Using Health Coaching in an Acute Trust environment Anna Groom Paediatric Diabetes Specialist...

Using Health Coaching in an Acute Trust environment

Anna Groom Paediatric Diabetes Specialist Dietician, Colchester Hospital University NHS Foundation Trust

Dr Andrew McDowell, Director, The Performance Coach

www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching

What we’re going to cover

1. What you already know about using health coaching in an acute setting

2. Key principles acute care clinicians have valued3. Examples of application4. Health Coaching technique5. Summary

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• In what particular circumstances do you think health coaching might be useful in acute settings?

• What do I think the benefits are for clinicians learning to use a coaching approach in acute settings?

Questions

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The acute setting experience

• What’s the patient experience here? – Expectation of being told– Easy to go into passive role

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TELLING / TRAINING

PUSH

PULL

Solving patient’s

problem for them -Offering the

clinician’s resources & experiences

Enabling patient tosolve 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

LISTENING TO UNDERSTAND

How do you change your default position?

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Integrating skills

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How do you see your patients?Bi-focal vision

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How do you use challenge with your patients?Challenge / Rapport model

Rapport

ChallengeAwarenessAwareness

Comfort

Exposure

Context

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

Building Activation

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Low activation signals problems (& opportunities)

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New mind-sets, skills, and techniques

TechniquesSpecific coaching techniques

and frameworks for conversations

SkillsGeneral coaching skills and

concepts

Mindset Developing a coaching

mindset

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What’s different about using health coaching in an acute setting

Perceived Challenges• Being part of a multi-disciplinary

team – the lone health coach…• Time to do it• The focus on outcomes and box

ticking• The need for expert input • The expectation of expert input

Benefits• We are getting outcomes• Reduced DNAs• Patients respond quite well• More engaging for clinician• Excellent for transitioning

– Child to adult– Acute to community

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What acute setting clinicians tell us they are using it for

Department Example

Emergency Managing frequent attenders

Pain Man Clinic Changing conversations about injections (Consultants)

Physiotherapy increasing adherence to exercises in outpatient clinics

Stroke Ward More appropriate goal setting

Rehabilitation Aligning clinical objectives with patient goals (small steps)

Pharmacy Medicines adherence on ward, at discharge, at dispensary

Surgery Supporting increase in sense of control after surgery

Paediatrics Relevant behaviour change with parent and child

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Example: Out patient Clinics

• 17 yr Adolescent with Type 1 diabetes• Different conversation – aligning clinical goal with personal ambition• Increased awareness of challenges of sustained self care• Highlighted fear of transition into adult services• Outcome: improved glycaemic control, increased knowledge of self

care, improved self esteem and confidence

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Example: In patient

• 14 year old Child with Anorexia Nervosa on acute children's ward• Provided framework for difficult conversation• Encouraged patient to identify own goals to allow sense of

increased control of situation upon discharge• Feedback from parents very positive re providing structure to

treatment and enabling sustained behaviour change

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Example: RehabilitationHampshire Hospitals, Winchester•Recovery Coaching•Entire Ward trained – all levels•Supporting faster and safer transition from recovery ward

– Increased in independence (Barthel (ADL) scores)– Increased self-efficacy– Fewer patients required residential care placements at discharge

•HE Wessex Wonderful Workforce Solution Award•Nursing Times national award – Care of Older People

– “It’s all about helping patients prepare for life at home. So while we are helping patients with everyday tasks such as washing and dressing, we’re talking to them about how they will cope at home and what support is available to them. This helps our patients take an active role in their recovery and helps them prepare for their return to routine daily life.”

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Components of Managing Health - Diamond modelControl

Learning

Motivation

Confidence

Managing Health

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Questions:1.Where are you now and what has contributed to that?2.Where would you like to be and what are the reasons for that?3.What can you do that is within your control to move this forward?

(Source: McDowell, The Performance Coach)


Key Learning

• Recognising – remembering that people feel vulnerable and passive in acute settings

• Consciously choosing the opportunities to move from mindset and general skills to specific techniques

• Flexing one’s default consulting position takes effort• When you start changing the way you work you get more from your patients

• Patients like it – but maybe not initially• Its catchy…. Other staff attracted to the approach• Its enjoyable – activated clinicians as well as activated patients

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Using Health Coaching in an Acute Trust environment Anna Groom Paediatric Diabetes Specialist...

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