Blog Post 3: C - Communicate in the Operational Risk Management (ORM) Approach to Medication Adherence

For those with a military background, operational risk management (ORM) is a familiar tactic used by the U.S. military to minimize risks at the tactical level, a principle now adapted to improve medication adherence in healthcare. The ABCD model—Assess, Balance Resources, Communications, and Do and Debrief—provides a structured framework to identify and address adherence challenges.

Following the assessment and resource-balancing phases, the third step is communications but in regards to medication adherence rephrasing it to counseling is more appropriate. Counseling is vital for engaging patients and ensuring the effective utilization of resources identified in the “B - Balance Resources” stage. This post, focuses on the logistics of counseling, leveraging the five WHO dimensions—patient-related factors, socioeconomic factors, therapy-related factors, condition-related factors, and healthcare system-related factors—as resources. I welcome your feedback as we explore this essential step.

The logistics of this process involve coordinating delivery methods, timing, and personnel to address the patient’s intentional (e.g., skipping doses due to beliefs) or unintentional (e.g., forgetting doses) non-adherence domains. By utilizing the five WHO dimensions as counseling resources, healthcare providers can build trust, clarify treatment goals, and empower patients to adhere to their regimens. Here are some educational counseling examples healthcare providers may use.

Patient-Related Factors - Schedule one-on-one sessions with pharmacists or nurses, using culturally tailored materials in the patient’s preferred language. Coordinate follow-up sessions at convenient times (e.g., evenings or weekends) to reinforce education.

Socioeconomic Factors - Arrange discreet counseling sessions with social workers via phone or in-person visits, and provide low-cost devices (e.g., basic phones) if needed. Time sessions to avoid work hours for employed patients.

Therapy-Related Factors - Coordinate brief, regular counseling check-ins via text or app notifications, and schedule therapy adjustment discussions with pharmacists during low-traffic clinic hours. Use automated systems to reschedule missed appointments.

Condition-Related Factors - Plan support group sessions or family-inclusive counseling in private settings, and use flexible timing (e.g., morning sessions for energy levels) with voicemail options. Coordinate with caregivers for follow-ups.

Healthcare System-Related Factors - Assign dedicated care coordinators for personalized counseling calls, integrating reminders via EHR systems. Schedule outreach with escalation protocols for non-responses.

With proper educational counseling you can move to D.

Stay tuned for the next post on “D - Do and Debrief” to explore implementation and evaluation. I’d love to hear your insights—share your feedback!