things worse than they could have been? I know by whether I'm getting change talk.

If I'm getting change talk, what I'm doing is headed in the right direction. If I'm getting the opposite — arguments against, what we call sustain talk — I know I need to adjust my sails and perhaps shift direction. It's a gentle guide, so I know how it's going at any point. Even if the person isn't completely ready to make a change in that moment, I can see what direction we're headed and whether we're making progress.

Mark Graban: Great. Jason, do you have a final thought for listeners?

Jason Wilcox: Yes. A thought has been going through my mind during this call, so I'll share it: my own personal why — why I chose motivational interviewing for leadership.

I've been training and coaching leaders for a number of years, and I've also been training and coaching people in motivational interviewing. About four years ago, I was sitting down with an executive, coaching him on leadership skills, and Sheldon looked at me and said, “You MI'd me again, didn't you?”

I don't know why it never connected for me before that moment, but it really did then. I'd coached and trained people in a lot of different leadership models, but I really like what motivational interviewing brings to the table. I started coaching and training people more on motivational interviewing as a leadership style and model, and that's where it all started to grow and develop — from seeing it in my own experience.

Mark Graban: That's great. Brian, would you like to add a final thought?

Brian Kersh: I'm quite happy to. We hear terms like transformational leader, servant leader, Lean manager. For us, what MI has given us is a way to put these different leadership approaches into practice. That's what really appeals to me about motivational interviewing, and I think I speak for Jason and Beth too.

I remember being brought into a Lean project, working with a clinic to improve access so patients could get in to see the clinicians more quickly. The team already had a good Green Belt leader working with them. This was a Yellow Belt project for me, and the Green Belt was there to mentor me.

The team and the Green Belt had stagnated. It wasn't until we took a step back, and I worked with the team and asked them why they would want to improve access — how it fit with their goals and values — that things changed. The team hadn't been coming up with any PDSA cycles or projects to work on. But once they were able to tell us how improving access would help them meet the mission of taking care of their patients, and help them be more effective and efficient — once they articulated their own reasons — they suddenly came up with multiple projects and started working on them.

It was a way of putting Lean management into practice that I hadn't thought of until working on that project. So for any of your listeners who want to learn how to be effective Lean managers, I think this is one practical strategy and approach they could learn to actually do that.

How to Reach the Authors

Mark Graban: That's great, and I hope this inspires people to do so. I've been talking with colleagues around the country this year about motivational interviewing, and I know it's prompted some of them to read the book and get similarly excited about these ideas. Hopefully this podcast will prompt other listeners to do the same. I'd love to hear what people think — come comment on the blog post for this episode. People can find the book on Amazon. Final question: how can people reach out to you if they're interested in training or coaching?

Jason Wilcox: I'd have them go to our website, which we're currently updating. It will have contact information for Beth, Brian, and myself.

Mark Graban: And what is that website?

Dr. Elizabeth Jenkins: miforleaders.com.

Mark Graban: Great. We'll link to that on the episode page as well. Again, our guests today have been Jason Wilcox, Brian Kersh, and Beth Jenkins. It's been great talking with you. Thank you so much for sharing with us on the podcast today.

Brian Kersh: Thank you, Mark.