Margaret Moore, MBA
Transcript of Margaret Moore, MBA
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coaching science in motion
Margaret Moore, MBAExecutive coachCo-Founder, Chair, Institute of Coaching, McLean Hospital, Harvard Medical School affiliateFounder, CEO, Wellcoaches CorporationCo-Founder, National Board for Health and Wellness Coaching
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disclosuresFounder, CEO, Wellcoaches CorporationSchool of Coaching for health professionals
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what I am going to talk about
20-year journey of coaching science to practice in healthcare
science that underpins coaching competencies
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2000Wellcoaches School
of Coaching founded
202013,000 coaches
trained in 50 countries
2009
Institute of Coaching
co-founded
McLean HospitalHarvard Medical School affiliate
2010National Board for Health & Wellness
Coaching co-founded
2016Led partnership with
NBME
2020AMA launched
coaching CPT codes
2021NBHWC Healthcare
Reimbursement Commission
Wellcoaches Digital to support coach on primary care team
evidence-based coaching protocol
coaching science and research
national standards and certification
coach joins the healthcare team
VISION: new coaching profession in healthcare
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MINDFULNESS
E M OT I O N A L I N T E L L I G E N C E
P O S I T I V E P S Y C H O L O G YA P P R E C I AT I V E I N Q U I R Y
C H A R A C T E R S T R E N G T H S
C U R I O S I T YT R A N S T H E O R E T I C A L M O D E L
WELL-BEING
SELF- DETERMINATION
R E L AT I O N A L F LO W
15 theories & domains
PERSONALITYM O T I VAT I O N A L I N T E R V I E W I N G
C O A C H I N G P S YC H O LO G Y
S O C I A L C O G N I T I V E T H E O R Y
R E L AT I O N A L C U LT U R A L T H E O R Y
HOPE PSYCHOLOGY
S E L F C O M PA S S I O NN O N V I O L E N T C O M M U N I C AT I O N
N E U R O S C I E N C E
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evidence-based coaching protocol1. Edman et al (2019). 54 healthcare employees
with chronic disease
2. Guthrie et al (2019). 172 participants using coaching and digital therapeutics for blood pressure control
3. Berman et al (2018). 118 participants with Type 2 diabetes complete 12 weeks of health coaching
4. Djuric et al (2017). 82 patients in primary care
5. Roy et al (2017). 1,306 chronic disease patients in medical fitness facility
6. Sherman et al (2017). 271 obese patients at MGH primary care practice
7. Eisenberg et al (2017). Teaching Kitchen project for 40 CIA employees
8. Sherman (2017). 17 pre-diabetes patients at MGH primary care practice
9. Hackshaw et al (2016). Intensive coaching for fibromyalgia - 9 patients
10.Long et al (2016). 19,800 coaching clients in employee wellness
11.Sforzo et al (2014). 161 patients coached on smoking cessation
12.Galantino & Schmid (2009). 30 cancer survivors
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Systematic Review Defined Common Elements of Health & Wellness Coaching
Coaches trained in behavior change, motivational techniques
Patient-centered (guided by patient values)
Patient determined goals
Self-discovery
Accountability
Combined with education
Ongoing relationship
Wolever et al. Systematic Review of the literature on health and wellness coaching. Global Adv Health Med J. 2013; 234-53
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2000-2004 2005-2008 2009-2012 2013-2016 2016-20182000-2004 2005-2008 2009-2012 2013-2016 2016-2018
H e a l t h & We l l n e s s C o a c h i n g R C T P u b l i c a t i o n s
Sforzo GA et al. Compendium of Health & Wellness Coaching: 2019 Addendum Am. J Lifestyle Med.
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Evidence of Positive Outcomes from Health & Wellness Coaching Literature
• literature screened using systematic review definition• compendium – 2000-2016, addendum – 2016-2018• 2 meta-analyses in 2018 – diabetes and hypertension show statistically significant positive outcomes• 108 randomized controlled studies; 82.4% of RCTs show statistically significant positive outcomes
2017 2019
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Volume of HWC visits: 2015-2020
• In April 2021, NBHWC surveyed 30 healthcare organizations that employ teams of HWC in 38 states
• Includes VA, UPMC, MGH, Mayo, Duke, UCSD, Cleveland Clinic, Intermountain, Indian Health Services, OSU, University of Vermont
• Estimated total HWC visit volume:• Individual: 1,061,262• Group visits: 110,000
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CPT options for HWC
health and well-being coaching – 0591T, 0592T, 0593T
annual wellness visits – Go438, G0439
depression & alcohol screening – G0444, G0442
obesity counseling – G0477
chronic care management – 99487, 99489, 99490
remote physiological monitoring – 99453-8 – bp, weight
phone/online assess and manage – 98966-8, G2061-63
chronic pain management – preventive medicine + opioid treatment – 99401, 99402, 99409, G0397
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HWC on Clinical Team
Physician/NP refers patient to HWC for obesity, metabolic
health, other health risks and chronic
conditions.
Physician/NP and HWC
may complete Annual Wellness Visit
HWC delivers health and well-being coaching,
individual or group
HWC delivers obesity counseling,
individual or group
HWC delivers RPM, chronic care
management, individual or group
Physician + HWC deliver preventive medicine visits, individual or
group
HWC delivers communication and management visits
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science that supports coaching competencies
1. self-determination theory2. transtheoretical model3. positive psychology4. adult development5. relational flow6. multiplicity of mind
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autonomy is the strongest primary drive
Deci, Ryan, (2000).The What and Why of Goal Pursuits. Psychological Inquiry. Vol 11. No. 4. 227-268
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judge
rescuefix
autonomy
competencerelationship
expert prescribing coach facilitating
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which kind of motivation leads to the cleanest kitchen?
Autonomous• Present – I’m cleaning up the kitchen because it’s fun
and challenging
• Future – I’m cleaning up the kitchen because it makes me feel good about my contribution to my marriage and family
External
• Inner critic – I am cleaning up the kitchen because I should – I will feel like a bad spouse if I do not
• External – l am only cleaning up the kitchen because my spouse will be angry if I don’t
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draw forth autonomous motivation
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envision one’s future self
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PC Cont PR Action Maint
ProsCons
~ 80% Need to ImproveMotivation (Increasing Pros) & Confidence (Decreasing Cons)
readiness stage prevalence estimate 40% 40% 20% Data from Hall, K. L. & Rossi, J. S. (2008). Meta-analytic examination of the
strong and weak principles across 48 health behaviors. Preventive Medicine, 46,266-274 . https://bit.ly/2SgB08o stage prevalence estimates from James
Prochaska, 2018.
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Moore, 2008
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Positive EmotionsBroaden Thinking
awarenessopen-minded
flexiblecreative
adaptableperipheral vision
big picture
Fredrickson (2013). Updated Thinking on Positivity Ratios. American Psychologist vol. 68 (9); 814-822
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psychological capital - HERO
hope
efficacy
resilience
optimism
Youssef-Morgan, C. M., & Luthans, F. (2015). Psychological capital and well-being. Stress and health: Journal of the International Society for the Investigation of Stress.
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wisdom & knowledge Creativity, Curiosity, Open-mindedness, Love of learning, Judgmentcourage Honesty, Bravery, Perseverance, Zesthumanity Kindness, Love, Social Intelligencejustice Fairness, Leadership, Teamworktemperance Forgiveness, Humility, Prudence, Self-regulationtranscendence Appreciation of beauty, Gratitude, Hope, Humor, Spirituality
CHARACTERVALUES in ACTION
www.viacharacter.org
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How Coaching Works @ YouTube
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SUB JECT
object
Subject Object Theory
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A mind once stretched by a new idea or understanding will never fully return to its original dimensions....
Oliver Wendell Holmes, Sr. Physician1809-1894
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create new connections
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assumption
transcend
GROWTH EDGEBlog: Hello. I am your growth edge.
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three levels of insight
learning: new skill
perspective shift: beliefs, values
quantum shifts: self-identity shifts
Clancy, A. L., & Binkert, J. (2016). Pivoting: A Coach's Guide to Igniting Substantial Change. Springer.
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growth edge higher wisdom
I have too much to do I am grateful to serve
no time for open questions listening gets more done faster
I focus on what’s wrong I build on what’s good
I am critical of you I accept that you are doing your best
I judge you I notice my biases
I feel sorry for you I understand what you feel
I am frustrated with you I am open and curious about you
I label you I see you as unique
I am better than you I am a work in progress
I don’t value you we are equals, doing our best
stop resisting me I triggered your resistance
get your act together you are doing your best
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creativity: generative moments
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imagine a new brain-wide network
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intuitive dance: a peak coaching experience
• masterful coaches dance more and better than novice coaches
• masterful dancing delivers better results
Moore, et al. (2005) Relational Flow: A Theoretical Model for the Intuitive DanceInternational Coach Federation Coaching Research Symposium Proceedings
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relational flow
• sense of zest and vitality
• empowerment; response-ability
• increased knowledge of self and others
• increased sense of worth
• desire for making more connections
Adapted from Jean Baker Millers “What Do We Mean by Relationship”Relational Cultural Theory
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key outcomes of relational
flow
1. self-discovery: I know myself better
2. more positive energy and positive emotion:I feel energized and more positive
3. more confidence (self efficacy): I believe I can do it
4. more readiness: I am ready to go
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a Harvard Health book published by William Morrow (2016)
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inner family
confidence
standard setter
body regulator
autonomythinker
meaning maker
creative
relational
adventurer
core self
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Carl Jung mental processes
Enneagram typecore drive
Myers Briggs1st brain function2nd brain function
Inner Family (Moore)
introverted feeling 1 reformer INFP, ISFP, ENFP, ESFP autonomy
extraverted feeling 2 helper ENFJ, ESFJ, INFJ, ISFJ relational
introverted intuition 9 peacemaker INTJ, INFJ, ENTJ, ENFJ meaning maker
extraverted intuition 4 individualist ENTP, ESFP, INFP, ISFP creative
introverted sensing 6 loyalist ISFJ, ISTJ, ESFJ, ESTJ regulator
extraverted sensing 7 enthusiast ESFP, ESTP, ISFP, ISTP adventurer
introverted thinking 5 investigator INTP, ISFP, ENTP, ESFP thinker
extraverted thinking 3 achiever ENTJ, ESTJ, INTJ, ISTJ standard setter
confidence 8 challenger confidence
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brain breaksgo no go
Moore. Brain Breaks Elude Me. (2016) Psychology Today.
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thank you