The healthcare sector invests heavily in treatment programs, preventive services, care coordination, behavioral health initiatives, and patient support systems. Yet according to Dr. Liz Barnett, founder of The MI Skills Lab, many outcomes are influenced long before those services are delivered. The determining factor is often whether a person chooses to engage in the first place.
Dr. Liz Barnett argues that many of the challenges facing healthcare and human service organizations emerge before services are ever delivered. She explains that sectors ranging from healthcare and behavioral health to child welfare, elder care, and recovery services all rely on an individual's willingness to engage. Patients may decline preventive screenings or disengage from care, while families may resist interventions designed to support them.
"The success of many services is determined before the service begins," Barnett explains. "If people do not engage, even the best-designed program cannot create the outcome it was intended to achieve."
That perspective has shaped her work through The MI Skills Lab, an organization that helps healthcare professionals, social service providers, educators, and family caregivers develop motivational interviewing skills. Motivational interviewing is an evidence-based communication approach designed to help people explore their own reasons for change rather than simply being told what they should do.
Barnett has spent more than 20 years training professionals and organizations in these methods, which have been validated in multiple peer-reviewed journal articles. Demonstrating skill gains for participants in both communication metrics and empathy, moving providers from practitioner-centered to client-centered practice.
According to Barnett, one of the most common challenges, ironically, is that many helping professionals already possess deep expertise in their fields. While expertise is valuable, it can sometimes create a tendency to focus on providing answers rather than understanding what motivates another person.
"The more knowledge people have, the more tempting it becomes to lead with advice," she says. "But lasting change often happens when people discover their own reasons for taking action."
Barnett points to concepts such as reflective listening and change talk as essential elements of productive engagement. "Rather than concentrating on resistance, practitioners learn to identify language that moves conversations toward possibility and action," she says. From her perspective, asking a different question can fundamentally change the direction of a discussion.
Research continues to support the importance of practice-based learning. A study found that students who participated in motivational interviewing training that incorporated deliberate practice demonstrated measurable improvements in reflective listening skills, with gains observed through both independent ratings and self-reported measures of skill development.
That emphasis on deliberate practice sits at the center of Barnett's training approach. Rather than concentrating on one-time educational events, she advocates for repeated opportunities to apply skills, receive feedback, and refine performance over time.
"Communication skills develop the same way as other complex skills, like tennis or piano," Barnett says. "People learn through practice, reflection, feedback, and repetition."
Her programs incorporate standardized client actors, simulated scenarios, coaching, and structured feedback. According to Barnett, these experiences create opportunities for participants to observe their own communication habits and identify areas for growth. The process also allows organizations to measure skill development rather than simply tracking attendance or participation.
The implications extend beyond professional settings. Barnett notes that difficult conversations increasingly occur at home, where family members often find themselves encouraging loved ones to seek care, address health concerns, participate in treatment, or make lifestyle changes. Yet many people have never been taught how to navigate those conversations effectively.
Her view is that motivational interviewing offers practical tools that can help both professionals and families approach those discussions with greater curiosity and effectiveness. "The goal is not persuasion," she says. "It is creating conditions where people feel heard and become more willing to consider change."
As health and human service systems continue searching for ways to improve outcomes, Barnett believes organizations should pay closer attention to the conversations that occur before services begin.
"The right words at the right moment can change the direction of an entire care journey," she says. "When people learn how to engage others more effectively, they create more opportunities for meaningful change to happen."
