Health Coaching for patient centred care and behaviour change Dr Penny Newman Clinical Lead, Health...
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Transcript of 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
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
Our long term condition challenge
• Lifestyle causation• Multiple comorbidity• Age and poverty related• Unaffordable
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
The impact is overwhelming
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
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
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
Self care and self care support
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
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
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
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
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
Expanding the tool box
• 2 day core programme
• Developing internal trainers
• Co-delivery to gain experience
• On-going roll out of health coaching skills
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
Uptake in a time of reform
nurses (44%) allied health professionals (28%)
doctors (9%)
nurses (44%) allied health professionals (28%)
doctors (9%)
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
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
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
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
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
Psychology, Coaching, Clinical Skills
13
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
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
Integrating skills
14
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
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
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
New mind-sets, skills, and techniques
TechniquesSpecific coaching techniques
and frameworks for conversations
SkillsGeneral coaching skills and
concepts
Mindset Developing a coaching
mindset
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
Widespread application
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
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
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
And indirectly …leadership
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
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
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
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
www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching
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