health coaching for patient centred care and behaviour change dr penny newman clinical lead, health...

Health Coaching for patient centred care and

behaviour changeDr Penny Newman

Clinical Lead, Health Coaching Programme, Associate, Health Education East of England

Dr Andrew McDowell, DirectorThe Performance Coach

www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching

Our aspiration

• NHS Constitution• National Voices• Renewable Energy –

sustainability• Cost savings


Our long term condition challenge

• Lifestyle causation• Multiple comorbidity• Age and poverty related• Unaffordable


The impact is overwhelming


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


Self care and self care support


Our response

• 2010 Regional Innovation Fund Health Coaching Pilot

• 2011 4 CCGs with national LTC Programme

• 2013/14 HEEoE roll out to 800 clinicians and develop 18 internal trainers


Aim: Equip clinicians with new skills, knowledge and behaviours• Promote self-care,

motivation and responsibility in patients

• Improve patient satisfaction • Provide a tailored approach

to different patient's needs• Supplement core clinical

skills


Expanding the tool box

• 2 day core programme

• Developing internal trainers

• Co-delivery to gain experience

• On-going roll out of health coaching skills


Uptake in a time of reform

nurses (44%) allied health professionals (28%)

doctors (9%)

nurses (44%) allied health professionals (28%)

doctors (9%)


Health coaching to support self managementIn 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


Health coaching transforms the clinician/patient relationship

• Role of patient • Role of clinicianA 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.

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


Psychology, Coaching, Clinical Skills

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Principles and models from Health Psychology & Behavioural Medicine

Skills & techniques from Performance &

Development Coaching

Knowledge and skills of Health

Practitioners

Behaviour Change theory Social Cognition theory Patient Activation Stages of Change Motivational Interviewing Positive Psychology Mindful awareness Cognitive Behaviour Therapy

Goal setting Coaching models Coaching competencies Range of approaches Awareness & Responsibility Potential & emergence Using Challenge & Rapport Scaling

Health knowledge Health recommendations Diagnostic skills Consultation skills Questioning skills Listening skills Problem solving skills Patient – clinician relationship


Integrating skills

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Key ingredients

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


New mind-sets, skills, and techniques

TechniquesSpecific coaching techniques

and frameworks for conversations

SkillsGeneral coaching skills and

concepts

Mindset Developing a coaching

mindset


Widespread application


Reported benefitsPatients•↑ 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


And indirectly …leadership


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


Evidence Centre Rapid Review275 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

• Include as part of a wider LTC programme

• UK research needed


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

health coaching for patient centred care and behaviour change dr penny newman clinical lead, health...

Documents

health health coaching

health coaching programme

health coaching skills

challenge slide

unaffordable slide

overwhelming slide

self care support slide

allied health professionals