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Flinders Chronic Condition Management Program

Monday, November 04, 2019

Krista Hirschmann, Ph.D., FACH

For decades, doctors have basically told patients what they should do. And part of why we have such low engagement rates is that while there’s some overlap between that and the patient’s own goals, in many cases I suspect doctors don’t really work that hard to figure out what the patient’s goals are.” 
Kevin Volpp MD, NEJM Catalyst
Sometimes I lie to my doctors.
Not real big lies—nothing betrayed by my lab results and tests, but little lies just to keep things moving along, to get what I want, and make the clinicians feel like they are doing a good job.
I know what they want to hear (“Yes, I understand what you are saying. Yes, I agree that is important. Yes, I’ll do it”). And then I leave their office and I do what I want, or rather, what life demands of me.
I wish I was quoting a renegade patient, but the truth is that I’m writing for myself. Understanding what is realistic, what resources I have, what I value, and how I prioritize my health are all part of engagement and my experience as a patient. Yet, truly understanding my world takes time to cultivate—time most clinicians don’t have. That is why I for 15 years I have been a champion of the Flinders Program for Chronic Conditions.
The Flinders Program is the evolution of 20 years of research by Flinders University Behavioural Health in Adelaide, Australia. Based on the principles of motivational interviewing, the internationally recognized Flinders Program systematically identifies specific barriers and what goals are most important to the person. It includes a versatile set of 4 tools and processes that support people to more effectively self-manage any condition or combination of conditions once they leave the hospital or office.
As a Flinders trainer, what I hear most commonly from the people who experience the Flinders Program is, “I wish my doctor knew all this about me,” or “it was helpful to think through my situation in a new way.” For the health care providers who are trained in the Flinders Program they find comfort in the structure, the connection and partnership they feel with the patient, as well as the specific person-centered care plan that sets goals designed by the patient that are truly important that person, instead of offering generic advice.
Though a Flinders interview often takes 60-90 minutes, it is an upfront investment, especially for complicated patients who often consume additional time and money with phone calls, hospital (re)admissions, and staff frustration. The research backing this argument is clear and growing, especially in the Asia-Pacific part of the world (see ). In the United States, the Flinders Program has been part of the award-winning rural health initiatives at St. Luke’s University Health Network ( where they continue to grow and invest in the program’s success.
The ultimate goal of the Flinders program is to create improved health outcomes by not only actively putting the patient back in the driver’s seat, but building a map together of where they hope to go and why. The investment that health professionals have made in their expertise is not wasted in this scenario, but rather utilized selectively in co-pilot role. Although, admittedly it can be challenging to sit in the passenger seat (especially when someone is learning how to drive!) it is also rewarding to watch a person’s autonomy grow and supportive relationships deepen. 
While the Flinders Chronic Condition Program may not be for everyone, I do find that often its use is the first step towards a more complete understanding of a person’s world. This understanding includes partnering with decisions that might otherwise look like non-adherence, thus reducing the pressure that patients might feel to lie!

Tags: communication, patient engagement, doctor's appointment, personal healthcare
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