findings from the evaluation dr alison carter, ies associate 11 november 2014
TRANSCRIPT
Findings from the Evaluation
Dr Alison Carter, IES Associate11 November 2014
Structure of the presentation
Aims and design of the evaluation Implementation of the intervention at
the evaluation sites Usefulness of health coaching Local evidence of impact
Questions for the evaluation
How has health coaching been implemented locally and within what context?
Is health coaching perceived as useful for clinicians and their patients?
Is there any local evidence of impact - health outcomes and/or consequences for organisations?
Evaluation logic model
Evaluation methods
Qualitative
Scoping • Focus groups with 18 clinicians• Interviews with 3 experts
Organisational case studies • Interviews with 9 co-ordinators
& team leaders• Focus groups with 41 clinicians• Follow up interviews with 20
clinicians & 5 co-ordinators• Interviews with 4 stakeholders
Quantitative
Patient experience surveys
Analysis of relevant local outcome data
Overview of take-up at evaluation sites
No of clinicians trained No of Internal trainers trained
Community services 95 5
CCG commissioner 36 1
Primary care (general practice) 0 0
Mental health services 33 1
Acute services 39 1
Source: HEEE/TPC records
Implementation in community services
‘Culture Change’ Process
Wider strategies not as key drivers as culture
Casting the net widely Clinicians selling the
concept to their peers Getting support from
senior stakeholders Rolling out widely in a
priority order Plans to document the
evidence
95 trained + 6 trainers
Sold as more effective way to address old problems
Health coaching-friendly organisation culture
Six trainers provided support and momentum
May have underestimated local resources required
Implementation in general practice
‘Research Project’ planned Drivers were self-
management, patient partnership and reduction in appointments
Designed a test pilot Plans for clinicians to
receive training Support requested from
CCG Plans to review results
0 trained, 0 trainers
Mixed reaction Accessing 2-days of
training can be difficult
Limitations of ten minute appointments
Highly valued by some as an easy to use ’mind-set’
Lots of examples of successes with patients
Implementation by CCG Commissioner
‘Project management’
Clear link to commissioning priority of integrated care
Targeting the ‘right’ individuals
Persuading people to participate
Focus now on data and outcome measures
No decision on roll out
27 trained, 1 trainer
High take-up across all 20 practices
Demand for refresher training
Awareness training for non-users would be helpful
Support needed for isolated trainers
Implementation in mental health services
‘Skills acquisition’
Clear link to new ways of working and National Recovery model
Targeting nurses and IAPT practitioners
Considering roll out through link into HR strategy
33 trained, 1 trainer
Some difficulties transferring learning : local support may help
Training quality praised Demand for more ‘Train
the Trainer’ places Difficult organisation
context has negative implications for learning
Implementation in acute services
Training intervention
Seen as tools for self-management
Targeting specialties with longer patient interactions
Booking onto training Team leaders
reviewing whether to adopt
No plans for roll out
37 trained, 1 trainer
Major difficulties in transferring learning to daily roles
Local mentoring or management support needed
Concern over lack of privacy in busy wards
Usefulness of the health coaching approach
2/3 clinicians were using health coaching and finding it useful
Spectrum of usefulness from revolutionary ‘light bulb’ moments to supplement to what already doing for greater impact
Used with a wide range of patients and conditions: depression, weight, smoking, foot ulcers, pain, anxiety, COPD, coronary heart disease, poor kidney function, Hypertension
Benefits reported – for clinicians
Reduced caseload: expedites discharge
Reduced demand on the service
Less pressure and responsibility for patient progress
Inspirational
Patients say ‘thank you’ more often
Professional pride at making a difference
Tools e.g. for goal-setting
Skill set for everyday holistic treatment
Benefits reported – for patients
Increased confidence Increased patient
empowerment Gives power/control
back More personalised
advice/care Reduces dependency Increased satisfaction
Enjoy life more Less medication Family able to help
support & spot future problems
Potential for reduced waiting times
Potential to prevent (re)admissions
Benefits reported - for NHS
Higher patient compliance
Reduction in episodes of care
Reduction in appointments per patient
Quality and consistency
Quicker discharge off caseload
Potential to cut waiting list times
Potential for less acute admissions
Less waste from unnecessary tests and medication
Local evidence of impact
51% increase in new patients - one clinician
Number of appointments by one clinician: comparison before and after training
Local evidence of impact (cont’d)
63% indicative cost saving from reduced clinical time when compared to usual non-health coaching approach - one patient
Potential annual saving of £12,438 per FTE - if reduced clinical time replicable across patients & if sustainable over time
Research needed into patient experience, health outcomes and impact on costs
Conclusions
Clinicians perceive health coaching is effective and point to multiple benefits
2-day training intervention is working with high levels of usage
There are implementation some issues: organisational culture and work context are key success factors
Mentoring or coaching locally needed to support transfer of learning to daily roles
Too early to see if ‘Train the Trainer’ model and numbers will deliver sustainability
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Thank you