1. Health Coaching for Behaviour Change
Maximise your impact as Leaders
Senior Operational Leaders and Front Line Leaders
Networking Event 8th May 2014

2. What do you already know about health coaching?2

3. What is Health Coaching?
In the clinical context “performance”= self-management
Health coaching is releasing a person’s potential to maximise their own health
Health coaching aims to raise awareness and increase responsibility for health
Coaching is about supporting someone to change their relationship to a problem or challenge 3

4. Behaviour Change Assistance
Health Coaching provides
Clinical Skills
Behaviour Change Assistance
Health Coaching 4

5. Fear as driver of the consultation dynamic?
Existential Anxiety
‘If I’m worried about something and I don’t go to the doctors, I might die … but if I do go, they might tell me I’m going to die’.
Entitlement Anxiety
‘If I go to the doctors and I’m not ill I might be humiliated. Am I entitled to present myself as ill for this reason, at this time?’.
Interactional Anxiety
‘Will I be able to say what I need to say? Will I be able to ask what I need to ask? And will I be heard?’
Existential Anxiety
‘If I miss something vital the patient might die or suffer’ (My professional identity is threatened)
Entitlement Anxiety
‘Might I get into trouble if I prescribe/refer… guidelines, targets, budgets, evidence-based medicine, etc., ?
Interactional Anxiety
‘Patients are unstoppable and insatiable. Will I be able to get what I need and shut them up. They expect me to solve their problem – will I have to handle disappointment/ anger?'
Patient’s Fears
Clinician’s
Fears
Adapted from: When doctors and patients talk: making sense of the consultation,
Martin Fischer and Gill Ereaut, The Health Foundation June 2012 5

6. Different kind of conversation
“Instead of treating patients as passive recipients of care, they must be viewed as partners in the business of healing, players in the promotion of health, managers of healthcare resources, and experts on their own circumstances, needs, preferences and capabilities.”
Coulter (2011) 6

7. Health Coaching Skills Development
Behaviour Change theory
Social Cognition theory
Patient Activation
Motivational Interviewing
Stages of Change
Positive Psychology
Mindful awareness
Cognitive Behaviour Therapy
Principles and models from Health Psychology & Behavioural Medicine
Health knowledge
Health recommendations
Diagnostic skills
Consultation skills
Questioning skills
Listening skills
Problem solving skills
Patient – clinician relationship
Knowledge and skills of Health Practitioners
Skills & techniques from Performance & Development Coaching
Goal setting
Coaching models
Coaching competencies
Range of approaches
Awareness & Responsibility
Focus on potential & emergence
Using Challenge & Rapport
Scaling 7

8. Coaching Mindset
How would practitioners need to think differently and what would they need to believe in order to engage with a health coaching approach? 8

9. How do your conversations lead to outcomes? Working with goals
What is the value of setting a goal?
Who’s goal? Patient’s or clinician’s?
What factors might influence patients’ willingness to set a goal?
What factors might influence clinicians’ willingness to work on setting a goal with patients? 9

10. How do you flex your style for different consultations
How do you flex your style for different consultations? A range of approaches
TELLING / TRAINING
PUSH
PULL
Solving
patient’s
problem for them - Offering the clinician’s resources & experiences
Enabling patient to
solve their own
problem - Accessing the patient’s resources & experiences
NON-DIRECTIVE
DIRECTIVE
SILENCE/WITNESS
ASKING QUESTIONS THAT
RAISE AWARENESS
CLARIFYING UNDERSTANDING
GIVING FEEDBACK
OFFERING GUIDANCE
GIVING ADVICE
REFLECTING
PARAPHRASING
SUMMARISING
MAKING SUGGESTIONS
LISTENING TO UNDERSTAND
Telling
Asking
Notes: 10 10

11. How do you see your patients? Bi-focal vision
What is the problem? (Patient is a problem)
What is the potential?
(Patient is resourceful and holds the solution) 11 11

12. How do you reflect on the dynamics of the consultation
How do you reflect on the dynamics of the consultation? Karpman Drama Triangle
Persecutor
Rescuer
Victim 12

13. How do you use challenge with your patients? Challenge / Rapport model
Awareness
Comfort
Exposure
Context 13

14. Sustained High Performance
Components of High Performance
Achievement
Learning
Meaning
Enjoyment
Sustained High Performance
Control = HM control over you symptoms
Learning = HM are you learning about you health/condition
Motivation = HM in touch with your motivation or willingness to address the issue
Confidence = HM confidence about your ability to manage your health/condition 14

15. Components of Managing Health – Diamond model
Control
Learning
Motivation
Confidence
Managing Health
Control = HM control over you symptoms
Learning = HM are you learning about you health/condition
Motivation = HM in touch with your motivation or willingness to address the issue
Confidence = HM confidence about your ability to manage your health/condition 15

16. Components of Managing Health
Using Scales to have a simple coaching conversation:
Where are you now and what has contributed to that?
Where would you like to be and what are the reasons for that?
What can you do that is within your control to move this forward? 16

17. Discussion What was the impact of using the coaching questions?
How did the process raise awareness and increase responsibility?

18. About the Performance Coach
The Performance Coach is proud to offer a range of innovative services to help organisations and individuals with an interest in leadership development, performance coaching and health coaching.
We pride ourselves at being the ‘best’ at collaborating with our clients, closing the ‘knowing/ doing’ gap and sustaining performance improvement over time.
We offer a range of services across the spectrum of; Diagnosis; Consultancy and Design; Development Solutions; Sustainable Engagement and Evaluation. We pride ourselves on using inventive ways to engage and sustain learning creating lasting impact.
For further information:
Dr Andrew McDowell, The Performance Coach
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The Performance Coach, Marble Arch Towers, 55 Bryanston Street, London, W1H 7AA 18