Episode 30: Caroline Bills
Megan Walker: Hello, I'm Megan Walker and welcome to Healthcare Online. Today I'm joined by our very special guest, Caroline Bills, who's the Director of Health Change Associates. Hi, Caroline, how are you today?
Caroline Bills: I'm well, thanks Megan.
Megan Walker: That's good. Very excited to have you along here for a chat about your background and the work that you've been doing and the shift that you're making into more of a scalable, growth opportunity that you've picked up and that you're running with. So do you want to kick us off and tell us about who you help, who you serve and the journey that you're on currently?
Caroline Bills: Yes. So basically I have been in the training space for a number of years, but I'm also a frontline physiotherapist by trade. And basically I help professionals and leaders trying to help their job to enable them to work smarter, not harder. And I do that by using a systematic training and implementation approach that really increases the uptake of advice.
The ultimate aim is so that healthcare consumers can go out and do what's needed and get better health outcomes. And the healthcare providers can get better job satisfaction because they're more confident to deal really with the complexities of working in healthcare.
Megan Walker: Absolutely. And so this is a really fascinating area for our listeners who are going to be leaning right into this. So we're talking about optimising a consultation so that the patient or the client is having more agency around their journey. Are they following instructions? Tell me, what's the aim of the overall big picture? What are we wanting to achieve here?
Caroline Bills: Yes, well, you've hit the nail on the head because it's actually what the service provider does to look at the way they're conducting that interaction to make it more likely that they can share information in a way that actually motivates people to go and follow their advice. So we have developed a really robust clinical practice methodology called Health Change Methodology.
What that is, is a practical set of tools that more clearly defines for workers what they need to do to personalise the interaction so they connect with people quickly and can do everything within their power to influence and make it more likely that people do follow their advice without basically assessing them and telling them what to do without providing the help.
So basically Health Change Methodology is a practical improvement system that embeds person-centred care. And I know that there's a lot of jargon there.
Megan Walker: That's all good, we're following you with bated breath. So what are some of the top three mistakes that you commonly see people making before they start working with you that might lead them to realise, well hang on, I know my stuff clinically but maybe I need a little bit of help in the delivery? What are some of those common mistakes that you come across that give you a royal eye twitch?
Caroline Bills: So the common mistake is that the way we've been trained tends to mean that our process is that we do a really detailed assessment, mainly so that we can then give those recommendations and jump straight to, in our mind, helping the client to actually do what's needed to improve their health. But the major mistake of doing that is that sometimes clinicians miss the fact that the client's actually not keen on that information or the clinician may end up talking about or assessing in areas that the client has no intention of changing.
That means that they don’t get on the same tram at the same time. And this is the challenge for health professionals, that they need to respond to those more subtle cues. Professionals are good at picking up the cues, but often the way our professional development courses have been created, it doesn't help them to quickly be able to respond and do it in the moment with the person in front of them.
That's really the common challenge that most professionals struggle with, as well as the challenge of always trying to do too much in too little time.
Megan Walker: Absolutely. So it's really a reframe, isn't it? I could imagine a lot of clinicians, therapists and practitioners are thinking the measure of success of that consultation will be to share as much information as humanly possible in the shortest period of time. And that must be a good thing because there I've shared all of that wisdom.
Caroline Bills: Absolutely, and it really just highlights that health professionals, while our knowledge is often absolutely critical to influencing what people do, a lot of the time there's a large percentage of patients out there that actually know what to do, but the trouble is they're not doing it either because they're not motivated, they haven't got a really strong internal driver or they may have a lot of really serious challenges that stop them doing what we might consider quite a simple task.
So clinicians actually need to be experts in influencing behaviour. And that's not necessarily always been the focus of their education.
Megan Walker: And so when we're shifting our mindset from “I'm going to go bulk overwhelm” to “now I'm taking you on more of a journey of results or outcomes,” does that involve coaching skills? What are some of the tools that someone would need to make that mindset shift?
Caroline Bills: Yes, well, ironically, Health Change Associates started as Health Coaching Australia. We started in the coaching space, teaching the coaching skills, very similar to a university course. We went back to the literature, the psychology and behaviour change literature, and that's where we started.
We quickly realised that the feedback we got from health professionals was, “Don’t tell me about the concepts and theories, just help me with what to do when I detect something with the person in front of me.” Because of course, this is an immensely complex skill. And if it was so simple, we'd all be doing it.
So it is the coaching skill set. Everyone often knows that they should be listening, that they should be checking in. But where Health Change Methodology helps them is that we just give a set of these practical tools that cuts all the jargon out and enables them to manage the complexities with a little bit more structure and guidance as to what strategies the professional should be focusing on.
Megan Walker: That's so good. So you're actually going to get a client-centred result. You're shifting the focus, aren't you? From the clinician delivery to client journey. Is that fair to say?
Caroline Bills: Yeah, absolutely. But at the same time, for some health professionals, they get very nervous about that. There's a lot of misperceptions about what client, patient, person-centred practice is. And that's fundamentally what our training does. It helps you get a much clearer view — it’s a lot more than I thought it was.
We also clearly say that a health professional's role is to tread that line between balancing your duty of care with the client's right to choose what they will and won't do, which is the fundamental concept of person-centred care. Yes, it is all about the person. However, for a health professional, they sometimes get nervous and say, “But they have to do this for their health or they're going to die.”
While that may be true, it's the way you frame that to the client that avoids that dreadful thing of “I'm telling you what to do.” Because we know that if we do that, there's a two-year-old in all of us that will come out and say, “Just because you told me that and the way you said it got me offside, I'm not going to do it.”
Megan Walker: It's like go ahead, rebel. I love it. I didn't realise until only recently that some negative behaviours are actually serving people. They gave the weight-loss example of, well, if I stay on the couch, I'm warm, I don't have to move, I don't have to buy exercise joggers or shoes or leave the house. And so whilst my negative behaviours are not serving me, sometimes they also are. Now that's getting into a really deep iceberg, but this is so multi-layered what you're teaching, isn't it? It's not just structuring a consult, it's “What do you do with the person who isn’t interested in what the clinician’s got to say because my current behaviours are actually serving me?” So what am I asking you — it's a huge picture, isn’t it, of change and how do we approach that change?
Caroline Bills: Yeah, well, you're absolutely correct, which is why the great thing about the methodology is that any health professional can do it at any level of their career and they'll get something from it. Really experienced clinicians have already learned all this stuff on the job. And our point is, hey, let's not wait for everybody just to learn it after 20 years of practice.
This is a skill set that you can teach. And that's what we've done — we've really cut through the complexity and labelled the six or seven skills. But what you've highlighted is each of those six or seven skills has other depths of layers in their application. You won't necessarily need all the tools all the time. It's not a compliance program, but it bridges that gap to help professionals with the concepts they're trying to achieve. Because professionals know the concepts, but it's giving them a little bit more of the how — but there are definitely lots of layers.
Megan Walker: So love it. Okay, beautiful. All right. So in your own career journey, I'll get you off the hot seat. That was really interesting. So you were a physio — how did all of this come about and why education? You could still be hands-on. Tell me, what was the trigger point for you changing the way you work and tell us more about your why?
Caroline Bills: Well, ironically, it was one of those sliding door moments that a colleague of mine was catching up. He had just shifted roles and I said, “What are you doing?” And he said, “I'm involved in rolling out these courses called health coaching at the time. You’d love it.”
And I went, “Really? What's that?” So this is a long time ago, nearly two decades ago. And I just happened to go to the course. I had already done my undergraduate, postgraduate, a master's by research and countless thousands of professional development courses and conferences. And I went to the two-day training and my jaw hit the ground because it just totally clarified the missing piece of the puzzle for my practice.
I was working in the area of chronic pain and I still am working clinically. It helped me immediately see — as I listened to the concepts, I went, “Yes, I do that one, I do that, I don’t do that one.” That’s an easier way. And more importantly, it highlighted and taught me conversational shared decision-making skills and ways to share information that are more effective.
As we've highlighted, I just went, now I get what I can do differently. I've been through that practice-change journey myself, and at times it's a little confronting. But once you just get over yourself and lean into, “Hey, nobody's ever an expert at this; dealing with people is the hardest thing we ever do,” it becomes a fascinating and really rewarding process.
And so then I jumped on board and became a facilitator and have since worked with the company in all sorts of different roles. And now I'm the Director of the company myself.
Megan Walker: Fantastic. I love the keywords that you said — lean in. Sometimes in our careers, we're faced with a juncture of frustration, and one of the actions is always lean in, do it, find a way to do it better. I could see that that really lit you up. And so now that you're on this journey, tell us about your vision for how you work. Having a program as opposed to selling time in your clinic — what does that look like for you in the future?
Caroline Bills: Well, the training elements of Health Change Methodology have been consistent for a while. During COVID, I transferred the course to a blended online platform. What your program has helped me do is find in some ways a better, more responsive platform that really can give professionals that flexibility.
We know that it's really hard for organisations to release staff for full-day or two-day workshops, even half-day workshops these days. So the more we can chunk it down and deliver it in flexible bite-sized pieces, the better. What I've been able to do is develop not only the content delivery elements, but also the reflective practice and practical implementation elements using a better, more responsive learning platform.
That's been really productive. This platform has also helped me stay in touch and keep connected with the people who have done the course. Because in the past, doing the course was the first step of the journey. Then you're left with changing your practice.
The good news is that we know the feedback we get from professionals is that many of them find that this is a course they can immediately go out and apply and get quite immediate quick wins on the board by just doing small tweaks to what they were already doing.
But what we know is the biggest challenge is keeping that momentum going. And we know that for time-poor clinicians to do that, the best way is to have the implementation support embedded into their workplace — having those corridor conversations, case discussions, or team meetings that really reinforce the training they've done.
A lot of the comments that I get from professionals after doing the course is, “I wish everybody in my team had done it so that then we could all use the same language and understand the tools so that we can all walk this path together.”
Megan Walker: Yeah, well how brilliant — now you can say to them, “And yes you can, it's online. Step this way.”
Caroline Bills: Yes, the challenge is that if we could all just read a book and get the knowledge online, we'd do it. What is critical is the reflective practice both personally and with your colleagues. More importantly, where the rubber hits the road for clinicians is: “What do I say to Mr. and Mrs. X on Monday for this particular issue I've got for their personal circumstances?”
You've got to come up with the phrasing — the exact question to ask and how to ask it in a way that doesn't get them offside or make them uncomfortable. That's really hard. Nobody can come up with a single right question. So we need that richness of sharing and a safe space so we can all help each other, because often other clinicians have come up with great ways that work in similar populations that you can immediately use.
We're all in for stealing good strategies — benchmarking, making it yours. That's where I'm really excited to be creating the Health Change Community Hub so that I can really help with that layered implementation over time.
Megan Walker: So good, so good. Now, what I wanted to ask you before we give people where to go and find out more about you is, what would you say to other clinicians who are thinking of having either a hybrid model or they want to build some kind of program or online course? What would your advice or insights be for those people who might have a traditional practice but are looking at doing something more scalable?
Caroline Bills: I think the absolute benefit of your services for health professionals — and ironically, of course, these are the key points that you keep reinforcing — are absolutely the key points that I reinforce in my training. It really highlights how knowing it just isn't doing it for yourself.
Megan Walker: Yes, knowledge without doing.
Caroline Bills: So I think the thing that is brilliant about the services you offer is that you really speak to the health professional market. People can come to your services knowing that they're not trying to be the next massive Instagram influencer necessarily, but that they can create what they want to share in a way that's practical, doable, ethical and aligned with their values — whether to expand their products or better serve consumers or patients.
Megan Walker: Yeah, wonderful. Tell us where we can find out more about you, Caroline. It's so amazing — the work you do is transformational. Where can we go and check you out, follow you and sign up for Health Change Methodology?
Caroline Bills: Well, my comms and tech side is still a work in progress — definitely one of my weak spots. But start at www.healthchange.com and perhaps follow the link to our short practical course, which is right up front. That website will be changing shortly, but that's a work in progress.
Megan Walker: You've done such a great job moving a big program from offline to digital. It's not a quick job. So we applaud you and everything you're doing. Thank you so much for having this chat with me, Caroline. Being part of our programs, it's just a joy to work with you and get your material out into more people's hands as well.
Caroline Bills: Well, that's an absolute pleasure and it's been so fabulous to have a supportive group that are all going through the same challenges so that you can ask really dumb questions and get great feedback on what you're doing. And that's really the gold that you provide. So thank you.
Megan Walker: Thanks, Caroline.
