Long-term staff absence can be very damaging to NHS organisations, and tackling the problem individually could prove to be the most effective solution. Jean Brading reports on what can be done to make a difference on the front line

Managing absence, rehabilitation and retention are all issues on HR managers' minds and the costs involved in neglecting them are huge.

We know time is crucial when trying to facilitate a return to work. Once people have been off work for more than a few weeks, it becomes increasingly difficult to motivate them to return. Unsurprisingly, the longer they have been away, the more they feel left out and lacking in confidence. Advice only goes so far - finding a way to engage with and help people decide to return is vital.

Motivational interviewing is an evidence-based technique that can be used to overcome the ambivalence people feel about making a behaviour change.

This technique lets you get behind the reluctance to return to work, get rid of blame, and address the ambivalence or discrepancy that absent workers may be feeling. Based on the assumption that we are all motivated towards something, the technique works to reduce resistance and move the person towards the goal. It has to be the client who voices the reasons for change.

The four principles of motivational interviewing

  • Express empathy;

  • develop discrepancy;

  • roll with resistance;

  • support self-efficacy.

Expressing empathy

Motivational interviewing borrows from person-centred counselling to place empathy at its heart. We need to remember that it is not pathology we are interested in: it is how we show respect for the process whereby the client makes sense of his or her situation.

The three points to remember are:

  • acceptance facilitates change;

  • reflective listening is fundamental;

  • ambivalence is normal.

Developing discrepancy

This is where a more directional focus kicks in. We have to move beyond exploration to help create cognitive dissonance – in other words, to show the discrepancy between the current situation and where the client wants to be. This will help the client decide to change.

The key points are:

  • the client rather than the counsellor should present the arguments for change;

  • change is motivated by a perceived discrepancy between present behaviour and important personal values or goals.

Rolling with resistance

You cannot make the person change. The more the impetus for change comes from the outside, the more likely he or she will resist. What you need to do is help reframe the perception. How you react to expressions of resistance is vital: go with it, be within that person’s frame of reference – and then help the person find the answers.

Essential elements of this are:

  • avoid arguing for change;

  • resistance is not directly opposed;

  • new perspectives are invited but not imposed;

  • the client is a primary resource in finding answers and solutions;

  • resistance is a signal to respond differently.

Supporting self-efficacy

Self-efficacy refers to the person’s belief that he or she has the ability to carry out and succeed with a specific task. Enhancing self-confidence in the client is crucial and a pre-requisite for positive change.

The main points here are:

  • a person’s belief in the possibility of change is an important motivator;

  • the client, not the counsellor, is responsible for choosing and carrying out change;

  • the counsellor’s own belief in the person’s ability to change becomes a self-fulfilling prophecy.

A practical approach

To build a person’s motivation to change, and to strengthen commitment to do so, requires particular techniques. One of these is to assess how the individual sees the importance of changing a specific behaviour and their confidence in doing so.

Having ascertained what the key issues are, you help the client use a scale of one to 10 to assess these, and then, using open questions, reflections and affirmations, encourage the client to see what could be done to change these numbers and facilitate them to take action.

Moving at the client’s pace is essential. Someone might be convinced of the personal value of change (importance) but not feel confident about mastering it (confidence), so this might need to be worked on. These factors determine a person’s readiness to change.

Motivational interviewing can give an invaluable framework for action-oriented discussions, to facilitate willingness to return to work. It can be used by all kinds of people, whether HR, line management or professional advisers such as job brokers or career counsellors.

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