What is Health Coaching? Dr Andrew McDowell Director, Health Coaching

What is Health Coaching?

• In the clinical context “performance”= self-management

• Health coaching is releasing a person’s potential to maximise their own health

Health coaching aims to raise awareness and increase responsibility for health

Coaching is about supporting someone to change their relationship to a problem or challenge

2

• “A behavioural intervention that facilitates participants in establishing and attaining health-promoting goals in order to change lifestyle-related behaviours, with the intent of reducing health risks, improving self-management of chronic conditions, and increasing health-related quality of life”

Van Ryn & Heaney (1997)

Introduction to Health Coaching

3

Clinical Skills

Behaviour Change Assistance

Health Coaching

Health Coaching provides

4

Fear as driver of the consultation dynamic?

Existential Anxiety

•‘If I’m worried about something and I don’t go to the doctors, I might die … but if I do go, they might tell me I’m going to die’.

Entitlement Anxiety

•‘If I go to the doctors and I’m not ill I might be humiliated. Am I entitled to present myself as ill for this reason, at this time?’.

Interactional Anxiety

•‘Will I be able to say what I need to say? Will I be able to ask what I need to ask? And will I be heard?’

Existential Anxiety

•‘If I miss something vital the patient might die or suffer’ (My professional identity is threatened)

Entitlement Anxiety

•‘Might I get into trouble if I prescribe/refer… guidelines, targets, budgets, evidence-based medicine, etc., ?

Interactional Anxiety

•‘Patients are unstoppable and insatiable. Will I be able to get what I need and shut them up. They expect me to solve their problem – will I have to handle disappointment/ anger?'

Patient’s

Fears

Clinician’s

Fears

Adapted from: When doctors and patients talk: making sense of the consultation, Martin Fischer and Gill Ereaut, The Health Foundation June 2012

5

“Instead of treating patients as passive recipients of care, they must be viewed as partners in the business of healing, players in the promotion of health, managers of healthcare resources, and experts on their own circumstances, needs, preferences and capabilities.”

Coulter (2011)

Different kind of conversation

6

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 Motivational Interviewing Stages of Change Positive Psychology Mindful awareness Cognitive Behaviour Therapy

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

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

Health Coaching Skills Development

7

Aims to • Increase health-related quality of life and outcomes

• Improve patient experience of the health system

Supports a person to

change their relationship

to their health

• Taps into their potential to self-manage

• Raises their awareness and sense of responsibility

• Supports them to actively self-manage

• Increases their confidence and motivation to act

Requires a different kind of

conversation

• Based on listening, trust, challenge and positive emotions

• Is collaborative and equal

• Tailored to the individual, their agenda and goals

• Requires transformation in the clinician/patient relationship

Useful in • Improving lifestyle

• Chronic disease management

• Pain management

• Managing unexplained symptoms

• Medicines management and optimisation

• Decision support

• Recovery and rehabilitation

• Mental health (primary care)

Benefits • Improved patient satisfaction and self-efficacy

• Some experience of reduced service utilisation and improved outcomes

• Creates a mind-set shift &resilience amongst clinicians as they move from expert to enabler

• Creates clinical champions for spread.

Critical elements in a health coaching approach…

8

How would practitioners need to think differently and what would they need to believe in order to engage with a health coaching approach?

Coaching Mindset

9

How do your conversations lead to outcomes?

Working with goals

• What is the value of setting a goal?

• Who’s goal? Patient’s or clinician’s?

• What factors might influence patients’

willingness to set a goal?

• What factors might influence clinicians’

willingness to work on setting a goal with

patients?

10

Source: Prof Judy Hibbard, University of Oregon (2008)

Building Activation

11

TELLING / TRAINING

PUSH

PULL

Solving patient’s

problem for them - Offering the

clinician’s resources & experiences

Enabling patient to solve their own

problem - Accessing the patient’s resources

& experiences

NON-DIRECTIVE

DIRECTIVE

SILENCE/WITNESS

ASKING QUESTIONS THAT

RAISE AWARENESS

CLARIFYING UNDERSTANDING

GIVING FEEDBACK

OFFERING GUIDANCE

GIVING ADVICE

REFLECTING

PARAPHRASING

SUMMARISING

MAKING SUGGESTIONS

Telling

Asking

How do you flex your style for different consultations?

A range of approaches

12

LISTENING TO UNDERSTAND

Listening attentively

Is the coach giving me their full attention?

Listening accurately

Has the coach fully understood my issue?

Listening empathically

Do they really appreciate my feelings about this / can they stand in my shoes?

Listening generatively

Can I think more clearly and positively when this person is listening to me?

How are you Listening to your patients?

Levels of Listening

13

How do you see your patients?

Bi-focal vision

What is the problem? (Patient is a problem)

What is the potential?

(Patient is resourceful and holds the solution)

14

Persecutor

Rescuer Victim

How do you reflect on the dynamics of the consultation?

Karpman Drama Triangle

15

Transactional

Transformation

Context

Rapport

Trust

How do you move from transactional conversations?

Building Trust and Rapport

16

How do you use challenge with your patients?

Challenge / Rapport model

Rapport

Challenge Awareness

Comfort

Exposure

Context

17

3 Three patients that I would like to try out a Health Coaching approach with

2 Two concepts or ideas that I intend to start or continue using in my work and organisation

1 One thing that had the most impact on me during this Workshop

Can you put these skills into action?

Action planning

18

Coaching Principles, Skills & Techniques

Principles Developing a coaching mindset • “people are more resourceful

than they think they are”

Skills Using general coaching skills and concepts • “listening skills”

Techniques Using specific coaching techniques and frameworks for conversations • “health coaching techniques”

19

Key challenges in changing style

• Learning to be less directive is very difficult

• Flexing one’s default consulting position takes a lot of effort

• It is uncomfortable to bring more challenge to conversations with patients

• Working with a coaching approach when colleagues are not

• Identifying which patients to focus on

• Managing time to support behaviour change

• Managing other responsibilities (QOF, managing risk, other required interventions)

20

Key themes in what clinicians say they have

learned about having different conversations

• The patient is resourceful and holds the solution

• A coaching approach = partnership with patients = sharing responsibility

• Finding out what the patient wants (goal) is key

• Being able to flex approach yields positive results

• Supportive challenge is possible

• Coaching techniques are broadly applicable for supporting behaviour change

• It is possible to coach in 10 minutes

“for the first time I can see a way to move my patients with chronic conditions into

a zone where they can make progress them

selves”

General Practitioner

21

Approach to skills development workshops

Health Coaching

Skills Development

Highly experiential

using a coaching

style

Fast paced and

challenging

Applied and skills based

Principles of coaching & behaviour change

Time to allow mindset shift

Application to real issues

Opportunities to practice

skills

Opportunities for feedback

22

• Self-management requires patients to

– Adhere to treatment recommendations

– Change health & lifestyle behaviours

– Play an active vs. passive role

• It is reported that average adherence rates for prescribed medication are about 50% and for lifestyle changes they are below 10%

(Bennett and Bodenheimer 2010)

Is what we are currently doing working?

23

For further information:

Dr Andrew McDowell, The Performance Coach

M: 44 (0) 7984 464 407 T: 44 (0) 203 4022 067/8

E: andrew@theperformancecoach.com W: http://www.theperformancecoach.com

The Performance Coach, Marble Arch Towers, 55 Bryanston Street, London, W1H 7AA

24