1. Health Coaching for patient centred care and behaviour change
Dr Penny Newman
Clinical Lead, Health Coaching Programme, Associate, Health Education East of England
Dr Andrew McDowell, DirectorThe Performance Coach

2. Our aspiration NHS Constitution National Voices
Renewable Energy – sustainability
Cost savings

3. Our long term condition challenge
Lifestyle causation
Multiple comorbidity
Age and poverty related
Unaffordable

4. The impact is overwhelming

5. Our current approach isn’t working
Low levels of patient understanding, adherence and behaviour change
Clinicians are not trained in behaviour change
Alignment between what patients want and what is provided is poor - goals, treatment choices, shared decision making and patient and carer involvement
Poor communication – introductions and interruptions
104% rise in GMC complaints
Paternalism breeds dependency… and increasingly affects patient satisfaction
Bennett H, Coleman E, Parry C, Bodenheimer, 2010
GMC Annual report 2013,
Rhoades DR, Fam Med 2001.
Wolever R, 2013
Coulter A, 2011
KPMG Creating value with patients, carers and communities 2014

6. Self care and self care support

7. Our response 2010 Regional Innovation Fund Health Coaching Pilot
CCGs with national LTC Programme
2013/14 HEEoE roll out to 800 clinicians and develop 18 internal trainers

8. Aim: Equip clinicians with new skills, knowledge and behaviours
A tailored consultation
Listen with compassion
Diagnose and fix
Guide and advise
Review and encourage
Support self care
Promote self-care, motivation and responsibility in patients
Improve patient satisfaction
Provide a tailored approach to different patient's needs
Supplement core clinical skills

9. Expanding the tool box 2 day core programme
Developing internal trainers
Co-delivery to gain experience
On-going roll out of health coaching skills

10. Uptake in a time of reform
nurses (44%)
allied health professionals (28%)
doctors (9%)

11. Health coaching to support self management
In the clinical context “performance”= self-management
Health coaching aims to raise awareness and increase responsibility for health
Health coaching is about supporting someone to change their relationship to a problem or challenge

12. Health coaching transforms the clinician/patient relationship
Role of patient
Role of clinician
The coach is a healthcare professional trained in behaviour change theory, motivational strategies, and communication techniques, which are used to assist patients to develop intrinsic motivation and obtain skills to create sustainable change for improved health and wellbeing.
Wolever 2013
A patient centred approach wherein patients at least partially determine their goals, use self-discovery and active learning processes together with content education to work towards their goals, and self-monitor behaviours to increase accountability all within the context of an interpersonal relationship with a coach.

13. Psychology, Coaching, Clinical Skills
Behaviour Change theory
Social Cognition theory
Patient Activation
Stages of Change
Motivational Interviewing
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
Potential & emergence
Using Challenge & Rapport
Scaling 13

14. Integrating skills 14 Clinical Skills Behaviour Change Assistance
relationship
Coaching
Self determined goals and activation 14

15. Key ingredients Foundations of coaching Patient self determined goals
Directive and non-directive approaches
Structuring health coaching conversations
Listening, trust, rapport and supportive challenge
Positive psychology approaches
Readiness to change
Managing interferences
Health coaching behaviour change techniques
Highly experiential using a coaching style
Fast paced and challenging
Time to allow mind-set shift
Application to real issues
Opportunities to practice skills and receive feedback

16. New mind-sets, skills, and techniques
Techniques Specific coaching techniques and frameworks for conversations
Useful for specific behaviour change conversations
E.g., TGROW, ABC model, Managing interferences
Skills General coaching skills and concepts
Useful in many clinical interactions to increase awareness and responsibility
E.g., Using supportive challenge, listening, empathy
Mindset Developing a coaching mindset
Useful in most clinical interactions and as a leadership skill
E.g., people are more resourceful than they think they are

17. Widespread application
Long term conditions
Respiratory, DM, CHD, neurological, pain, cancer
Mental health
Depression, anxiety, stress
Prescribing
Compliance
Rehabilitation
Frail elderly
Functional and skill development
Palliative care
End of life
Pain management
Widespread application
Improved communication, lifestyle, shared decision making, integrated care

18. Reported benefits Patients ↑ motivation to change ↑ satisfaction
Improved health/outcome
Clinicians
↑ effective consultations
↑ resilience & job satisfaction
Use with colleagues and others
Organisation
↑ quality of care
↓ complaints
Meet strategic priorities
Improve multidisciplinary working
Impact on utilisation, costs and outcomes

19. And indirectly …leadership

20. What clinicians find difficult
Need to recognise need for change & value patient empowerment
Learned behaviour hard to change
Can require complex interpersonal skills
Challenging patients is uncomfortable
When to apply and with whom
Time - managing all responsibilities and maintaining skills
Using a coaching approach when colleagues are not
Contra cultural – very different from biomedical model
Clinician activation = Patient activation

21. Evidence Centre Rapid Review 275 studies, 109 RCTs
In research on health coaching services (vs as part of usual care)
Vulnerable groups benefit
Can support patients motivation to self manage
Can support adoption of healthy behaviours
Applicable to population and of use by all professionals
Insufficient evidence about the most cost effective training
Mixed evidence on outcomes
Insufficient evidence on costs
Include as part of a wider LTC programme
UK research needed

22. Summary
No brainer Skills in empathetic communication that supports patient's motivation to look after themselves, including the most disadvantaged, improves patient and clinician satisfaction and looks like it may improve outcome and save money