Health Coaching Coordinators Event 4 February 2014

1. Health Coaching Coordinators Event4 February 2014

2. Welcome, Introductions, and Overview of the Day

3. Our strategic approach – Health Coaching Dr Penny Newman GP, Consultant in Public Health Director of Service Integration, Colchester Hospital NHS University Foundation Trust Clinical Lead, Health Coaching Programme

4. Obese male, late 50's, DMT2 and history of cardiac failure. Wants to lose weight but puts many barriers in place to make changes. In past practice I have resulted to making suggestions to help him lose weight and each time he has returned having gained a bit more weight and not done anything differently and always has a valid reason/excuse. Case studies

5. LTCs : A burning platform Lifestyle causation: Cost of obesity £5 billion, to double by 2050 when the population will be mainly obese. Age and poverty related: 58% 60yrs + have >1 LTC, the poorest 60% higher prevalence and 30% more severity Comorbidity: 3 + LTCs increase from 1 to 2.9m 2008 – 2018, 2-3 X more mental health problems Unaffordable: Equal 50%, 64% and 70% of GP, OP appointments & inpatient bed days and £7/10 of health & social care spend Data Sources Kings Fund, RCP

6. Worsening diabetes in the UK(Diabetes in the UK, Diabetes UK 2004) 2.9 mill 1.4 mill

7. New approaches are required • Half of patients leave primary care not understanding what their doctor told them • Though shared decision-making is associated with improved outcomes, only 9% of patients participate in decisions • Average adherence rates for prescribed medications are about 50%, and for lifestyle changes they are below 10% • Study in primary care showed most doctors interrupt within 12 seconds • Drs attitude & communication are largest source of complaints to GMC (up by 45% and 65% vs 24% in other areas)

8. Learnt dependency Paternalism breeds dependency, encourages passivity and undermines people’s capacity to look after themselves. It may appear benign, comfortable and reassuring, but it is a hazard to health. (Coulter, 2011)

9. As telling people what to do doesn’t work A flexible consultation style vs. premature focus on diagnose and fix

10. Health Coaching Coaching Coaching is the art of facilitating the development, learning and performance of another Health coaching Helping people gain the knowledge, skills, tools and confidence to become active participants in their care so that they can reach their self-identified health goals Bennett & Bodenheimer 2010

11. Health Coaching combines 11

12. Builds onconsultations models

13. A range of approaches NON-DIRECTIVE Informing Telling LISTENING TO UNDERSTAND REFLECTING PULL SUMMARISING Enabling patient to solve their own problem - Accessing the patient’s resources & experiences PARAPHRASING PUSH CLARIFYING UNDERSTANDING Solving patient’s problem for them -Offering the clinician’s resources & experiences ASKING QUESTIONS THAT RAISE AWARENESS GIVING FEEDBACK MAKING SUGGESTIONS Asking Discovery OFFERING GUIDANCE GIVING ADVICE TELLING / TRAINING DIRECTIVE The Performance Coach 13

14. “Give patients a fish” or “teach patients to fish”? Bennett, H Coleman E, Parry C, Bodenheime T

15. History in East of England NHS Suffolk RIF health coaching pilot for practice nurses – 4 days training and longer appointments Significant improvements in self efficacy, 98% patient satisfaction Further pilots in CCGs (with national LTC programme) Business case and procurement – used in USA, UK, Australia – strong evidence Procured £500k HEE roll out – for all organisations

16. Health Coaching : Conversations for Better CareConcepts, skills and application for the East of England Programme Concepts, skills and application for the East of England Programme 2 day training for clinicians 17 programmes run to date 7 programmes booking currently 13 programme dates being arranged Train the trainer also available (10 days total)

17. What clinicians say they are using the skills for

18. Benefits for patients and clinicians Increased patient satisfaction, confidence and motivation (self efficacy) Mind-set shift - can see a different way of interacting with patients (and colleagues) Role shift from expert (responsible for fixing) to enabler Personal development and resilience Use with colleagues and teams Emerging evidence of positive impact on utilisation, costs and outcomes

19. Benefits to NHS organisations

20. Burning platform to burning ambitionFrom TEDxMaastricht - Bas Bloem - "From God to Guide" http://www.youtube.com/watch?client=mv-google&hl=en&gl=GB&v=LnDWt10Maf8&feature=youtu.be&nomobile=1

22. Sharing progress to date and learning with each other Karen Bloomfield, Leadership and Organisational Development Manager

24. Uptake Data 240 clinicians undertaken the 2 day health coaching skills programme 163 more clinicians booked to attend (More training dates are being planned for May and June) 14 clinicians have attended Train the Trainer 28 organisations have accessed places to date

25. Health Coaching Evaluation 5 organisations are involved with the IES evaluation: Norfolk and Norwich University Hospitals NHS Foundation Trust Norfolk and Suffolk NHS Foundation Trust North Norfolk CCG Hawthorn Drive Surgery, a GP practice in Ipswich Cambridge Community Services NHS Trust (more on this later)

26. Clinician Feedback “This is the most powerful course I have ever had the privilege of attending. I left completely inspired, and couldn’t wait to start applying the techniques and the different approach” “Excellent time saving skills learnt. The skills will help communication, co-operation and collaboration with my colleagues and in team situations” Survey issued to all Health Coaching practitioners who have attended the programme -To gain feedback on health coaching activity we have asked clinicians a set of questions via an online survey.

27. Discussion How is your role as a Health Coaching Co-ordinator going? What’s working well about Health Coaching in your organisation so far? What are your top tips for organisations just starting out? What else will help to progress and sustain Health Coaching?

28. Content and Practice of the Health Coaching Skills Programme Dr Andrew McDowell, Psychologist and Director of the Performance Coach

29. What do you already know about health coaching? 29

30. What is Health Coaching? 30 • 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

31. Introduction to Health Coaching 31 • “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)

32. Health Coaching provides 32

33. Fear as driver of the consultation dynamic? Clinician’s Fears Patient’s Fears Adapted from: When doctors and patients talk: making sense of the consultation, Martin Fischer and Gill Ereaut, The Health Foundation June 2012 33

34. Different kind of conversation 34 “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)

35. Critical elements in a health coaching approach… 35

36. Core 2 Day Programme Structure 36

37. CoachingMindset How would practitioners need to think differently and what would they need to believe in order to engage with a health coaching approach? 37

38. How do your conversations lead to outcomes? Working with goals 38 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?

39. How do you flex your style for different consultations?A range of approaches NON-DIRECTIVE SILENCE/WITNESS LISTENING TO UNDERSTAND Telling REFLECTING PULL SUMMARISING Enabling patient to solve their own problem - Accessing the patient’s resources & experiences PARAPHRASING PUSH CLARIFYING UNDERSTANDING Solving patient’s problem for them -Offering the clinician’s resources & experiences ASKING QUESTIONS THAT RAISE AWARENESS GIVING FEEDBACK MAKING SUGGESTIONS Asking OFFERING GUIDANCE GIVING ADVICE TELLING / TRAINING DIRECTIVE 39

40. How do you see your patients?Bi-focal vision 40

41. How do you reflect on the dynamics of the consultation?Karpman Drama Triangle 41

42. How do you use challenge with your patients?Challenge / Rapport model Context Exposure Awareness Challenge Comfort Rapport 42

43. Can you put these skills into action? Action planning 43

44. Principles, Skills & Techniques 44

45. Key challenges in changing style 45 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)

46. Key themes in what clinicians say they have learned about having different conversations • “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 46 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

47. Approach to skills development workshops 47

48. How the 2 day programme works 48

49. How the Train the Trainer approach works 49