Health Literacy Universal Precautions Toolkit, 3rd Edition

An action plan outlines one or more easy steps a patient can take to attain a health goal, such as losing weight or improving self-management of a chronic condition. Patients and health professionals create action plans together. This tool describes the process of creating and following up on action plans.

TIP

Use action plans to help patients:

• Change their diet.
• Cut down or stop smoking, drinking, or drugs.
• Increase physical activity.
• Manage stress or emotions.
• Sleep better.
• Take medicines correctly.

Action

Train clinicians and staff to work with patients on action planning.

Successful action planning requires working collaboratively with patients.

• Decide who will be responsible for action planning and make sure they have the skills they need. Many people can engage patients in action planning, including clinicians, nurses, medical assistants, diabetes educators, health coaches, and others.
  • The University of California at San Francisco Center for Excellence in Primary Care has resources on health coaching and produced this 6-minute video that shows ineffective and effective ways to engage patients in action planning. A longer version of the video explains the steps for creating action plans with patients.
  • You can find short videos and action planning resources at the Centre for Collaboration, Motivation, and Innovation.
  • The resources in the AMA Steps Forward's Health Coaching Module can get your practice started with action planning.

  Create action plans with patients.

  

  • Ask permission to talk about health behaviors. For example,
    • "Would you like to talk about ways you could improve your health now?"
    • "Shall we discuss whether there is anything you would like to do for your health in the next week or two?"
  • Use an action plan form to guide and record the conversation. This simple Action Plan Form, with an example of a completed form, can be modified to fit your needs using this Word template. This Action Plan Form is available in English and Spanish.
  • Find out what patients want to work on. Ask patients, "What matters to you?" You may have a different opinion about what is most important, but always start with the topic the patient chooses.
  • Ask patients to choose a goal. For the plan to be successful, the goal must be important to the patient.
  • Help patients break down goals into manageable steps. Have patients pick one specific step they want to try. Steps should be small and realistic to do over a short time (e.g., 1 week). If they get stuck you could ask, "Would you like me to share some ideas that others have used?"
  • Assess confidence. Assess the patient's confidence by asking, "On a scale of 1 to 10, with 1 being not sure at all and 10 being very sure, how sure are you that you can follow this action plan?" Research shows that a confidence level of 7 or above increases the likelihood that the patient will carry out the plan.
    • If they are below 7, explore what barriers might stand in their way and revise the plan so the patient feels more confident.
    • Ask patients who can help them succeed with their action plan. Support at home is key to success.
  • Ask when they’ll start the action plan. Set a concrete start date.
  • Confirm the action plan with teach-back. For example, you could say, "Just to make sure we’re on the same page, what are you going to start next Monday?"
  • Set a time for followup. Following up lets patients know that you are interested in helping them achieve behavior change. Ask patients when and how they'd like to check in and set a date and time. Go to Tool 6: Follow Up with Patients to learn about different ways to follow up.
  • Make a copy of the action plan. Give a copy to the patient and document the plan in their medical record. If your electronic health record does not have dedicated action plan fields, determine how the practice will standardize documentation so everyone can find it easily.

  Follow up after the visit.

  • At the appointed date and time, contact the patient.
  • When patients have not stuck to their action plan, reassure them that this is common and help them develop a plan that they can achieve.
  • When patients have followed their action plan, congratulate them! Work with patients to plan the next step. Each small step gets patients closer to the ultimate goal of improving their health-related behaviors.
  • Update the medical record to reflect the current plan the patient is working on.

  TIP

  It can be tempting to make suggestions, but action plans need to come from patients. Try having a menu of options (e.g., lists of exercises, foods to cut down on) that can give patients ideas for specific steps they can take. MyHealthfinder.gov has many suggestions for making healthy changes.

  Track Your Progress

  Randomly select the records of at least 20 patients slated to have action plans who were seen in the past week, and calculate the percentage who have an action plan. Check again in 2 months, 6 months, and 12 months to see if there has been an increase in that percentage.

  Look at the records of at least 20 patients with action plans. See how many have notes on whether: (1) there was followup, (2) initial steps have been completed, (3) additional steps have been added, and (4) goals have been achieved. Repeat in 2 months, 6 months, and 12 months to see if there has been an increase in the percentages.

  Before implementing this tool and 2, 6, and 12 months later, collect patient feedback on a selection of questions about this tool from the Health Literacy Patient Feedback Questions.