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Health coaching or people with Long Term Conditions
Thursday 15 October 201512pm – 1pm
Penny Newman, Norfolk Community Health and Care and National Innovation Fellow
Andrew McDowell, Director The Performance Coach&
Beverley MatthewsLTC Programme Lead, NHS Improving Quality
#A4PCC #LTCimp #LTCyearofcare
LTC Year of Care Commissioning Developing a Year of Care Capitated Budget approach for those with Complex Care Needs
• Programme information
• 5 Early Implementer sites
• Fast Followers Community
• Whole Population Datasets
• Simulation Model
#A4PCC #LTCimp #LTCyearofcare
LTC Person Centred Care:Delivering Person Centred Care for People with LTCs
• Improvement Sites
• LTC Toolkit
• Snapshot Survey
• Simulation Model
#A4PCC #LTCimp #LTCyearofcare
LTC Learning CommunityEstablishing a Virtual Community for All to Share and Learn
• LTC Dashboard
• Case Studies
• Lunch and Learn Series
• The Bulletin
@NHSIQ @bev_j_matthews #LTCImp #LTCyearofcare
#A4PCC #LTCimp #LTCyearofcare
Action for Person Centred Care
o Taking action to make person-centred care for people with long-term conditions a reality
o Looking at what needs to change and why we need to change
o Co-produced with NHS England and Coalition for Collaborative Care and developed with health and care professionals, policy makers and people with long-term conditions
o What you can do:o Make a commitment embedding
patient-centred care in your work at www.engage.england.nhs.uk/survey/ltc-declaration
o Tell your teams about our worko Use the hashtag #A4PCC when you see
work that is relevant to person-centred care for people with LTCs
o Let us know of any events, activities or social media opportunities that we can join forces with you
#A4PCC – Action for Person-Centred Care
@NHSIQ @bev_j_matthews #LTCImp #LTCyearofcare
Case study: Health coaching skills for clinicians to support self-care and behaviour change
Read the full article here
Date Topic Guest Speaker(s)15 Oct 2015 Practical strategies for innovating in
health and housing
Tweetchat with @wecommissioners
Paul TaylorInnovation Coach - Bromford Lab
Will LilleyNew Ventures Manager, Bromford
4 Nov 2015 Writing letters directly to patients
Tweetchat with @wecommissioners
Bev MatthewsProgramme Delivery Lead
NHSIQ
17 Dec 2015 Simulation Model Claire Cordeaux, Executive VP Healthcare - Simul8
Julie Renfrew, NHS Improving Quality
Coming soon Continuing the discussion about behavioural change and care planning
Angela CoulterKings Fund
LTC Lunch & Learn E-SeminarsEstablishing a Virtual Community for all to share and learn
#A4PCC #LTCimp #LTCyearofcare
Health coaching: empowering patients through conversation
Dr Penny NewmanClinical Director, Health Coaching Programme, Health Education East of England
Dr Andrew McDowell, Director, the Performance Coach
Empowering patients through conversation
Dr Penny NewmanClinical Director, Health Coaching Programme, Health Education East of England
Dr Andrew McDowell, Director, the Performance Coach
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
Need to tap into the renewable energy of patients
The majority of care is self care and support
• 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• Paternalism breeds dependency
• 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 2001. • Wolever R, 2013• Coulter A, 2011
When patients see a clinician, their consultation may not be working
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.
Health coach training builds skills in communication and behaviour change into routine clinical practice
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
Skills taken from psychology and coaching expand the tool box
14
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
McDowell, 2014
Key ingredients
Foundations of coaching
Self determined goals
Directive and non-directive approaches
Structuring health coaching conversations
Listening, trust, rapport and supportive challenge
Readiness to change
Managing interferences
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
Source: McDowell, 2014
New mind-sets, skills, and techniques
TechniquesSpecific health coaching
techniques and frameworks for conversations
SkillsGeneral health coaching skills
and concepts
Mindset Developing a 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, Managing
interferences
E.g., Using supportive challenge, listening,
empathy
E.g., people are more resourceful than they
think they are
Source: McDowell, 2014
How do you see your patients?Bi-focal vision
What is the problem?(Person is a problem)
What is the potential? (Person is resourceful and holds the solution)
17Source: McDowell, The Performance Coach
ProgressHealth 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
London Deanery• TTT and co-delivery• Delivered to 300
Leeds system – Health and Social care• Has developed 15 accredited HC trainers• In process of co-delivery moving to independent delivery
Wessex system – Health & Social care• Has developed 6-8 accredited HC trainers• Delivered to 200 with TPC, Scheduled a further 200
independently
Three evaluations growing the evidence base
• University College Suffolk. Pre and post coaching patient self-efficacy questionnaires with practice nurses
• HEEoE/TPC. Post programme clinician surveys immediately and at 6 months
• Institute of Employment Studies. Qualitative evaluation of 5 pilot sites – acute, community, mental health and primary care
Reported benefits
Patients• ↑ motivation to change• ↑ satisfaction • Improved health/outcome
Clinicians• ↑ effective consultations • ↑ resilience and job satisfaction• Use with colleagues and others
Organisation• ↑ quality of care • ↓ episodes of care, unnecessary tests
and appointments• Meet strategic priorities • Improve multidisciplinary working • Impact on utilisation, costs and outcomes
Widespread application, mostly with long term
conditions but also in decision
making and compliance
Single or multiple
long term
conditions
Self management
Mild anxiety/depression
RehabEnd of life
Lifestyle/wellness
Evidence Centre Rapid Review275 studies, 109 RCTs
• Vulnerable groups benefit • Can support patients motivation to
self manage and adopt healthy behaviours
• Widespread application to patients and can be used by all professionals and peers
• Insufficient evidence about cost effectiveness and mixed evidence on outcomes
• Include as part of a wider LTC programme and UK research needed
Requires clinicians to be open to change
• 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
Health coaching training one of 17 innovations chosen for the National Innovation Accelerator (NIA)
Programme
NIA aims to contribute to the NHS Five Year Forward View and: • create the conditions and cultural change
necessary for proven innovations to be adopted faster and more systematically by the NHS
• deliver demonstrable patient and population benefit.
Next steps Are you having the most effective
conversations?
House of Care
Learn with other
regions
Create a social movem
ent
More trainin
g in East of Englan
d
Phase 3. Health coaching training
Evaluate
outcomes
Improved outcomes for people with LTCS and reduce NHS costs
Phase 3. More learning, spread, alignment and participation
Our Vision
Clinician training encourages• A shift from fixer to
enabler• New skills in
behaviour change• Grows ability to listen
and build rapport
Raise patients’ awareness and responsibility for health • Taps into patients
internal motivation to change
• Patients achieve their own self-identified goals
Support patients change their relationship to the condition• To thrive in the
presence of disease and better manage their own health and care.
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
ContactsDr Andrew McDowell• Director, The Performance Coach
Dr Penny Newman • Clinical Director Health Coaching, HEEoE
• For more information https://eoeleadership.hee.nhs.uk/healthcoaching
Date Topic Guest Speaker(s)15 Oct 2015 Practical strategies for innovating in
health and housing
Tweetchat with @wecommissioners
Paul TaylorInnovation Coach - Bromford Lab
Will LilleyNew Ventures Manager, Bromford
4 Nov 2015 Writing letters directly to patients
Tweetchat with @wecommissioners
Bev MatthewsProgramme Delivery Lead
NHSIQ
17 Dec 2015 Simulation Model Claire Cordeaux, Executive VP Healthcare - Simul8
Julie Renfrew, NHS Improving Quality
Coming soon Continuing the discussion about behavioural change and care planning
Angela CoulterKings Fund
LTC Lunch & Learn E-SeminarsEstablishing a Virtual Community for all to share and learn
#A4PCC #LTCimp #LTCyearofcare
