Health coaching: empowering patients through conversation

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1 Empowering patients through conversation Health coaching: empowering patients through conversation Dr Penny Newman GP, Medical Director, Norfolk Community Health and Care NHS Trust Dr Penny Newman Clinical Director, Health Coaching Programme, Health Education East of England National Innovation Fellow, Health Foundation, UCL Partners, NHS England, Health Education East of England Dr Andrew McDowell, Director, the Performance Coach

2 Are you having the most effective conversations?

3 Are you having the most effective conversations? On a scale from 1 to 10.. (where 1 = none of your patients, and 10 = all of your patients ) What proportion of your patients do you feel are: 1. Are fully satisfied with the consultations they have with you? 2. Follow the lifestyle advice you offer? 3. Could do more to care for themselves and change their behaviour?

4 When patients see a clinician, their consultation may not be working Only a third to a half of patients comply with prescribed medications and 10% with lifestyle advice Clinicians are not trained in behaviour change Only half of patients feel they are sufficiently involved in their care Alignment between what patients want and what is provided is poor - goals, treatment choices, shared decision making Poor communication leads to complaints Source: Newman Bennett H, Coleman E, Parry C, Bodenheimer, 2010 KPMG Creating value with patients, carers and communities 2014 GMC Annual report 2013, Rhoades DR, Fam Med Wolever R, 2013 Coulter A, 2011

5 Are we creating learnt dependency and fuelling demand? Doing things to people instead of with them can be profoundly disempowering. It encourages patients to believe that professionals have all the answers and that they themselves lack relevant knowledge and skills, and hence have no legitimate role to play in decisions about their healthcare. Paternalism breeds dependency, encourages passivity and undermines people s capacity to look after themselves. It may appear benign, comfortable and reassuring, but it is a hazard to health. Coulter, 2011

6 FYFV: Tap into the renewable energy of patients NHS aspires to enable people to take more responsibility NHS Constitution National Voices Five Year Forward View To meet the growing LTC challenge Lifestyle causation Multiple comorbidity Age and poverty related Improve health and reduce health and care costs Detrimental health behaviours 60% of deaths LTCs 70% of costs Address inequalities

7 Health coaching is a method of patient education that guides and prompts a patient to be an active participant in their care and behavior change Health Coach training builds skills in communication and behaviour change into routine clinical practice Source: Newman and McDowell

8 Suffolk primary care pilot Aims 1. To improve the care and lives of people with LTCs 2. To raise awareness and responsibility in patients to improve self care and management of their own LTC 3. To enable patients to identify their goals and develop their own personal care plans 4. Improve the consultation skills of practice nurses to include health coaching or skills in behaviour change 5. To enable the nurses to practice their skills and explore self care with patients in longer appointments Methods 3 interventions : coaching skills training, longer appointments and care planning 3 rural and 5 urban practices Train 13 practice nurses over 4 days Offered 290 patients appointments On average, participants reported significantly greater self-efficacy postcoaching than pre-coaching, 85% would recommend to someone with a similar condition

9 Number of participants Progress Health Education East of England 2 day multidisciplinary programme Nearly 800 clinicians trained - nurses (44%), allied health professionals (28%) doctors (9%) 43 participating organisations acute, community, primary care, mental health and social services 20 local trainers accredited to deliver independently Uptake of HEE EoE Health coaching programme nurses (44%) AHP (28%) doctors (9%) Month

10 Two day training programme creates new mind-sets, skills, and techniques Techniques Specific health coaching techniques and frameworks for conversations Skills General health coaching skills and concepts Mindset Developing a health coaching mindset Useful for specific behaviour change conversations Useful in many interactions to increase awareness and responsibility Useful in all interactions and as a leadership skill E.g., TGROW, ABC model, understanding barriers, MI E.g., Listening, questioning, supportive challenge, empathy, goal setting E.g., people are more resourceful than they think they are Source: McDowell, 2014

11 How do you see your patients? Bi-focal vision What is the potential? (Person is resourceful and holds the solution) What is the problem? (Person is a problem) Source: McDowell, The Performance Coach 11

12 The Range of Coaching Approaches Telling PUSH Solving someone s problem for them - Offering the leaders resources & experiences TELLING / TRAINING OFFERING GUIDANCE GIVING ADVICE DIRECTIVE CLARIFYING UNDERSTANDING ASKING QUESTIONS THAT RAISE AWARENESS GIVING FEEDBACK MAKING SUGGESTIONS NON-DIRECTIVE SILENCE/WITNESS LISTENING TO UNDERSTAND REFLECTING PULL SUMMARISING PARAPHRASING Enabling someone to solve their own problem - Accessing their own resources & experiences Asking Source: McDowell, The Performance Coach

13 Four evaluations to date of international and local evidence Pre and post coaching patient selfefficacy questionnaires with practice nurses Post programme clinician surveys immediately and at 6 months Qualitative evaluation of 5 pilot sites acute, community, mental health and primary care Rapid review of international evidence commissioned Source: Newman

14 Reported benefits Activates patients motivation to self manage and adopt health behaviours satisfaction Applicable to a range of conditions Useful in medicines optimisation, decision making, LTC management and lifestyle change Effective with vulnerable groups Activates clinicians effective consultations/manage difficult conversations resilience and job satisfaction Can be used by all professionals and peers Useful with colleagues e.g. in leadership role Catalyses organisational change quality of care episodes of care, unnecessary tests and appointments Meet strategic priorities e.g. FYFV Improve multidisciplinary working Creates champions for self care Impact on utilisation, costs and outcomes Source: Newman

15 Requires clinicians to be open to change Need to recognise need for change and 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

16 Three phases of health coaching training in East of England Phase Date Action Phase 1 Phase 2 4 day accredited health coach training implemented in NHS Suffolk and funded by Regional Innovation Fund Roll out 2 day training at scale across East of England commissioned by Heath Education East of England Phase 3 Accelerate diffusion of range of applications of health coaching through Health Education East of England and National Innovation Accelerator (NIA) funded programme 2010 Training designed and piloted with 13 practices nurses from 8 Suffolk GP practices (and 4 East of England CCGs) by Drs Newman and McDowell 2013/15 Nearly 800 clinicians and 20 trainers from all professions and 45 organisations trained in multidisciplinary groups 2015/16 Develop a social movement as mechanism for diffusion Create resources making health coaching easy to adopt Source: Newman

17 Health coaching part of National Innovation Accelerator (NIA) Programme NIA commissioned to contribute to the NHS Five Year Forward View : To create the conditions and cultural change necessary for proven innovations to be adopted faster and more systematically NIA/HEEoE plan for heath coaching is to create a social movement and resources to make it easy to adopt Source: Newman

18 Our vision for health coaching social movement Clinician training encourages A shift fixer to enabler New skills in behaviour change Grows ability to listen and build rapport Reduced tests, appointments & prescribing Raises patients awareness and responsibility for health Taps into patients internal motivation to change Patients achieve their own self-identified goals Support patients to change their relationship to the condition To thrive in the presence of disease and better manage their own health and care Health coaching is helping people gain the knowledge skills, tools and confidence to become active participants in their care so that they can reach their self determined goals. Source: Newman and McDowell

19 House of Care: National delivery system for people with LTCS Health coaching improves care planning, activates clinicians and their patients

20 Growing interest in health coaching nationally Need to be skilled in behaviour change or coaching strategies to support individuals to be empowered and confident in managing their conditions and wellbeing through secondary prevention The most important thing is that we enable health care professionals to have better conversations with patients. Changing the conversation can be as simple as moving from starting your appointments with How can I help you to what would you like to talk about?

21 Are you having the most effective conversations?

22 Next steps: help create a social movement and change the conversation Interested? - join platform healthcoachtrainers.slack.com for information, member groups and chat A series of interactive design workshops and resources for organisations available July 2016 Explore options for training - contact Dr Andrew McDowell, The Performance Coach andrew@theperformancecoach.com For general information - contact Dr Penny Newman NIA Fellow, UCLP, Health Foundation, NHS England, HEEoE penny.newman1@nhs.net For more information